Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes?

Abstract

Enhanced Recovery after Surgery (ERAS) protocols are multimodal perioperative care pathways designed to accelerate recovery by minimizing the physiologic stress of a surgical procedure. Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions. Though there is evidence associating individual ERAS protocol elements (e.g., preoperative carbohydrate loading, judicious perioperative fluid administration, and early initiation of postoperative nutrition) with improved outcomes, ensuring high compliance with all elements of an ERAS protocol will maximize benefits to the patient. After ERAS implementation, data collection on protocol process measures can help providers target education and interventions to improve protocol compliance and patient outcomes.

Keywords

Enhanced Recovery after Surgery - fast-track surgery - outcomes

• References

• 1 Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis 2012; 27 (12) 1549-1554
• 2 Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011; 149 (06) 830-840
• 3 Tan SJ, Zhou F, Yui WK. , et al. Fast track programmes vs. traditional care in laparoscopic colorectal surgery: a meta-analysis of randomized controlled trials. Hepatogastroenterology 2014; 61 (129) 79-84
• 4 Thiele RH, Rea KM, Turrentine FE. , et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 2015; 220 (04) 430-443
• 5 Miller TE, Thacker JK, White WD. , et al; Enhanced Recovery Study Group. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 2014; 118 (05) 1052-1061
• 6 Teeuwen PH, Bleichrodt RP, Strik C. , et al. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery. J Gastrointest Surg 2010; 14 (01) 88-95
• 7 Nygren J, Hausel J, Kehlet H. , et al. A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr 2005; 24 (03) 455-461
• 8 Maessen J, Dejong CH, Hausel J. , et al. A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 2007; 94 (02) 224-231
• 9 Archibald LH, Ott MJ, Gale CM, Zhang J, Peters MS, Stroud GK. Enhanced recovery after colon surgery in a community hospital system. Dis Colon Rectum 2011; 54 (07) 840-845
• 10 Rona K, Choi J, Sigle G, Kidd S, Ault G, Senagore AJ. Enhanced recovery protocol: implementation at a county institution with limited resources. Am Surg 2012; 78 (10) 1041-1044
• 11 Keller DS, Bankwitz B, Woconish D. , et al. Predicting who will fail early discharge after laparoscopic colorectal surgery with an established enhanced recovery pathway. Surg Endosc 2014; 28 (01) 74-79
• 12 Feroci F, Lenzi E, Baraghini M. , et al. Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 2013; 23 (03) 259-265
• 13 Feldheiser A, Aziz O, Baldini G. , et al. Enhanced Recovery after Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 2016; 60 (03) 289-334
• 14 Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014; (08) CD009161
• 15 Rollins KE, Lobo DN. Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials. Ann Surg 2016; 263 (03) 465-476
• 16 Larson DW, Lovely JK, Cima RR. , et al. Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. Br J Surg 2014; 101 (08) 1023-1030
• 17 Aarts MA, Okrainec A, Glicksman A, Pearsall E, Victor JC, McLeod RS. Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay. Surg Endosc 2012; 26 (02) 442-450
• 18 Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 2009; 13 (03) 569-575
• 19 Zhuang CL, Ye XZ, Zhang CJ, Dong QT, Chen BC, Yu Z. Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomized clinical trials. Dig Surg 2013; 30 (03) 225-232
• 20 Agrafiotis AC, Corbeau M, Buggenhout A, Katsanos G, Ickx B, Van de Stadt J. Enhanced recovery after elective colorectal resection outside a strict fast-track protocol. A single centre experience. Int J Colorectal Dis 2014; 29 (01) 99-104
• 21 Berian JR, Ban KA, Mohanty S. , et al. “Adherence with Enhanced Recovery Components Contributes to Improved Outcomes.” Scientific Forum #05: Quality, Safety and Outcomes I, 10/17/2016. ACS Clinical Congress Annual Conference, October 16–20, 2016 Washington, DC. Published Abstract: JACS 223(4)S105–S106