Enhanced Recovery After Colon Surgery in a Community Hospital System

被引：39

作者：

Archibald, Lyle H. ^{[1
]}

Ott, Mark J. ^{[1
]}

Gale, Craig M. ^{[1
]}

Zhang, Jie ^{[1
]}

Peters, Matthew S. ^{[1
]}

Stroud, Gary K. ^{[1
]}

机构：

[1] Intermt Healthcare, Surg Serv Clin Program, Salt Lake City, UT 84111 USA

来源：

DISEASES OF THE COLON & RECTUM | 2011年 / 54卷 / 07期

关键词：

Fast-track colon surgery; Enhanced recovery after colon surgery; Multidisciplinary care; Quality improvement; Colorectal surgery; RANDOMIZED CONTROLLED-TRIAL; LENGTH-OF-STAY; CONTROLLED REHABILITATION; EARLY AMBULATION; SURGICAL CARE; PROGRAM; RESECTION; PATHWAY; COMPLICATIONS; LAPAROTOMY;

D O I：

10.1007/DCR.0b013e31821645bd

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BACKGROUND: Enhanced recovery after colon surgery has not been widely adopted in the United States and Europe, despite evidence that postoperative complications and hospital length of stay are decreased. OBJECTIVE: We sought to evaluate the introduction of a comprehensive care process for enhanced recovery after colon surgery in 8 community hospitals. DESIGN: A system-wide, surgeon-directed, multidisciplinary committee developed a comprehensive enhanced-care quality-improvement program. Surgeons and operations leaders in each hospital developed the internal structure to implement the process. PATIENTS: Surgeons had the option of entering or not entering patients in the enhanced-care pathway. Other than trauma patients, there were no exclusion criteria. MAIN OUTCOME MEASURES: To limit selection bias, the study population included all patients undergoing colon resections (those entered and not entered in the care process). Length of stay, postoperative days, hospital costs, 30-day readmission rate, and return to surgery for the study population were compared with a 2-year historical baseline. RESULTS: Forty-two percent of the study population was entered in the enhanced-care process. The average length of stay and the number of postoperative days in the study population decreased by 1.5 (P < .0001) and 1.3 (P < .0001) days. The rate of readmissions and returns to surgery remained stable (P > .05), and the average hospital cost decreased by $1763 (P = .02). Generalized linear regression analysis demonstrated that the enhanced-care process was a more significant variable than was the surgical approach (laparoscopic vs open surgery) in decreasing length of stay. LIMITATIONS: The degree of compliance with care process elements and the relative contribution of each element of the care process are unknown. CONCLUSIONS: A comprehensive enhanced-care colon surgery care process was successfully introduced in a community hospital system, as indicated by the clinical outcome measures.

引用

页码：840 / 845

页数：6

共 25 条

[1] Functional recovery after open versus laparoscopic colonic resection - A randomized, blinded study [J].

Basse, L ;

Jakobsen, DH ;

Bardram, L ;

Billesbolle, P ;

Lund, C ;

Mogensen, T ;

Rosenberg, J ;

Kehlet, H .

ANNALS OF SURGERY, 2005, 241 (03) :416-423

[2] Colonic surgery with accelerated rehabilitation or conventional care [J].

Basse, L ;

Thorbol, JE ;

Lossl, K ;

Kehlet, H .

DISEASES OF THE COLON & RECTUM, 2004, 47 (03) :271-277

[3] A clinical pathway to accelerate recovery after colonic resection [J].

Basse, L ;

Jakobsen, DH ;

Billesbolle, P ;

Werner, M ;

Kehlet, H .

ANNALS OF SURGERY, 2000, 232 (01) :51-57

[4] Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise [J].

Bosio, Raul M. ;

Smith, Bryan M. ;

Aybar, Pablo Serrano ;

Senagore, Anthony J. .

AMERICAN JOURNAL OF SURGERY, 2007, 193 (03) :413-415

[5] Surgical Site Infection Prevention: The Importance of Operative Duration and Blood Transfusion-Results of the First American College of Surgeons-National Surgical Quality Improvement Program Best Practices Initiative [J].

Campbell, Darrell A., Jr. ;

Henderson, William G. ;

Englesbe, Michael J. ;

Hall, Bruce L. ;

O'Reilly, Michael ;

Bratzler, Dale ;

Dellinger, E. Patchen ;

Neumayer, Leigh ;

Bass, Barbara L. ;

Hutter, Matthew M. ;

Schwartz, James ;

Ko, Clifford ;

Itani, Kamal ;

Steinberg, Steven M. ;

Siperstein, Allan ;

Sawyer, Robert G. ;

Turner, Douglas J. ;

Khuri, Shukri F. .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2008, 207 (06) :810-820

[6] Variability in Length of Stay After Colorectal Surgery Assessment of 182 Hospitals in the National Surgical Quality Improvement Program [J].

Cohen, Mark E. ;

Bilimoria, Karl Y. ;

Ko, Clifford Y. ;

Richards, Karen ;

Hall, Bruce L. .

ANNALS OF SURGERY, 2009, 250 (06) :901-907

[7] Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey [J].

Delaney, Conor P. ;

Senagore, Anthony J. ;

Gerkin, Todd M. ;

Beard, Timothy L. ;

Zingaro, Wendy M. ;

Tomaszewski, Kenneth J. ;

Walton, Laura K. ;

Poston, Sara A. .

AMERICAN JOURNAL OF SURGERY, 2010, 199 (03) :299-304

[8] Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection [J].

Delaney, CP ;

Zutshi, M ;

Senagore, AJ ;

Remzi, FH ;

Hammel, J ;

Fazio, VW .

DISEASES OF THE COLON & RECTUM, 2003, 46 (07) :851-859

[9] HOSPITAL STAY LENGTH AS AN EFFECT MODIFIER OF OTHER RISK-FACTORS FOR NOSOCOMIAL INFECTION [J].

DELGADORODRIGUEZ, M ;

BUENOCAVANILLAS, A ;

LOPEZGIGOSOS, R ;

LUNACASTILLO, JD ;

GUILLENSOLVAS, J ;

MORENOABRIL, O ;

RODRIGUEZTUNAS, B ;

CUETOESPINAR, A ;

RODRIGUEZCONTRERAS, R ;

GALVEZVARGAS, R .

EUROPEAN JOURNAL OF EPIDEMIOLOGY, 1990, 6 (01) :34-39

[10] Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection [J].

Gatt, M ;

Anderson, ADG ;

Reddy, BS ;

Hayward-Sampson, P ;

Tring, IC ;

MacFie, J .

BRITISH JOURNAL OF SURGERY, 2005, 92 (11) :1354-1362

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