Towards optimizing perioperative colorectal care: outcomes for 1,000 consecutive laparoscopic colon procedures using enhanced recovery pathways

Am J Surg. 2012 Mar;203(3):353-5; discussion 355-6. doi: 10.1016/j.amjsurg.2011.09.017. Epub 2012 Jan 20.

Abstract

Background: Learning curves and efficiency concerns have slowed the integration of laparoscopy into colorectal practice. We evaluated our experience with laparoscopic colorectal (LC) surgery using enhanced recovery pathways (ERPs).

Methods: One thousand consecutive LC procedures performed by 2 surgeons over a 5-year period using previously published, standardized ERPs were assessed.

Results: The mean age was 59, and the mean body mass index was 29.5. Procedures included segmental colectomy (54%), proctectomy (19%), total colectomy (11%), ostomy (5%), and other procedures (11%). Diagnoses included malignancy (41%), diverticulitis (16%), inflammatory bowel disease (13%), and other (30%). The mean operative time was 151 minutes, and the mean blood loss was 55 mL. Conversion to an open surgery occurred in 5.8%, whereas 2.3% were performed using a hand-assist procedure. The mean hospital stay was 4.1 days (median 3), with a 6% readmission rate. Complications (20%) included mortality (0.3%), wound infection (4%), and anastomotic leak (1.4%).

Conclusions: LC surgery with ERP offers excellent outcomes with efficient use of resources.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Colectomy / methods
  • Colectomy / standards
  • Colon / surgery*
  • Colonic Diseases / mortality
  • Colonic Diseases / surgery*
  • Colostomy / methods
  • Colostomy / standards
  • Digestive System Surgical Procedures / methods
  • Digestive System Surgical Procedures / standards*
  • Humans
  • Laparoscopy / standards*
  • Length of Stay / statistics & numerical data
  • Middle Aged
  • Patient Readmission / statistics & numerical data
  • Perioperative Care / methods
  • Perioperative Care / standards*
  • Postoperative Complications / epidemiology
  • Quality Improvement
  • Rectal Diseases / mortality
  • Rectal Diseases / surgery*
  • Rectum / surgery*
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome