STANDARDIZED PERIOPERATIVE CARE PROTOCOLS AND REDUCED LENGTH OF STAY AFTER COLON SURGERY

Background: Recent studies have suggested that critical pathways and s tandard order sets decrease hospital length of stay and improve qualit y of care. A recently conducted prospective, randomized study at our i nstitution found that patients undergoing elective colon resections ha d earlier return of bowel function if perioperative epidural anesthesi a and analgesia were provided. All patients in the study were also pla ced on a standardized perioperative regimen. We hypothesized that the standardized perioperative protocol used in this study contributed to early return of bowel function and hospital discharge compared with si milar patients managed off protocol. Study Design: To test this hypoth esis, we performed a case-controlled study comparing the hospital cour ses of 36 study patients to 36 control patients undergoing colorectal surgery by the same surgeons during the same calendar year. The distri bution of types of operations and anesthetic techniques was similar in both groups. Results: As dictated by the protocol, all study patients had their nasogastric tubes removed, were started on a low fat liquid diet, and ambulated in the first postoperative day. Nasogastric tubes were removed in control patients and study patients 2.2 +/- 0.9 (mean value +/- SD) and 1.0 +/- 0.0 days postoperatively, respectively. Con trol patients were started on an oral diet, usually clear liquids, an average of 2.9 +/- 1.1 days postoperatively, a specific liquid diet wa s started 1.0 day postoperatively in study patients (p < 0.001). Retur n of bowel function, as determined by bowel tones, natus, and bowel mo vements, occurred approximately 1 day earlier in study patients. Study patients were discharged 1 day sooner than control patients. Conclusi ons: Our results suggest that the return of bowel function and the len gth of stay of patients undergoing colon surgery are improved if patie nts are entered into a standardized protocol that eliminates variation in intraoperative and postoperative anesthesia and postoperative surg ical care. We believe these results can be reproduced in routine clini cal surgery by having a clearly outlined protocol for perioperative ca re similar to that used in this study. (C) 1998 by the American Colleg e of Surgeons.