Randomized Controlled Trial: ERAS Program on Colorectal Cancer Surgery Decrease the Length of Patients’ Hospital Stay
Supsamutchai C, MD1, Palitnonkiat V, MD1, Sangiemsak M, MD2, Jirasiritham J, MD1, Hiranyatheb P, MD1, Chatmongkonwat T, MD1, Choikrua P, BSc3
Affiliation : 1 Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 2 Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 3 Surgical Research Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Colorectal carcinoma is the third leading cause of cancer-related deaths in Thailand. Complete surgical resection is one
of the main options for curative treatment. Enhanced recovery after surgery (ERAS) programs can decrease the length of hospital
stay by two to three days, and decrease postoperative complications by 30 to 50% when compared to traditional programs. The
aim of this study is to compare the ERAS program to the traditional program after surgery in the length of hospital stay, postoperative
complications, and rate of revisits within 30 days of the patients being discharged.
Objective : To evaluate how different lengths of hospital stays, post operative complications, readmission rates, postoperative
nausea vomiting, pain between traditional and ERAS program in colorectal cancer patients admitted to Ramathibodi Hospital to
adapt the ERAS protocol in practical use in Ramathibodi patients who underwent surgery.
Materials and Methods : The authors randomized patients with colorectal carcinoma who underwent surgery followed by ERAS
program and traditional program, between 1 June 2015 and 18 May 2017 in Ramathibodi Hospital. The inclusion criteria were
elective colorectal surgery, patients’ age between 18 to 75 years old, clinical and pathological diagnosis colorectal cancer, American
Society of Anesthesiologist classification 1 to 3, and patients who had signed a consent form. Exclusion criteria included previous
abdominal surgery, immobilized patients, and patients who refused to join the program or did not return for follow-up appointments.
Results : Forty-six patients with colorectal carcinoma underwent surgery. Twenty-two patients were treated with the traditional
program, and twenty-four patients were treated with the ERAS program. The average age was 62+8.17 years old in the traditional
program, and 63+9.05 years old in the ERAS program. The median length of hospital stay was 8 days (7 to 9) in the traditional
program, and 6 days (5 to 6.5, p<0.0001) in the ERAS program. Postoperative complications, pain score, post-operative nausea
vomiting and revisit rate in both programs were not different.
Conclusion : The ERAS program showed benefits in decreased length of hospital stays for colorectal cancer surgery patients.
Postoperative complications, pain score, post-operative nausea vomiting and revisit rate within 30 days after discharge in both
groups were not different.
Keywords : Colorectal surgery, Enhanced recovery after surgery, Length of hospital stay
