European Journal of Nutrition & Food Safety

Background: Enhanced recovery programmes (ERP) have been used in NHS hospitals since 2009 (NHS Improvement, [1]) and include provision of supplement drinks prior to surgery, contrary to traditional methods. This retrospective audit of an ERP aims to compare length of hospital stay (LOHS) and complication rates to reported standards Lassen et al, [2], Varandhan et al, [3], which indicate a reduction in LOHS (of at least 2 days) and complication rates (50% reduction) following introduction of ERP. The secondary aim was to compare LOHS, complication rates and mortality of diabetic and non-diabetic subsamples. 
Method: All patients who undertook the colorectal ERP between September 2005 and May 2013 were included in this audit (N=1,305). No exclusions were made for patients with comorbidities, BMI outside the normal range or type of surgery undertaken. Data was collected by the hospital and coded and analysed by the researchers, using IBM SPSS Statistics 20. Pearson’s Chi squared tests were used to determine associations between number of supplements taken with LOHS and with survival rate and differences between complications and survival rates in patients with diabetes (n=135), compared to patients without diabetes (n=1170). A non-parametric independent samples test was used to determine differences in LOHS between patients with and without diabetes. ANOVA was used to determine differences between number of supplements taken prior to surgery and whether a complication was experienced post-operatively. Level of significance was set at p ≤0.05. Ethics for the audit were obtained through the hospital Trust.
Results: Median LOHS was reduced by 3.0 days and no difference was found between LOHS in diabetic and non-diabetic subsamples. Complication rates were high, with 53.4% of patients experiencing a complication postoperatively. Although no difference was displayed in LOHS, patients with diabetes were found to have an increased complication rate (55%). Mortality rate was almost doubled in patients with diabetes, compared to patients without.
Discussion: LOHS met standards for reduction; similar results have been found by other studies Teeuwen et al, [4]. Complication rates were higher than the standard, which may be explained by the inclusion of patients with comorbidities. It is interesting that LOHS was equal for diabetic and non-diabetic subsamples, as patients with diabetes are often excluded from ERPs Noblett et al, [5]. The results of this audit support the continued use of the colorectal ERP within this NHS Trust.
Conclusion: This audit found the ERP at this Southwest Trust was meeting standards for reduction in LOHS by at least two days and that patients with diabetes who undertook this service did not experience an increased LOHS but were at increased risk of experiencing post-operative complications.