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Session: ePoster Monitor 3-Quality and Cost 2

eP297 - Fast Track Robotic Rectal Surgery with Diverting Loop Ostomy. What Does It Require?

Sunday, June 2, 2024
11:15 AM – 11:20 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Alexandra Wilson, DO

    CRS Fellow
    Swedish Medical Center
    Swedish Hospital
    Seattle, WA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • DM

    Doug Morte, MD

    Fellow
    MultiCare Health System
    Tacoma, Washington, United States

    Disclosure information not submitted.

  • Laila Rashidi, MD FASCRS (she/her/hers)

    Colorectal Surgeon
    Washington State University
    Washington State University
    Seattle, Washington, United States

    Disclosure information not submitted.

Purpose/Background: Ambulatory surgery has gained increasing popularity due its potential to assist health care with shortage of bed and staff and good patient outcomes. Implementation of an advanced enhanced recovery after surgery (ERAS) program with extensive preoperative education and passing of discharge milestones in the combination with minimally invasive surgery allows for shorter length of stay. This study identifies patient factors and protocols that are associated with successful implementation of robotic rectal cancer surgery with diverting ostomy to achieve ambulatory surgery.Methods/Interventions: This is a retrospective review of all rectal cancer cases with loop ileostomy performed by one surgeon in a single institution from February 2019 to July 2023. The procedures were divided into abdominoperineal resection and low anterior resection/proctectomy, all enrolled in ERAS. In addition, every patient was educated regarding stoma care, complications, and post operative expectations. Length of stay and patient factors were evaluated.Results/Outcomes: A total of 102 patients were evaluated, 22 patients underwent an abdominoperineal resection, 80 patients underwent a low anterior resection. Chart review showed that all patients had preoperative education with ostomy nurses, received education on ostomy management, and all had at least one family member involved in education. All patients met specific ERAS metrics to be discharged including adequate pain control, tolerating diet, ambulating, and working with inpatient ostomy nurses. The readmission rate for these patients was 4 out of 24 (16%) for APR and 8 out of 72 (11%) for LAR. The average LOS with an ostomy is typically 4 days (1), but this study showed how 1-2 day LOS is achievable with appropriately educating the patients, and undergoing advanced ERAS.Conclusion/

Discussion: This study not only demonstrated the effectiveness of a patient education, surgical approach, and advanced ERAS in treating rectal cancer but also examined the specific patient factors that influenced success, particularly in reducing hospitalization length of stay. This study underscores the safety, efficiency, and efficacy of advanced ERAS protocols in achieving shorter length of stays.