W. J. Farrington1, A. Gullick1, T. S. Wahl1, L. Goss1, M. Morris1, J. Cannon1, G. Kennedy1, D. I. Chu1 1University Of Alabama At Birmingham Medical Center,General Surgery,Birmingham, AL, USA
Introduction: The laparoscopic approach to colorectal surgery has several advantages compared to traditional open surgery including reduced length-of-stay (LOS). While the effectiveness of Enhanced Recovery After Surgery (ERAS) on reducing LOS is well-documented, it remains unclear whether ERAS equilibrates the LOS differences between open and laparoscopic surgery. We hypothesized that ERAS would reduce the LOS for both open and laparoscopic surgery and eliminate these differences.
Methods: A single-institution retrospective review of patients undergoing both laparoscopic and open colorectal surgery before and after the implementation of ERAS was conducted. Patient and procedure-specific variables were recorded. Primary outcome was post-operative LOS. Univariate and bivariate comparison were made. Chi-square and Wilcoxon Rank Sums tests were used to determine differences among categorical and continuous variables, respectively.
Results: Four hundred and twenty patients were included in this study. The pre-ERAS (n=210) patient groups included laparoscopic (n=68) and open (n=142) surgical approaches for both benign and malignant disease. The post-ERAS (n=210) group included laparoscopic (n=92) and open (n=118) surgeries. Patient gender, race, ASA class, smoking and insurance status did not differ by surgical approach among Pre-ERAS and ERAS patients (p>0.05). However, age, indication for surgery, procedure type, and operative time were significantly different by surgical approach in both pre-ERAS and ERAS groups (p<0.05). Prior to the initiation of ERAS, laparoscopic surgery exhibited an advantage in shorter LOS compared to open surgery (5 v. 6 days, p= 0.049). With ERAS, the LOS advantage of laparoscopic surgery was eliminated and LOS was similar between laparoscopic and open surgeries (4 v. 4 days, p= 0.12) (Figure 1).
Conclusion: ERAS reduces LOS for both laparoscopic and open colorectal surgery. Importantly, the LOS advantage of laparoscopic surgery was eliminated with ERAS. These data suggest that ERAS has positive effects on all approaches to colorectal surgery and should be used widely.
