Factors influencing implementation of an enhanced recovery programme in colorectal surgery
thesisposted on 29.06.2015, 14:22 by Ugochukwu Chima Ihedioha
In order to distinguish essays and pre-prints from academic theses, we have a separate category. These are often much longer text based documents than a paper.
Introduction: Major recent advances in modern surgery have focussed on processes and pathways relating to perioperative recovery. Optimising patients perioperatively is essential in improving outcomes. The enhanced recovery programme is an integrated pathway that combines evidence based practice in a synergistic manner to improve outcomes. This research concerns perioperative recovery for patients undergoing major abdominal surgery. Aim: The aim of this study was to investigate the factors that influence the implementation of an enhanced recovery programme in patients undergoing elective colorectal surgery. Method: The study was done in four phases. The first phase was to assess the feasibility of introducing fast track surgery in our unit by recruiting patients undergoing reversal of loop ileostomy so as to reduce hospital stay. The second phase, compared laparoscopic colorectal surgery with open colorectal surgery with regards to hospital stay and complication rates. Both groups of patients were followed up over a two year period to compare incisional hernia rates. The third phase, compared the use of video education in the psychological preparation of patients undergoing elective colorectal resection with information leaflets and verbal information. The fourth phase, compared short term outcomes between patients undergoing elective colorectal resection early in the week(Monday to Wednesday) with those later in the week(Thursday to Friday). Results: Early discharge is safe and achievable following reversal of loop ileostomy. Laparoscopic surgery does not improve short term outcomes following colorectal surgery compared with open surgery. Long term outcomes (incisional hernia rates) are similar. Supplementing video education with oral and written information prepares patients better psychologically for surgery although it does not improve short term outcomes. Operating on patients earlier in the week improves short term outcomes. Conclusion: The enhanced recovery programme is feasible and safe and should be practiced by individual units offering colorectal surgery. Patients benefit from preconditioning using video education and being operated upon early in the week