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Enhanced Recovery Pathway for Urgent Colectomy

Roulin, Didier ; Blanc, Catherine ; Muradbegovic, Mirza ; Hahnloser, Dieter ; Demartines, Nicolas ; Hübner, Martin

In: World Journal of Surgery, 2014, vol. 38, no. 8, p. 2153-2159

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    Title
    • Enhanced Recovery Pathway for Urgent Colectomy
    Author
    • Roulin, Didier. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    • Blanc, Catherine. Department of Anesthesiology, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    • Muradbegovic, Mirza. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    • Hahnloser, Dieter. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    • Demartines, Nicolas. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    • Hübner, Martin. Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011, Lausanne, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • World Journal of Surgery, 2014, vol. 38, no. 8, p. 2153-2159. Springer US; http://www.springer-ny.com
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:324749
    Summary
    Background: Enhanced recovery protocols have been proven to decrease complications and hospital stay following elective colorectal surgery. However, these principles have not yet been reported for urgent surgery procedures. We aimed to assess our initial experience with urgent colectomies performed within an established enhanced recovery pathway. Methods: In a prospective cohort study, all patients undergoing colonic resection between April 2012 and March 2013 were treated according to a standardized enhanced recovery protocol. Urgent surgeries were compared with the elective procedures with regards to baseline characteristics, compliance with enhanced recovery items, and clinical outcome. Results: Patients (N=28) requiring urgent colonic resection were included and compared with patients undergoing elective colectomy (N=63). Overall compliance with the protocol was 57% for the urgent compared with 77% for the elective procedures (p=0.006). The pre-operative compliance was 64 versus 96% (p<0.001), the intra-operative compliance was 77 versus 86% (p=0.145), and the post-operative compliance was 49 versus 67% (p=0.015), for the urgent and elective resections, respectively. Overall, 18 urgent patients (64%) and 32 elective patients (51%) developed postoperative complications (p=0.261). Median postoperative length of stay was 8days in the urgent setting compared with 5days in the elective setting (p=0.006). Conclusions: Many of the intra-operative and post-operative enhanced recovery items can also be applied to urgent colectomy, entailing outcomes that approach the results achieved in the elective setting.