Decreasing Length of Stay After Colectomy: The Role for Enhanced Recovery Pathways

Health care in the United States has seen a shift during the past decade toward evidencebased treatment and cost containment. One variable used as a surrogate for quality and effective care in colorectal surgery is length of stay (LOS). With the advent of enhanced recovery protocols (ERPs) and increasing use of laparoscopy, the LOS after colectomy has undergone considerable reduction during the past decade. The ERP targets 5 key areas within preoperative, intraoperative, and postoperative care: preoperative patient counseling; preservation of gastrointestinal function; minimizing organ dysfunction; opioid-sparing pain control; and maintaining patient autonomy. Adoption of ERP in combination with laparoscopy has been shown to consistently decrease LOS by 2 days.