Darent Valley Hospital, Dartford and Gravesham NHS Trust, has been working to improve outcomes for patients undergoing major bowel surgery, through laparoscopic surgery and the Enhanced Recovery Programme (ERP), and has reduced recovery times by three weeks.
Factors used to speed up recovery include; carbohydrate loading prior to surgery, use of laparoscopic surgical techniques, better cardiac and fluid monitoring (including oesophageal doppler monitoring), and early return to food following surgery.
Speaking about ERP, Dr Michael Parker, Consultant General and Colorectal Surgeon at Darent Valley Hospital, commented: “By enabling patients to leave hospital sooner and recover more quickly we are saving the trust a significant amount of money. For the third of patients we treated who were returning to work we also saved the economy substantial sums by enabling them to return to work a full three weeks earlier than before.”
The team at Darent Valley combined laparoscopic surgery with ERP for a series of 200 patients undergoing colorectal surgery between January 2003 and June 2007. These patients were compared against a group of patients undergoing open colorectal surgery, also at Darent Valley.
The median length of stay in hospital was reduced to just five days. In comparison the UK National Bowel Cancer Audit for 2004-5 reports the national average for open colorectal surgery to be almost double, at 11 days. The median length of time for patients at Darent Valley to return to "normal" after being discharged, was slashed from 29 days (for patients undergoing open surgery) to just seven.
Michael and his team are looking at the possibility of reducing length of stay by one more day which may be the optimum without increasing the risk of readmission. They hope to extend the combination of laparoscopic surgery and the enhanced recovery programme to other surgical specialties.
