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Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection

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Abstract

Purpose

The aim of this study was to see whether the application of the enhanced recovery programme for colorectal resection improves the results and, in turn, the influence of complexity and size of the hospitals in applying this and its results.

Methods

A multi-centric prospective study was controlled with a retrospective group. The prospective operation group included 300 patients with elective colorectal resection due to cancer. The centres were divided depending on size and complexity in large reference centres (group 1) and area and basic general hospitals (group 2). The retrospective control group included 201 patients with the same characteristics attended before the application of the programme. Completion of categories of the protocol, complications, perioperative mortality and stay in hospital were recorded.

Results

The introduction of the programme achieved a reduction in mortality (1 vs. 4 %), morbidity (26 vs. 39 %) and preoperative (<24 h vs. 3 days) and postoperative (7 vs. 11 days) stays (p < 0.01). There was greater fulfilment of protocol in group 2 with the mean number of items completed at 8.46 and 60 % completed compared with the hospitals in group 1 (7.70 completed items and 55 % completion). The size of the hospital had no relation to the rate of complications (21.3 vs. 26.5 %). In smaller sized and less complex hospitals, the average length of stay was 1.88 days less than in those of greater size (6.45 vs. 8.33 days).

Conclusion

Patients treated according to an enhanced recovery programme develop significantly fewer complications and have a shorter hospital stay. The carrying out of protocol is greater in smaller and less complex hospitals and is directly related to a shorter stay in hospital.

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Authors and Affiliations

  1. Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/ Huertos y Molinos s/n., C.P. 03202, Elche, Alicante, Spain

    Antonio Arroyo

  2. Department of Colorectal Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

    José Manuel Ramirez

  3. Health Technology Assessment, Agencia Laín Entralgo, Madrid, Spain

    Daniel Callejo & Sergio Maeso

  4. Department of Surgery, Hospital d’Igualada, Igualada, Spain

    Xavier Viñas

  5. Department of Surgery, Fundación Hospital Calahorra, Calahorra, Spain

    Roger Cabezali

  6. Department of Anesthesiology, University Hospital of Elche, Elche, Spain

    Elena Miranda

Authors
  1. Antonio Arroyo
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  2. José Manuel Ramirez
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  3. Daniel Callejo
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  4. Xavier Viñas
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  5. Sergio Maeso
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  6. Roger Cabezali
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  7. Elena Miranda
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Consortia

Spanish Working Group in Fast Track Surgery (GERM)

Corresponding author

Correspondence to Antonio Arroyo.

Additional information

Spanish working group in fast track surgery (GERM): Emilio Maseda, Rafael Uña and Damián García-Olmo (Hospital Universitario La Paz, Madrid, Spain); Carlos Moreno, Marina Manzanera, Francisco A Quezada and Telesfora Sempere (Hospital General La Mancha Centro, Alcázar de San Juan, Spain); Eva Llacer, Carlos Maristany, Arantxa Muñoz and Albert Navarro (Hospital Universitario Mútua Terrassa, Terrassa, Spain); Javier Cerdán, Gonzalo Sanz, Pedro Moral and Fernando Esteban (Hospital Clínico San Carlos, Madrid, Spain); Pablo Royo, Vicente Aguilella, Julia Guillen, Tomás Ruiz, José Cuartero, Mariano Martínez and José M Ramírez (Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain); Enrique Moncada, Manuel Núñez, Luis C Luna and José E Casal (Hospital Do Meixoeiro, Vigo, Spain); Roger Cabezali, Carlos Emparan, Pablo Soriano and Javier Isla (Fundación Hospital Calahorra, Calahorra, Spain); Antonio Arroyo, Elena Miranda, Jaime Ruiz-Tovar, Andres Frangi, Mª José Alcaide, Alberto López, Fernando Candela and Rafael Calpena (Hospital General Universitario de Elche, Elche, Spain); José V. Roig, Francisco Villalba, Antonio Salvador and Alfonso Garcia-Fabrique (Hospital General Universitario de Valencia, Valencia, Spain); Luis M Jiménez, Elena Monge, Irene Hidalgo and Emilio Del Valle (Hospital General Universitario Gregorio Marañón, Madrid, Spain); Rafael Morales, José Noguera (Hospital Son Llatzer, Palma de Mallorca, Spain); Xavier Viñas, Enric Macarulla, Victor Murga and Ana Pedregosa (Hospital d’Igualada, Igualada, Spain); Juan A Blasco, Sergio Maeso and Daniel Callejo (Health Technology Assessment, Agencia Laín Entralgo, Madrid, Spain).

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Arroyo, A., Ramirez, J.M., Callejo, D. et al. Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection. Int J Colorectal Dis 27, 1637–1644 (2012). https://doi.org/10.1007/s00384-012-1497-4

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  • DOI: https://doi.org/10.1007/s00384-012-1497-4

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