Factors influencing length of stay after elective bowel resection within an enhanced recovery protocol

Trent W. Stethen, Yasir A. Ghazi, Robert Heidel, Brian Daley, Linda Barnes, James Mcloughlin

Research output: Contribution to journalArticle

Abstract

A multimodality approach to enhance recovery after bowel surgery is demonstrated to reduce complications and decrease patient length of stay (LOS). This study evaluates the factors that influence patient LOS within a formal enhanced recovery protocol. From January 2014 to December 2016, all consecutive patients admitted to one ward, who had undergone bowel resection and were enrolled in an enhanced recovery protocol, were evaluated prospectively. We entered every patient’s data into the American College of Surgeons Risk Calculator (ACSRC) to compare predicted versus actual outcomes. Statistical analysis of clinical factors, patient participation, and outcomes compared with the overall LOS was performed. Of 670 bowel resections performed during the study period, a total of 127 (19%) patients met the criteria and were analyzed for comorbidities, type of surgery, complications, and participation in recovery protocols. The median length of stay (mLOS) for all patients was 4.0 days (1.8–24.6 days). Factors influencing mLOS included laparoscopic versus open surgery (P 5 0.006), COPD (P 5 0.003), missing 24 hours of ambulation (P < 0.001), use of patient-controlled analgesia (P 5 0.011), and diagnosis of insulin-dependent diabetes mellitus (P 5 0.041). Increasing the use of morphine equivalents (MEs) increased mLOS beyond the ACSRC estimate (P 5 0.003). Developing a major complication increased mLOS by 8.5 times the ACSRC estimate. Conclusion: A multimodality approach to enhance surgical recovery after bowel surgery decreases the LOS. The surgical approach, participation in ambulation, insulin-dependent diabetes mellitus, and COPD influenced the overall LOS. Increasing use of morphine equivalents and developing a complication increased mLOS beyond the ACSRC preoperative risk estimates.

Original languageEnglish (US)
Pages (from-to)1240-1245
Number of pages6
JournalAmerican Surgeon
Volume84
Issue number7
StatePublished - Jul 1 2018

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Length of Stay
Chronic Obstructive Pulmonary Disease
Morphine
Walking
Patient Participation
Patient-Controlled Analgesia
Type 1 Diabetes Mellitus
Statistical Factor Analysis
Comorbidity
Surgeons

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Factors influencing length of stay after elective bowel resection within an enhanced recovery protocol. / Stethen, Trent W.; Ghazi, Yasir A.; Heidel, Robert; Daley, Brian; Barnes, Linda; Mcloughlin, James.

In: American Surgeon, Vol. 84, No. 7, 01.07.2018, p. 1240-1245.

Research output: Contribution to journalArticle

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