Enhanced Recovery After Surgery: Eliminating the Length of Stay Advantage of Laparoscopic Surgery

Objective: A laparoscopic approach to colorectal surgery has been widely accepted as a superior modality of treatment when compared to traditional open surgery. Previous studies, based on conventional postoperative care, have... [ view full abstract ]

Objective: A laparoscopic approach to colorectal surgery has been widely accepted as a superior modality of treatment when compared to traditional open surgery. Previous studies, based on conventional postoperative care, have exhibited a decreased duration of hospital length of stay (LOS) when comparing laparoscopic and open approaches. Currently, there is insufficient data to demonstrate the LOS advantage of laparoscopic surgery after implementation of an enhanced recovery after surgery (ERAS) pathway. The intention of this study is to determine if the LOS advantage exists for patients undergoing laparoscopic surgery following the introduction of an ERAS pathway.

Methods: A single institution retrospective analysis of patients undergoing both laparoscopic and open colorectal surgery before and after the implementation of an ERAS pathway was reviewed. This analysis included gender, age, co-morbidities, operative indication, procedure, operative time, and LOS.

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 for patients treated with similar disease processes. Prior to the initiation of ERAS, laparoscopic surgery exhibited an advantage in LOS (5 v. 6 days, p= 0.049). However, following the initiation of an ERAS system, the LOS advantage of laparoscopic surgery was eliminated (4 v. 4 days, p= 0.12).

Conclusions: Among our patient population, the LOS advantage of laparoscopic versus open surgery was eliminated following the implementation of an ERAS pathway.