Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Wong PML (1), Cheung WL (1), Or SKC (1), Chan MFE (1), Kwong SFS (1), Tsui FPY (2), Chan CSA (2), Wong LM (3), Ng M (3), To SH (3), Hui E (3), Ling YH (3)
Affiliation :
(1) Physiotherapy Department, RTSKH (2) Department of Anaesthesia, PYNEH (3) Department of Surgery, RTSKH
Introduction :
Enhanced Recovery After Surgery (ERAS) is an evidence-based multidisciplinary perioperative care which has gained popularity because of improved patient outcomes after surgery. While most ERAS programs were applied in minimally invasive surgeries, the same concept could also benefit patients undergoing open surgeries as well. The ERAS for Colorectal Surgery program at RTSKH was implemented in July 2021 to include all eligible patients undergoing colorectal surgery, regardless of the surgical approach. The majority of our patients had open surgery. Our program included preoperative education, prehabilitation, perioperative multimodal analgesia and postoperative early rehabilitation coordinated between surgeons, anesthesiologists and physiotherapists to facilitate early discharge and recovery.
Objectives :
To evaluate the efficacy of the ERAS program in colorectal surgery at RTSKH.
Methodology :
Patients scheduled for colorectal surgery from July 2021 to June 2023 were recruited. Eligible patients were identified by surgeons or physiotherapists to a prehabilitation program to maximize their physical ability before surgery. Perioperative multimodal analgesia including epidural analgesia (EA) or patient-controlled analgesia (PCA) were prescribed after individualized assessment by anaesthetists. Postoperative physiotherapy was started on day 1 and continued throughout the in-patient phase. After discharge, patients continued their rehabilitation at out-patient physiotherapy department up to 6 months. The primary outcome was length of stay (LOS) and secondary outcomes including pain score (Numeric Rating Scale NRS on postop day1-3, upon discharge, 3 months and 6 months), functional parameters including the Veterans Specific Activity Questionnaire (VSAQ), 6-Minute Walk Test (6MWT), 30s Chair-Stand Test (30sCST), Dominant Handgrip Strength (DHS), Body Mass Index (BMI) and Skeletal Muscle Mass (SMM) were measured. Additional data (LOS, pain scores) were extracted from previous year (September 2020 – July 2021) as control group for comparison.
Result & Outcome :
113 patients (65 males, 48 females, mean age 68.1) were recruited. 17 patients underwent prehabilitation. 71 patients attended post-op physiotherapy with 32 patients completed 3-month and 6-month assessments. Out of these 32 patients, 78.1% had open surgery (N=25). The LOS of ERAS group and control group were 10.53 and 11.09 days respectively (p<0.001); duration of post-operative EA or PCA were shortened in ERAS group (3.11 vs 3.34 days, p<0.05). There was also persistent reduction in pain score from postoperative day 1 to discharge (0.94 vs 0.13 at rest, p=0.001, 3.07 vs 0.81 during movement, p<0.001) and throughout the post-discharge period (0.26 vs 0.00 at rest at postop 3 weeks vs 6 months, p=0.039, 1.23 vs 0.03 during movement at postop 3 weeks vs 6 months, p=0.001). Subjective functional activity (VSAQ) improvement (4.36-->4.77-->5.48 METs) were significant at 3 weeks, 3 months and 6 months. Objective tests including 6MWT and 30sCST also showed significant improvements from 3 weeks to 3 months (p<0.05) then plateau off at 6 months. Significant improvements in DHG (26.31-->29.07kg), BMI (21.67-->22.4) and SMM (41.62-->43.06kg) were also seen at 3 weeks to 6 months. Our results showed that ERAS program in open colorectal surgery was effective in facilitating rehabilitation and discharge, improved pain relief, physical function and body composition with sustained benefits up to 6 months.
