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Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study

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Abstract

Background

Although enhanced recovery programs (ERPs) have been proven to be beneficial after laparoscopic colon surgery, they may result in adverse clinical outcomes following failure. This study analyzed risk factors associated with ERP failure after laparoscopic colon cancer surgery.

Methods

We analyzed the outcomes of 208 patients who underwent ERPs following laparoscopic colon cancer surgery between June 2007 and April 2013. The ERP included early oral feeding, early ambulation, and regular laxative administration. ERP failure was defined as postoperative hospital stay of more than 5 days related to postoperative complications, unplanned readmission within 30 days of surgery, or death.

Results

Surgical procedures included anterior resection (n = 101), right hemicolectomy (n = 90), and left hemicolectomy (n = 17). The mean postoperative hospital stay was 6.5 ± 2.3 days (range 3–24 days). ERP failure occurred in 36 patients (17.3 %), with no mortality; reasons included ileus (n = 14), wound infection (n = 4), chylous drainage (n = 3), anastomotic bleeding (n = 3), pneumonia (n = 1), or readmission (n = 11) owing to delayed complications. Univariable analysis showed that ERP failure was associated with proximal colon cancer, side-to-side anastomosis, longer operation time, increased blood loss, and longer resected specimen length. Multivariable analysis showed that side-to-side anastomosis [odds ratio (OR) 4.534; 95 % confidence interval (CI) 1.902–10.811; P = 0.001] and increased blood loss (OR 1.004; 95 % CI 1.001–1.008; P = 0.041) were independent risk factors for ERP failure.

Conclusions

We showed that increased blood loss and side-to-side anastomosis in comparison with end-to-end anastomosis were independent risk factors associated with ERP failure after laparoscopic colon cancer surgery. This suggests that intraoperative elements may be important determinants to obtain successful postoperative recovery in the era of ERP.

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Acknowledgments

The Medical Research Collaborating Center, Seoul National University Bundang Hospital, Korea, provided support for statistical analysis. The authors are indebted to J. Patrick Barron, Professor Emeritus of Tokyo Medical University and Adjunct Professor of Seoul National University Bundang Hospital for his contributions to manuscript editing.

Disclosures

Heung-Kwon Oh, Myong Hun Ihn, Il Tae Son, Jin Taek Park, Jaebong Lee, Duck-Woo Kim, and Sung-Bum Kang have no potential conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea

    Heung-Kwon Oh, Myong Hun Ihn, Il Tae Son, Jin Taek Park, Duck-Woo Kim & Sung-Bum Kang

  2. Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea

    Jaebong Lee

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  1. Heung-Kwon Oh
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Correspondence to Sung-Bum Kang.

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Oh, HK., Ihn, M.H., Son, I.T. et al. Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study. Surg Endosc 30, 1086–1093 (2016). https://doi.org/10.1007/s00464-015-4302-y

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