Authors (including presenting author) :
Chan NC (1), Chan PY (1), Cheung WM (1), Fung WL (1), Hui GK (1), Pang YW (1)
Affiliation :
(1) Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Patients undergoing major colonic resection used to have prolonged stay due to pain, immobility or various complications. The Colectomy with All-rounded Recovery Enhancement (CARE) programme was launched in PYNEH for all patients undergoing colectomy since January 2021. Specific assessment, optimization and prehabilitation were offered at our multi-disciplinary perioperative medicine clinic. Intravenous iron would be prescribed for suitable patients with haemoglobin <10g/dL.
Patients 75 years old or less were further recruited under enhanced recovery after surgery (ERAS) pathway where they received bundle multimodal analgesics before and after surgery, intra-operative intravenous lignocaine and post-operative patient-controlled analgesia (PCA). Pre-operative carbohydrate loading, early oral feeding and mobilization post-operatively were encouraged. Tubes and drains were inserted with higher thresholds.
Objectives :
The primary outcome was length of stay (LOS). Secondary outcomes were perioperative transfusion rates, pain scores, PCA duration and consumption.
Methodology :
This was a retrospective audit to all patients under CARE ERAS from January – September 2021. Comparable cases in 2019 were selected as control. Cases were identified from the operating theatre management system and clinical management system. Mean values were compared for continuous data with Mann-Whitney U test while chi-square test was used for categorical data. P-value (p) of <0.05 was considered significant.
Result & Outcome :
50 patients under CARE ERAS were compared with 50 control patients. There was no significant difference in basic demographics (including age, sex, American Society of Anaesthesiologists grading). Surgically, both groups had similar intra-operative complication, stoma creation and open conversion rates. There was a 30% reduction in drain insertion rate in the CARE ERAS group (p 0.002).
CARE ERAS patients started fluid diet 1.2 days earlier (p <0.001) and were ambulatory nearly 2 days earlier (p <0.001) than control patients. LOS under CARE ERAS was shortened by 2.5 days (p 0.013).
There was a 10-fold reduction in pre-operative transfusion rate (p 0.008) and 8-fold reduction in post-operative transfusion rate (p 0.031) compared with control. Pre-operative haemoglobin levels, intraoperative blood loss and intraoperative transfusion rate were similar in both groups.
The use of perioperative multimodal analgesia improved post-op day 1 pain score on movement (p 0.024) and shortened overall duration of PCA use (p 0.01).
CARE ERAS programme successfully enhanced patients’ recovery, reduced perioperative transfusion rate and shortened LOS, which translates to more cost-effective use of hospital resources.
