Appendix 1: CPT Codes
44143 (Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure))
44144 (Partial colectomy with resection, colostomy, and creation of mucofistula)
44145 (Colectomy, partial; with coloproctostomy (low pelvic anastomosis))
44146 (Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy)
44147 (Colectomy, partial; abdominal and transanal approach)
44155 (Colectomy, total, abdominal, with proctectomy; with ileostomy)
44157 (Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, includes loop ileostomy, and rectal mucosectomy, when performed)
44158 (Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoir (S or J), includes loop ileostomy, and rectal mucosectomy, when performed)
44207 (Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis))
44212 (Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy)
45110 (Proctectomy; complete, combined abdominoperineal, with colostomy)
45112 (Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis))
45113 (Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomy)
45119 (Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performed)
45395 (Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy)
45397 (Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed)
Appendix 2: Compliance Data
Compliance of ER protocol elements
Baseline data for patients undergoing surgery in the nine months prior to ER implementation (55 patients)
- Morphine equivalents 21.0 9.96
- Total Morphine equivalents 197.1 216.4
- OR Fluid balance 2,633.6 1251.8
- Total hospital fluid balance 4,422.0 4,693.1
Data for patients undergoing surgery since ER implementation (144 patients)
- Morphine equivalents 5.3 19.1
- Total Morphine equivalents90.30 291.44
- OR Fluid balance 1,089.38 1359.4
- Total hospital fluid balance -1014.76 3867.9
- OOB on POD 1 = 44.4%
- PO intake within 6 hours of surgery 91.7%
- Neuroaxial analgesia – 93.5%
Appendix 3: Linear regression for Cost of Hospital Stay (in US dollars)
UnivariateVariable / Coefficienta / 95% CI / p value
Age / $246.07 / $84.00-408.13 / 0.003
Male Sex / $315.18 / $3,673.71-4,304.08 / 0.877
Race
White / Reference
African-American / -$1072.93 / -$8,067.99-5,922.14 / 0.763
Hispanic / $21,894.22 / $6,217.07-37,571.37 / 0.006
BMI / $302.53 / -$10.52-615.57 / 0.058
Diabetes / $6,223.18 / $1,121.98-11,324.38 / 0.017
Smoking / -$3,303.47 / -$7,946.55-1,339.61 / 0.163
Functional Status
Independent / Reference
Partially Dependent / $10,100.55 / -$2,859.29-23,060.38 / 0.126
Dependent / $79,625.41 / $45,656.87-113,593.90 / <0.001
Preoperative Wt Loss >10% / -$4,321.22 / -$12,053.34-3,410.90 / 0.272
ER protocol / $1,085.279 / -$2,825.47-4,996.03 / 0.585
Surgery type
Open / Reference
MIS / -$4,650.68 / -$9,279.90- -21.45 / 0.049
Sphincter Preserved / -$2,214.02 / -$6,448.07-2,020.04 / 0.304
ASA Class
ASA Class 1 / Reference
ASA Class 2 / $1,921.71 / -$32,610.24-36,453.66 / 0.913
ASA Class 3 / $8,442.88 / -$26,082.92-42,968.68 / 0.631
ASA Class 4 / $18,504.17 / -$18,674.09-55,682.42 / 0.328
Any morbidity / $18,244.81 / $13,904.07-22,585.54 / <0.001
Length of Stay 6 days / $13,688.87 / $10,082.90-17,294.84 / <0.001
Multivariable*
Variable / Coefficient / 95% CI / p value
Age / $112.42 / -$31.88-256.72 / 0.126
Race
White / Reference
African-American / $1,364.25 / -$4,506.46-7,234.95 / 0.648
Hispanic / $15,947.46 / $2,778.00-29,116.91 / 0.018
Diabetes / $4,013.95 / -$398.33-8,426.22 / 0.074
Functional Status
Independent / Reference
Partially Dependent / $2,515.03 / -$9,005.56-14,035.62 / 0.668
Dependent / $80,068.31 / $50,648.26-109,488.40 / <0.001
Surgery type
Open / Reference
MIS / $650.46 / -$3,583.21-4,884.12 / 0.763
Any morbidity / $13,645.73 / $9,411.73-17,879.73 / <0.001
Length of Stay 6 days / $9,847.92 / $6,178.04-13,517.79 / <0.001
CI: confidence interval; ER: enhanced recovery; ASA: American Society of Anesthesiologists
p-value <0.05
*Adjusted R-squared = 0.319
aAll coefficients may be interpreted as US dollars.