Int J Colorectal Dis
DOI 10.1007/s00384-012-1497-4


Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection

Antonio Arroyo & José Manuel Ramirez & Daniel Callejo & Xavier Viñas &Sergio Maeso & Roger Cabezali
& Elena Miranda &Spanish Working Group in Fast Track Surgery (GERM)

Accepted: 7 May 2012
# Springer-Verlag 2012


Purpose The aim of this study was to see whether the appli- cation of the enhanced recovery programme
for colorectal resection improves the results and, in turn, the influence of com- plexity and size of the hospitals
in applying this and its results. Methods A multi-centric prospective study was controlled with a retrospective group.
The prospective operation group included 300 patients with elective colorectal resection due to cancer. The centres were
divided depending on size and complexity in large reference centres (group 1) and area and basic general hospitals (group 2).
The retrospective control group included 201 patients with the same characteristics attended before the application of the
programme. Completion of categories of the protocol, complications, perioperative mortality and stay in hospital were recorded.

Results The introduction of the programme achieved a re-duction in mortality (1 vs. 4 %), morbidity (26 vs. 39 %)
and preoperative ( < 24 h vs. 3 days) and postoperative (7 vs. 11 days) stays (p < 0.01). There was greater fulfilment of protocol in group 2 with the mean number of items com- pleted at 8.46 and 60 % completed compared with the hospitals in group 1 (7.70 completed items and 55 % com- pletion). The size of the hospital had no relation to the rate of complications (21.3 vs. 26.5 %). In smaller sized and less complex hospitals, the average length of stay was 1.88 days less than in those of greater size (6.45 vs. 8.33 days).