Clin Colon Rectal Surg 2019; 32(02): 102-108
DOI: 10.1055/s-0038-1676474
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Implementation of an ERAS Pathway in Colorectal Surgery

Paul Cavallaro
1   Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Liliana Bordeianou
1   Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2019 (online)

Abstract

Enhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.

 
  • References

  • 1 Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 2014; 38 (06) 1531-1541
  • 2 Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010; 29 (04) 434-440
  • 3 Younis J, Salerno G, Fanto D, Hadjipavlou M, Chellar D, Trickett JP. Focused preoperative patient stoma education, prior to ileostomy formation after anterior resection, contributes to a reduction in delayed discharge within the enhanced recovery programme. Int J Colorectal Dis 2012; 27 (01) 43-47
  • 4 Phatak UR, Li LT, Karanjawala B, Chang GJ, Kao LS. Systematic review of educational interventions for ostomates. Dis Colon Rectum 2014; 57 (04) 529-537
  • 5 Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006; 8 (07) 563-569
  • 6 Hausel J, Nygren J, Lagerkranser M. , et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93 (05) 1344-1350
  • 7 Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998; 17 (02) 65-71
  • 8 Levy BF, Scott MJ, Fawcett WJ, Day A, Rockall TA. Optimizing patient outcomes in laparoscopic surgery. Colorectal Dis 2011; 13 (Suppl. 07) 8-11
  • 9 Hübner M, Blanc C, Roulin D, Winiker M, Gander S, Demartines N. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg 2015; 261 (04) 648-653
  • 10 Keller DS, Ermlich BO, Delaney CP. Demonstrating the benefits of transversus abdominis plane blocks on patient outcomes in laparoscopic colorectal surgery: review of 200 consecutive cases. J Am Coll Surg 2014; 219 (06) 1143-1148
  • 11 Niraj G, Kelkar A, Hart E. , et al. Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial. Anaesthesia 2014; 69 (04) 348-355
  • 12 Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359 (9320): 1812-1818
  • 13 Brandstrup B, Tønnesen H, Beier-Holgersen R. , et al; Danish Study Group on Perioperative Fluid Therapy. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 2003; 238 (05) 641-648
  • 14 Srinivasa S, Taylor MH, Sammour T, Kahokehr AA, Hill AG. Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials. Acta Anaesthesiol Scand 2011; 55 (01) 4-13
  • 15 Lei WZ, Zhao GP, Cheng Z, Li K, Zhou ZG. Gastrointestinal decompression after excision and anastomosis of lower digestive tract. World J Gastroenterol 2004; 10 (13) 1998-2001
  • 16 Feo CV, Romanini B, Sortini D. , et al. Early oral feeding after colorectal resection: a randomized controlled study. ANZ J Surg 2004; 74 (05) 298-301
  • 17 Petrelli NJ, Stulc JP, Rodriguez-Bigas M, Blumenson L. Nasogastric decompression following elective colorectal surgery: a prospective randomized study. Am Surg 1993; 59 (10) 632-635
  • 18 Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O. ; French Associations for Surgical Research. Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. Arch Surg 1998; 133 (03) 309-314
  • 19 Merad F, Hay JM, Fingerhut A. , et al; French Association for Surgical Research. Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. Surgery 1999; 125 (05) 529-535
  • 20 Denost Q, Rouanet P, Faucheron JL. , et al; French Research Group of Rectal Cancer Surgery (GRECCAR). To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: the GRECCAR 5 randomized trial. Ann Surg 2017; 265 (03) 474-480
  • 21 Taqi A, Hong X, Mistraletti G, Stein B, Charlebois P, Carli F. Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program. Surg Endosc 2007; 21 (02) 247-252
  • 22 Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics (Sao Paulo) 2011; 66 (12) 2001-2005