Care after Colonic Operation—Is it Evidence-Based? Results from a Multinational Survey in Europe and the United States

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Abstract
Despite clinical evidence showing that steps can be taken perioperatively to enhance postoperative recovery and decrease morbidity in colonic operation patients, there is no comprehensive information on how widespread such practices are, or the combination of such steps into effective multimodal rehabilitation (fast-track) colonic surgery programs to decrease hospital stay. This survey investigated clinical practice around colonic operations across Europe and the United States. The survey was conducted in 295 hospitals in the United Kingdom, France, Germany, Italy, Spain, and the United States. Details of perioperative care and postoperative recovery were recorded for 1,082 patients who had undergone elective colonic operations and who were discharged (or died) over a 2-week period (United States: up to 4 weeks). Preoperative bowel clearance was used in >85% of patients. A nasogastric tube was left in situ postoperatively in 40% versus 66% of patients in the United States and Europe, respectively, and was removed about 3 days postoperatively. It took 3 to 4 days until 50% of the patients first tolerated liquids and 4 to 5 days until 50% of patients were eating and having a bowel movement. Postoperative ileus was found to persist for over 5 days in approximately 45% of patients. Mean length of postoperative hospital stay was over 10 days in the United Kingdom, France, Germany, Italy, and Spain, and 7 days in the United States, compared with 2 to 5 days reported in trials of fast-track colonic surgery programs. Strategies that can contribute to improved recovery and reduced complications after colonic operations do not appear to be applied optimally in clinical practice across Europe and the United States. These findings indicate a potential for major improvements in outcomes and reduction of costs if peri- and postoperative care can be adjusted to be in line with published evidence.