University of Wisconsin–Madison Medical College of Wisconsin

Implementation of an Enhanced Recovery After Surgery Program for Colorectal Surgery at a Community Teaching Hospital

Mallory S. Bray, MD; Angela L. Appel, MD; Kara J. Kallies, MS; Andrew J. Borgert, PhD; Brittany A. Zinnel, BS; Stephen B. Shapiro, MD, FACS

WMJ. 2017;116(1):22-26.

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Introduction: Perioperative programs aimed at decreasing surgical stress to colorectal patients can reduce hospital length of stay and morbidity while improving the patient’s perception of the surgical experience. Our goal was to transform patient care from a perioperative platform based on individual physician and nurse choice to a standardized evidence-based Enhanced Recovery After Surgery (ERAS) protocol for all patients undergoing elective colorectal resections.

Methods: An institutional review board-approved retrospective review was performed for the first 12 months of ERAS protocol-driven patient care in 2014 and compared to the prior 12 months (2013) of individual choice managed care.

Results: Ninety-nine patients and 92 patients underwent elective colorectal surgery in the post-ERAS and pre-ERAS period, respectively. The post-ERAS group experienced a shorter length of stay (4.9±2.7 vs 6.2±4.0 days, P=0.001), were more likely to advance to a general diet on postoperative day 1 (72% vs 9%, P<0.001), and had quicker return of bowel function (2.3±1.8 vs 2.8±1.1 days, P<0.0001) compared to the pre-ERAS group. Thirty-day complications were similar between the post-ERAS and pre-ERAS groups and included anastomotic leak (4% vs 0%, P=0.120), surgical site infections (4% vs 8%, P=0.990), and abscess (3% vs 3%, P=0.990). Eleven (11%) post-ERAS patients and 7 (8%) pre-ERAS patients were readmitted within 30 days postoperative (P=0.410).

Conclusion: We implemented change through a new system of care based upon standardized evidence-based ERAS protocols through the preoperative, intraoperative, and postoperative patient experience. In the first year of the ERAS program, patients experienced a reduced length of stay without a significant difference in morbidity or mortality.

Author Affiliations: General Surgery Residency, Department of Medical Education (Bray, Appel); Department of Research, Gundersen Medical Foundation (Kallies, Borgert, Zinnel); Department of General and Vascular Surgery (Shapiro); Gundersen Health System, La Crosse, Wis.
Corresponding Author: Stephen B. Shapiro, MD, FACS, Department of General and Vascular Surgery, Gundersen Health System, 1900 South Ave C05-001, La Crosse, WI 54601; phone 608.775.5187; fax 608.775.7327; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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