New Approach to Colorectal Surgical Care Results in Shorter Recovery Times, Lower Costs
A new, multidisciplinary approach to managing patients undergoing a colorectal operation results in shorter hospital stays, fewer complications, and lower medical costs, according a study published by Thiele et al in the Journal of the American College of Surgeons.
Currently, patients undergoing colorectal surgery remain in the hospital for 5 to 10 days and often experience significant pain and complications. In an effort to improve these outcomes, researchers at the University of Virginia Health System (UVA-Health), Charlottesville, developed a standardized approach for colorectal surgical care. The program, based on the principles known as enhanced recovery, incorporates proven practices that lead to faster recovery into the preoperative, intraoperative, and postoperative phases of surgical patient care. UVA-Health is a participant in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®).
Enhanced Recovery Protocol
The new approach enables patients to become engaged in their own care from the start. Nurses provide surgical patient educational materials, checklists, and counseling prior to the operation. During and after the operation, local anesthesia modalities—such as intravenous lidocaine infusion and spinal anesthesia—are used, instead of opioids like morphine. Patients are encouraged to eat, get out of bed, and start walking as soon as possible after the operation.
“The key to our success is that we brought everyone who cares for these patients together—including anesthesiologists, nursing staff, pharmacists, and nutritionists—and we coordinated every detail of their care,” said study coauthor Traci Hedrick, MD, FACS, Assistant Professor of Surgery.
Study Details
For the study, Dr. Hedrick and colleagues analyzed data from 207 consecutive patients at UVA-Health undergoing elective colorectal operations before and after the enhanced recovery protocol was implemented. 109 patients were studied in the enhanced recovery group, and 98 in the conventional group.
The primary outcome was risk-adjusted length of stay, with the investigators using the ACS NSQIP® Surgical Risk Calculator to estimate expected length of stay. After implementing the protocol, the surgical team found that length of hospital stay decreased by 2.2 days, overall complication rate decreased 17%, and patient satisfaction scores with pain control increased 55%.
In addition, the study results showed that using the enhanced recovery approach reduced health-care costs by as much as $7,129 per patient, corresponding to a total cost savings of more than $700,000 in the enhanced recovery group.
With a before-and-after study design, there is always the possibility that the patients in the study might not be similar. The researchers did note that a limitation of the study was in the before-and-after study design. Well-designed randomized controlled trials are considered the gold standard.
In order to stratify risk, the researchers entered all patient information into the NSQIP risk calculator, which then provided a predicted length of stay for each patient. "We were actually able to prove that the predicted length of stay was the same for both groups, indicating that both groups were very similar and that the comparisons were accurate," Dr. Hedrick said.
Further, researchers demonstrated that before their protocol was initiated, patient stays were on average 1.6 days longer than the NSQIP predicted length of stay. After the new standardized model of care was implemented, patient stays were about half a day below the NSQIP predicted length of stay.
“We are now working to implement a similar protocol for other surgical specialties, as well as looking for additional ways to further improve our outcomes and patient experience,” Dr. Hedrick said.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
