Colorectal surgical outcomes following implementation of an enhanced recovery after surgery programme in Cape Town

Keywords: colorectal surgery, perioperative care, ERAS, LMIC, surgical checklist

Abstract

Background: Colorectal surgery is commonly performed for benign and malignant colorectal disease. The aim of this study was to describe length of stay (LOS), complications and its associated factors in patients undergoing elective colorectal surgery following implementation of an enhanced recovery after surgery (ERAS) programme in South Africa (SA).

Methods: Socio-demographic, pre- intra- and postoperative clinical details and compliance to the ERAS guidelines were recorded in all patients undergoing colorectal surgery in a private practice in Cape Town, SA. Means and standard deviations or medians and interquartile range (IQR), as appropriate, were used to describe continuous variables and frequencies and percentages for categorical variables. Bivariate and multivariate analyses using linear regression of log transformed LOS and logistic regression for development of complications were performed.

Results: Between 2015 and 2019, 457 patients had elective colorectal surgical procedures. The median LOS was 5 days (IQR 3–7). Pre- and intraoperative compliance was 92% and 86% respectively. In total, 203 (44%) patients developed 346 complications, of which 61% were minor. On bivariate analysis, increased intraoperative compliance was associated with a significant decrease in LOS (coefficient [ß] = 0.987, 95% confidence interval [CI] 0.984–0.991) and complications (odds ratio [OR] 0.457, 95/5 CI 0.266–0.787). For every additional 30 minutes of theatre time, irrespective of type of procedure, LOS increased by 8% and complications by 12%. On multivariate analysis, laparoscopic compared to open surgery was also associated with a shorter LOS (exp [ß] = 0.667, 95% CI 0.580–0.767 p < 0.001) and reduced complications (OR 0.457, 95% CI 0.266–0.787).

Conclusion: Our results show that high compliance to the ERAS guidelines is possible in the private sector in SA and that a significant reduction in LOS can be achieved without placing the patient at a higher risk of complications.

Author Biographies

R L Oodit, University of Cape Town

Department of Surgery, University of Cape Town and Department of Global Surgery, University of Cape Town and Dr Matley and Partners, Constantiaberg MediClinic Hospital, South Africa

D A Constant, University of Cape Town

Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

F Maree, Dr Matley and Partners

Dr Matley and Partners, Vincent Palotti Life Health Hospital, South Africa

I Lorrimer, Dr Matley and Partners

Dr Matley and Partners, Vincent Palotti Life Health Hospital, South Africa

E K Dalwai, University of Cape Town

Department of Surgery, University of Cape Town and Dr Matley and Partners, South Africa

J Moodley, University of Cape Town

Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town and Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, South Africa

Published
2021-12-08
How to Cite
Oodit, R., Constant, D., Maree, F., Lorrimer, I., Dalwai, E., & Moodley, J. (2021). Colorectal surgical outcomes following implementation of an enhanced recovery after surgery programme in Cape Town. South African Journal of Surgery, 59(4), 157-163. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3512
Section
Colorectal Surgery