Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery

Background: Accelerated recovery pathways may reduce length of hospital stay after surgery but there are few data on minimally invasive colorectal operations. Methods: An enhanced recovery pathway (ERP) was instituted, including preoperative analgesia, limited intravenous fluids and opiates, and early feeding. Intrathecal analgesia was administered as needed, but epidural analgesia was not used. The first 66 patients subjected to the ERP were case-matched by surgeon, procedure and age (within 5 years) with patients treated previously in a fast-track pathway (FTP). Short-term and postoperative outcomes to 30 days were compared. Results: Hospital stay was shorter with the ERP than the FTP: median (interquartile range, i.q.r.) 3 (2-3) versus 3 (3-5) days (P < 0.001). A 2-day hospital stay was achieved in 44 and 8 per cent of patients respectively (P < 0.001). Patients in the ERP had a shorter time to recovery of bowel function: median (i.q.r.) 1 (1-2) versus 2 (2-3) days (P < 0.001). Thirty-day complication rates were similar (32 per cent ERP, 27 per cent FTP; P = 0.570). Readmissions within 30 days were more common with ERP, but the difference was not statistically significant (10 versus 5 patients; P = 0.170). Total hospital stay for those readmitted was shorter in the ERP group (18 versus 23 days). Conclusion: ERP decreased the length of hospital stay after minimally invasive colorectal surgery.