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Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols.

Publication ,  Journal Article
Ban, KA; Berian, JR; Liu, JB; Ko, CY; Feldman, LS; Thacker, JKM
Published in: Dis Colon Rectum
July 2018

BACKGROUND: Implementation of enhanced recovery protocols in colectomy reduces length of stay and morbidity, but it remains unknown whether benefits vary by clinical diagnosis. OBJECTIVE: Outcomes after colectomy in the setting of enhanced recovery protocols were compared for 3 diagnoses: 1) neoplasm, 2) diverticulitis, and 3) IBD. DESIGN: This was a retrospective registry-based cohort study. SETTINGS: Novel enhanced recovery variables were released in the American College of Surgeons National Surgical Quality Improvement Program in 2014. PATIENTS: Patients with enhanced recovery variable data undergoing elective colectomy (July 2014 to December 2015) for neoplasm, diverticulitis, or IBD were included. MAIN OUTCOME MEASURES: The primary outcome of interest was prolonged length of stay. Additional outcomes included surgical site infection, death/serious morbidity, reoperation, readmission, and days to achieve per os pain control, tolerance of a diet, and return of bowel function. RESULTS: We identified 4620 patients with neoplasm, 1730 patients with diverticulitis, and 593 patients with IBD. Patients undergoing colectomy for IBD were more likely to have prolonged length of stay (OR, 1.98; 95% CI, 1.46-2.69), death/serious morbidity (OR, 1.62; 95% CI, 1.13-2.32), and readmission (OR, 1.54; 95% CI, 1.15-2.08) compared with patients with neoplasm. Patients with IBD took longer than patients with neoplasm or diverticulitis to achieve per os pain control (mean, 4.2 days vs 3.4 and 3.5 days, p < 0.001) and tolerate a diet (mean, 4.1 days vs 3.7 and 3.5 days, p < 0.001). No statistically significant differences in outcomes between patients with neoplasm and diverticulitis were seen. LIMITATIONS: There may be heterogeneity among implemented enhanced recovery protocols. CONCLUSIONS: Patients undergoing colectomy for neoplasm and diverticulitis have improved outcomes in comparison with patients undergoing colectomy for IBD. Knowledge of expected outcomes for patients with different diagnoses may inform clinician and patient expectations. See Video Abstract at http://links.lww.com/DCR/A623.

Duke Scholars

Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

July 2018

Volume

61

Issue

7

Start / End Page

847 / 853

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Recovery of Function
  • Prognosis
  • Postoperative Complications
  • Perioperative Care
  • Patient Readmission
  • Pain, Postoperative
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ban, K. A., Berian, J. R., Liu, J. B., Ko, C. Y., Feldman, L. S., & Thacker, J. K. M. (2018). Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum, 61(7), 847–853. https://doi.org/10.1097/DCR.0000000000001102
Ban, Kristen A., Julia R. Berian, Jason B. Liu, Clifford Y. Ko, Liane S. Feldman, and Julie K. M. Thacker. “Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols.Dis Colon Rectum 61, no. 7 (July 2018): 847–53. https://doi.org/10.1097/DCR.0000000000001102.
Ban KA, Berian JR, Liu JB, Ko CY, Feldman LS, Thacker JKM. Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum. 2018 Jul;61(7):847–53.
Ban, Kristen A., et al. “Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols.Dis Colon Rectum, vol. 61, no. 7, July 2018, pp. 847–53. Pubmed, doi:10.1097/DCR.0000000000001102.
Ban KA, Berian JR, Liu JB, Ko CY, Feldman LS, Thacker JKM. Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum. 2018 Jul;61(7):847–853.

Published In

Dis Colon Rectum

DOI

EISSN

1530-0358

Publication Date

July 2018

Volume

61

Issue

7

Start / End Page

847 / 853

Location

United States

Related Subject Headings

  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Reoperation
  • Recovery of Function
  • Prognosis
  • Postoperative Complications
  • Perioperative Care
  • Patient Readmission
  • Pain, Postoperative