Enhanced Recovery Protocol Improves Postoperative Outcomes and Minimizes Narcotic Use Following Resection for Colon and Rectal Cancer

Abstract

Background: Enhanced recovery pathways (ERP) are associated with improved recovery. However, data on outcomes following the ERP implementation in colorectal cancer (CRC) are limited. We set out to study the postoperative outcomes, opioid use patterns, and cost impact for patients undergoing colon or rectal resection for cancer.

Methods: A retrospective review of all elective CRC resections from January 2015 to June 2018 at a single institution was performed. Patient demographics, operative details, and postoperative outcomes were collected. Colon and rectal patients were studied separately, with comparison of pre-ERP to post-ERP patients.

Results: 192 patients underwent elective colorectal resection for cancer. In January 2016, an ERP was implemented for all elective resections – 71 patients underwent surgery in the pre-ERP period (33 colon and 38 rectal) and 121 (56 colon and 65 rectal) occurred in the post-ERP period.There were differences with regard to age, gender, or BMI before or after the implementation of ERP for both groups (all p > 0.05). For both colon and rectal cancer patients, ERP reduced time to regular diet (both p < 0.05) and length of stay (colon: 3 vs. 4 days; rectal: 4 vs. 6 days; both p< 0.01). ERP patients also consumed fewer total narcotics (colon: 44 vs. 184 morphine milligram equivalents (MME), p < 0.01; rectal: 121 vs. 393 MME, p < 0.01).

Conclusions: ERP use reduced length of stay and narcotic use with similar total costs and no difference in 30-day complications for both colon and rectal cancer resections.

Keywords: colorectal surgery, colorectal cancer, enhanced recovery protocol, outcomes, resource utilization, narcotics