Enhanced recovery after surgery, based perioperative bundle reduces 30-day unplanned readmission after laparoscopic colorectal cancer surgery

Abstract

BACKGROUND

Laparoscopic resection has become standard for colorectal cancer (CRC) but postoperative recovery is often impaired by delayed gastrointestinal function, poor mobility and inadequate pain control resulting in increased risk of complications and unplanned readmission. Recovery is generally slower with conventional care, which follows conservative feeding and activity protocols. Enhanced recovery after surgery (ERAS) pathway combines several evidence-based perioperative interventions that reduce surgical stress and promote recovery, but there are no specific data regarding the effect of this program on 30-day unplanned readmission after laparoscopic colonoctol cancer surgery. This study was designed to compare an ERAS-based perioperative bundle with conventional care in terms of 30-day unplanned readmission and recovery outcomes.

AIM

To analyze the impact of ERAS pathway-based comprehensive perioperative management bundle on 30-day unplanned readmission rate after laparoscopic radical resection for CRC, and to evaluate its improvement effects on patients’ recovery-related indicators, functional recovery, and quality of life.

METHODS

We retrospectively analyzed 77 patients underwent laparoscopic radical resection for CRC in the Department of Gastrointestinal Surgery of our hospital from July 2020 to June 2021. Patients were divided based on the initiation time of rehabilitation treatment protocols: Control group (n = 38, conventional rehabilitation care) and intervention group (n = 39, ERAS pathway-based comprehensive perioperative management bundle). The intervention group received a combination of preoperative individualized rehabilitation education, postoperative early activity training, gastrointestinal function rehabilitation, multimodal analgesia, psychological support and discharge preparation with continuity of care as multilateral comprehensive managementiy. The unplanned 30-day readmission rate, recovery-related indicators, pain scores, functional recovery indicators, satisfaction with treatment and quality of life were compared between the groups.

RESULTS

The 30-day unplanned readmission rate in the intervention group (5.1%) was significantly lower than that recorded in controls (23.7%) (Fisher’s exact test, P = 0.024). Compared with the control group, time to first ambulation, first flatus, first defecation and recovery of gastrointestinal function in intervention group were shorter (all P < 0.001). Patients in the intervention group had significantly lower pain scores than those in the control group on postoperative days 1, 3, and 7 (all P < 0.001). In the intervention group, the 6-minute walk distance on postoperative day 7 was significantly greater than that in the control group (P < 0.001). Barthel Index scores at discharge and 30 days postoperatively in the intervention group were superior to those of the control group (P < 0.05). At 30 days postoperatively, the patient satisfaction scores in the intervention group were significantly higher than the controls (P < 0.001), and all dimensions of 36-item short-form health survey quality of life scale showed various degrees of improvement at 30-day after surgery (P < 0.05).

CONCLUSION

The ERAS pathway-based comprehensive perioperative management bundle can reduce the 30-day unplanned readmission rate after laparoscopic CRC surgery significantly, which in effectively promotes early postoperative recovery, pain control, functional recovery level and improves quality of life. In summary, the synergistic effects of each individual component are attributed to these clinical advantages because the intervention is a multi-component bundle and worthy of clinical perioperative care promotion and application.

Keywords: Enhanced recovery after surgery; Multidisciplinary enhanced recovery interventions; Laparoscopic surgery; Colorectal neoplasms; Unplanned readmission; Postoperative recovery

Core Tip: This study evaluated the impact of a comprehensive perioperative management bundle based on an enhanced recovery after surgery (ERAS) pathway on 30-day unplanned readmission rates following laparoscopic radical resection for colorectal cancer (CRC). The intervention group (n = 39) had a significantly lower 30-day unplanned readmission rate compared with the conventional care group (per protocol, n = 38), 5.1 percent vs 23.7 percent, P = 0.024 among 77 patients. The ERAS bundle which included early mobilization, multimodal pain control, early enteral feeding, abdominal massage, psychological support as well as formalized discharge planning significantly accelerated recovery of gastrointestinal function and significantly reduced postoperative pain scores at all time points whilst improving exercise tolerance and activities of daily living along with improved quality of life overall at 30 postoperative days. These results suggest that the clinical benefits of ERAS are attributable to its synergistic multi-component bundles instead of individual interventions. The program provides a practical evidence-based approach to perioperative care that should be more broadly implemented in CRC surgical units.