Establishing an enhanced recovery protocol (ERP) with high compliance improves patient reported quality of recovery after elective minimally invasive colorectal surgery
Louisa Oste, Wolfgang Schwenk, Anna Calaminus, Lena Marina Kruckau, Torsten ÜberrückAbstract
Objectives
The aim of this prospective data analysis was to evaluate the patient reported quality of postoperative recovery in patients undergoing elective minimally invasive colorectal surgery and to assess the impact of a ERP (Enhanced Recovery After Surgery Protocol) compared to traditional perioperative care.
Methods
158 patients undergoing elective colorectal surgery were prospectively enrolled. The first 28 patients were treated during 3 months of ERP development and received standardized traditional care. The following 130 patients were treated under optimized perioperative management with an ERP. Quality of recovery was assessed using the validated QoR-15 questionnaire on postoperative days 2 and 5. Secondary outcomes included the pre- and postoperative length of hospital stay. The functional recovery, compliance to ERP and postoperative mobilization times were also measured.
Results
Patients in the ERP group showed significantly higher QoR-15 scores on both postoperative day 2 and day 5 compared to the traditional care group indicating a better quality of patient perceived recovery. The duration of initial intensive care observation, the time until removal of the urinary catheter, first bowel movement and until regaining autonomy were all significantly reduced in patients treated according to the ERP. Similarly, mobilization times on the day of surgery as well as on postoperative days 1–3 were significantly longer in the ERP group, indicating earlier and more consistent patient activity. These findings reflect a faster restoration of physiological function and independence The ERP group also had a shorter median length of stay (6 vs. 8 days) correlating with a faster functional recovery.
Conclusions
Implementation of an ERP in elective colorectal surgery significantly improves patient-reported quality of recovery, accelerates functional recovery and reduces length of hospital stay. Key determinants of early postoperative recovery were the baseline recovery status and the occurrence of postoperative complications, whereas demographic or procedural variables appeared to have less impact.