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AIM Enhanced recovery after surgery programmes aim to attenuate the stress response to surgery and are said to be associated with reduced hospital morbidity and mortality. However, data on their effect on infective complications and the systemic inflammatory response remains limited. Recent studies have shown that the magnitude of the systemic inflammatory response following surgery predicts the development of infective complications. The aim of the present study was to assess the impact of enhanced recovery on the rate of infective complications, and the systemic inflammatory response, following colorectal cancer resection.
METHODS Patients undergoing elective resection for colorectal cancer were included in the study (n=310). The patients were admitted to one of two independent colorectal units. One unit employed enhanced recovery procedures (n=150), the other used conventional care (n=160). From a prospectively maintained database, data on postoperative infective complications and C-reactive protein concentrations on postoperative days 1 to 5 was extracted.
RESULTS A total of 310 patients were included. Age and sex were similar in both groups. Co-morbidity, as demonstrated by ASA scores, was significantly less in the enhanced recovery group, and there were also fewer rectal cancers as well as earlier tumour stage (p=0.005, p=0.030, and p=0.008 respectively). In the enhanced recovery group length of stay was significantly shorter and laparoscopic surgery was used in approximately 30% of cases (both p<0.001). The method of perioperative care was not significantly associated with a difference in the rate of postoperative infective complications, or C-reactive protein on postoperative days 1 to 5.
When patients with rectal cancers were excluded from further analysis (n=211), age, sex and tumour stage were similar in both groups. Co-morbidity remained significantly less in the enhanced recovery group (p=0.024), length of stay was significantly shorter and laparoscopic surgery was used in 30% of cases (both p<0.001). Enhanced recovery was significantly associated with a reduction in the development of pneumonia following elective surgery for colon cancer (p=0.028), but was not associated with a significant difference in the systemic inflammatory response following on postoperative days 1 to 5.
CONCLUSION Enhanced recovery was associated with a significant reduction in length of hospital stay. In contrast, the post-operative systemic inflammatory response was similar in the conventional care and enhanced recovery groups. Overall complication rates, both infective and non-infective, were also similar. Enhanced recovery does not appear to be associated with a reduction in the postoperative systemic inflammatory response or overall infective complications.