Development and Evaluation of Enhanced Recovery After Surgery Program for Patients with Colorectal Cancer Surgery

Eun Ja Kim; Jeong Sook Park

doi:10.7475/kjan.2019.31.6.677

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Kim and Park: Development and Evaluation of Enhanced Recovery After Surgery Program for Patients with Colorectal Cancer Surgery

Original Article

Korean Journal of Adult Nursing 2019; 31(6): 677-690.

Published online: 20 December 2019

DOI: https://doi.org/10.7475/kjan.2019.31.6.677

Development and Evaluation of Enhanced Recovery After Surgery Program for Patients with Colorectal Cancer Surgery

Eun Ja Kim¹

, Jeong Sook Park²

¹Staff Nurse, Keimyung University Dongsan Medical Center, Daegu, Korea.

²Professor, College of Nursing, Keimyng University, Daegu, Korea.

Corresponding author: Park, Jeong Sook. College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3907, Fax: +82-53-580-3916, jsp544@kmu.ac.kr

Received 17 August 2019 Revised 19 December 2019 Accepted 4 December 2019

Korean Society of Adult Nursing

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to develop and evaluate the effectiveness of the Enhanced Recovery After Surgery (ERAS) program for colorectal cancer surgery patients.

Methods

This program was developed using ADDIE model. It includes preoperative care (counseling, encouraging liquid food intake, avoiding mechanical bowel preparation, encouraging sips of water up to two hours before surgery) and postoperative care (removal of Foley catheter the day after surgery, water intake after three days, beginning liquid diet intake after four days, a soft diet after five days, supplementing high carbohydrate drinks beginning three days after surgery, and early mobilization on the day of surgery). An experimental group of 15 patients in the ERAS program (July 1, 2017~March 31, 2018) and a control group of 24 patients in the existing program (July 1, 2016~March 31, 2017) were compared. Date was analyzed using independent t-test, χ² test, Fisher's exact test and Mann-Whitney U test.

Results

The time before beginning the soft diet was significantly shorter in the ERAS group than the control group (U=56.00, p<.001). The hospital stay length was significantly decreased in the ERAS group (9.53±1.35) compared to the control group (13.29±4.57) (U=72.50, p=.002). No significant differences emerged in frequencies of postoperative bowel function recovery, complications, or readmission.

Conclusion

Although the recommendations of the traditional ERAS were not fully applied in this ERAS program, it offers improved clinical outcomes for patients with laparoscopic colon cancer surgery.

Keywords: Perioperative care, Colorectal neoplasm, Laparoscopy

Figures and Tables

Figure 1

Model of stage of design and development of enhanced recovery after surgery program.

Figure 2

Comparison of traditional surgery management program and early recovery program.

Table 1

Homogeneity Test of General Characteristics and Surgery-related Characteristics (N=39)

Exp.=experimental group; Cont.=control group; SD=standard deviation; BMI=body mass index; ASA=american society of anesthesiologists; TNM=tumor, node, metastasis; IV=intra venous;^†Fisher's exact test; ^‡χ² test; ^§Mann-whitney u test.

Table 2

Difference Between the Two Groups about Bowel Function Recovery, Starting Date of Soft Diet and Length of Hospital Stay (N=39)

Exp.=experimental group; Cont.=control group; SD=standard deviation; ^†Mann-whitney u test.

Table 3

Frequency Analysis Between the Two Groups about Complication and Readmission (N=39)

Exp.=experimental group; Cont.=control group; ^†Fisher's exact test.

ACKNOWLEDGEMENT

This article is a condensed form of the first author's master's thesis from Keimyung University.

Notes

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

^AUTHORSHIP

Study conception and design acquisition - KEJ and PJS.
Data collection - KEJ
Analysis and interpretation of the data - KEJ and PJS.
Drafting and critical revision of the manuscript - KEJ and PJS.

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ORCID iDs

Eun Ja Kim
https://orcid.org/0000-0001-8389-4529

Jeong Sook Park
https://orcid.org/0000-0001-8356-6998

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