News & Commentary

Enhanced recovery protocol reduces LOS

Many who go under the knife probably wish surgeons wouldn’t starve them and cut off their water supply before surgery but accept the deprivation as necessary. For more than 15 years, hospitals in Europe have used a different technique, called an enhanced recovery protocol (ERP), which involves giving patients a drink a few hours before surgery that contains carbohydrates, electrolytes, minerals, and vitamins. Patients also receive painkillers before the operation, and epidurals placed during the surgery remain in place after the procedure. Patients are encouraged to walk soon after surgery and are usually discharged earlier.

Maybe that’s the reason more hospitals in the United States should consider the ERP approach, at least when it comes to colorectal surgery, suggest the authors of a recent study in the Journal of the American College of Surgeons. Researchers at the University of Virginia Health Center compared results of colorectal surgeries before (August 2012 to February 2013) and after (August 2013 to February 2014) trying the ERP approach.

The conventional method involves fasting, liberal fluid administration in the intraoperative period, the use of nasogastric tubes and opioid-centric pain measurement strategies, and plenty of bed rest.

Treatment for the ERP group (109 patients) cost nearly $800,000 less in total than treatment for the group (98 patients) treated in the conventional way. There was a substantial reduction in length of stay as well. Patient satisfaction also improved considerably during the study period.

Length of stay for colorectal surgery patients relative to the medical center as a whole


Source: Thiele RH et al., Journal of the American College of Surgeons, February 2015

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