Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?
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Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme? / Munk-Madsen, P.; Eriksen, J. R.; Kehlet, H.; Gögenur, I.
In: Colorectal Disease, Vol. 21, No. 12, 2019, p. 1438-1444.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Why still in hospital after laparoscopic colorectal surgery within an enhanced recovery programme?
AU - Munk-Madsen, P.
AU - Eriksen, J. R.
AU - Kehlet, H.
AU - Gögenur, I.
PY - 2019
Y1 - 2019
N2 - Aim: Enhanced recovery after surgery programmes in elective colorectal surgery have been developed and implemented widely, but a subgroup of patients may still require longer hospital stays than expected. The aim of this study was to identify and describe factors compromising early postoperative recovery by asking ‘why is the patient still in hospital today?’ after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery programme. Method: Patients undergoing elective laparoscopic colorectal cancer resection were evaluated postoperatively with predefined potential reasons for still being in hospital. The primary outcome was ‘reason for still being in hospital’ on postoperative day 0–4 and secondarily length of stay with a focus on differences between patients with and without a stoma. Results: Ninety-six patients having colorectal cancer surgery were included. The median length of stay for the whole group was 3 days (range 1–14). The four dominant causes for patients without a stoma to be in hospital were lack of gastrointestinal function, lack of early mobilization, lack of normal micturition and nausea. Patients with a stoma stayed in hospital due to stoma training, lack of gastrointestinal function, lack of free micturition and a miscellaneous ‘others’ group. Conclusion: Delayed gastrointestinal function, insufficient mobilization, poor urinary function and stoma care training have been characterized as dominant compromising factors for postoperative recovery. Together with a focus on frailty, future studies should focus on improving early mobilization, prevention and treatment of postoperative urinary retention and improved stoma care training, in order to minimize delay in postoperative recovery and discharge.
AB - Aim: Enhanced recovery after surgery programmes in elective colorectal surgery have been developed and implemented widely, but a subgroup of patients may still require longer hospital stays than expected. The aim of this study was to identify and describe factors compromising early postoperative recovery by asking ‘why is the patient still in hospital today?’ after laparoscopic colorectal cancer surgery within an enhanced recovery after surgery programme. Method: Patients undergoing elective laparoscopic colorectal cancer resection were evaluated postoperatively with predefined potential reasons for still being in hospital. The primary outcome was ‘reason for still being in hospital’ on postoperative day 0–4 and secondarily length of stay with a focus on differences between patients with and without a stoma. Results: Ninety-six patients having colorectal cancer surgery were included. The median length of stay for the whole group was 3 days (range 1–14). The four dominant causes for patients without a stoma to be in hospital were lack of gastrointestinal function, lack of early mobilization, lack of normal micturition and nausea. Patients with a stoma stayed in hospital due to stoma training, lack of gastrointestinal function, lack of free micturition and a miscellaneous ‘others’ group. Conclusion: Delayed gastrointestinal function, insufficient mobilization, poor urinary function and stoma care training have been characterized as dominant compromising factors for postoperative recovery. Together with a focus on frailty, future studies should focus on improving early mobilization, prevention and treatment of postoperative urinary retention and improved stoma care training, in order to minimize delay in postoperative recovery and discharge.
KW - delayed postoperative recovery
KW - ERAS
KW - ileus
KW - laparoscopic colorectal surgery
KW - length of stay
U2 - 10.1111/codi.14762
DO - 10.1111/codi.14762
M3 - Journal article
C2 - 31309661
AN - SCOPUS:85070767142
VL - 21
SP - 1438
EP - 1444
JO - Colorectal Disease
JF - Colorectal Disease
SN - 1462-8910
IS - 12
ER -
ID: 236216671