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Introduction
The enhanced recovery after surgery (ERAS) protocol encompasses a number of evidence-based interventions designed to lessen the impact of surgery upon the patient. It has been shown to reduce the length of stay and improve outcomes in elective colorectal surgical patients when compared to traditional post-operative management. NHS diabetes has recently released guidelines on the management of adults with diabetes undergoing surgery. Despite this, no studies have assessed the impact of diabetes on patients in an ERAS programme.
Methods
Two laparoscopic colorectal surgeons trained in the national Fellowship Programme were appointed in early 2010. Consecutive patients undergoing elective major colorectal procedures from March 2010 to September 2011 had data regarding length of stay , comorbidities and major complications prospectively collected.
Results
143 patients were included in the study. Average age was 64 (range 21-88). The median length of stay in the non-diabetic group was 5 days (Interquartile range 4-7.5, n=125) whilst in the diabetic group the median length of stay was significantly longer at 7 days (5-15.5, n=18, P=.041, Mann-Whitney).
Discussion
Diabetic patients who have elective colorectal procedures have a significantly longer length of stay in hospital than non-diabetic patients despite being managed with an ERAS protocol. This has implications for perioperative management of diabetic patients. It is unclear whether the increased length of stay is due to a higher rate of major complications or a slower return of gut function. Further work needs to be undertaken to look at markers of gut function in the postoperative period.