In the Journals

Enhanced recovery program reduced narcotic use, costs, length of stay in community hospital

Implementation of a colorectal enhanced recovery after surgery program in a community hospital decreased narcotic use, costs and length of stay without higher rates of readmission or morbidity, according to recent study data.

Researchers performed a prospective study of an enhanced recovery after surgery (ERAS) colorectal program in a community hospital setting to determine its efficacy and safety as part of an ERAS program initiated in 2010 at Legacy Good Samaritan Medical Center in Portland, Ore. They evaluated practice patterns and outcomes for 244 patients who underwent elective colon and rectal resection before ERAS was implemented in 2009 and after in 2011 and 2012. They also wanted to determine if improved outcomes could be achieved independent of the laparoscopic approach.

The investigators found that laparoscopy increased from 57.4% in 2009 to 88.8% in 2012 (P<.001). Length of stay (LOS) was reduced from 6.7 to 3.7 days (P<.001) with no significant increase in 30-day readmission rate (17.6% vs. 12.5%). Patient-controlled narcotic analgesia use dropped from 63.2% to 15% (P<.001) and duration of use dropped from a mean of 67.8 hours to 47.1 hours (P=.02).

Ileus rate was reduced from 13.2% to 2.5% (P=.02), and intra-abdominal infection declined from 7.4% to 2.5% (P=.24). No significant differences between colorectal cancer diagnosis and LOS, readmission rate, ileus and intra-abdominal infection were observed (all P>.05). Reductions in LOS saved approximately $3,202 per patient in 2011 vs. $4,803 per patient in 2012.

“We have demonstrated with this study that a colorectal ERAS program can be effectively applied to and integrated within a community hospital setting,” the researchers concluded. “The program can successfully speed patient recovery without increasing postoperative morbidity or readmission rates. Our results validate use of ERAS programs to include community hospital care settings.”

Disclosure: The researchers report no relevant financial disclosures.