Implementation of ERAS protocol in elective colorectal surgery results in reduction in length of stay; discharge within 48 hours is feasible and safe

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

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Implementation of an ERAS Pathway in Colorectal Surgery

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676474 ◽

2019 ◽

Vol 32 (02) ◽

pp. 102-108 ◽

Cited By ~ 9

Author(s):

Liliana Bordeianou ◽

Paul Cavallaro

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Postoperative Care ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Standardized Protocol ◽

Improve Hospital ◽

Eras Protocol

AbstractEnhanced 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.

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Instituting an ERAS protocol for colorectal surgery in a large teaching community hospital decreases length of stay and cost while improving functional status on discharge

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2017.04.058 ◽

2017 ◽

Vol 19 ◽

pp. 91

Author(s):

Luciana Mullman ◽

Ope Popoola ◽

Mark Gilder ◽

Richard Pitera ◽

Varun Chakravorty

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Functional Status ◽

Community Hospital ◽

Teaching Community ◽

Eras Protocol

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Another Brick in the Wall of an Ongoing Discussion– Reduction of Anastomotic Leaks after Colorectal Resection by Preoperative Mechanical Bowel Preparation in Combination with Oral and Parenteral Antibiotics?–A Clinical Retrospective Single Center Study

Austin Journal of Clinical Case Reports ◽

10.26420/austinjclincaserep.2021.1211 ◽

2021 ◽

Vol 8 (5) ◽

Author(s):

Safia O ◽

◽

Kuebler S ◽

Mall JW ◽

Tallbot SR ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Bowel Preparation ◽

Elective Surgery ◽

Mechanical Bowel Preparation ◽

Oral Antibiotic ◽

Single Center ◽

Elective Colorectal Surgery ◽

Single Center Study ◽

Center Study

Background: In colorectal surgery, postoperative Anastomotic Leak (AL) is a serious complication. Besides the surgeon`s experience, bowel preparation may have an impact on AL, but the published data are still inconclusive. The purpose of this retrospective single center study was to investigate the role of preoperative Mechanical Bowel Preparation (MBP) in combination with Oral Antibiotic Bowel Preparation (OBP) and parenteral antibiotics in a certified highvolume colorectal center. Methods: In the period of January 2017 to December 2019, all colon and rectal surgeries were recorded and separated into emergency and elective surgeries. Patients in the elective surgery group were further divided into two groups: patients with Bowel Preparation (BP) and patients without BP and were evaluated concerning to AL, postoperative hospital length of stay and mortality. Results: Between 2017 to 2019, 625 patients underwent colorectal surgery. 262 patients had emergency operations and were therefore excluded from the study. 363 patients underwent colorectal elective surgery (197men, 166 women). 44.0% received Combined Bowel Preparation (CBP), 46.8% received no BP, 3.3% received OBP only, 4.1% received MBP only, and for 1.1% nothing was documented. CBP was not only associated with a reduction in the rate of AL (P=0.038) (14.1% vs. 4.4%), but also with reduction in mortality (P=0.032) (7.6% vs. 1.2%) and length of stay (P=0.016) (14 vs. 11 days). Conclusion: Our retrospective data showed a significant impact of preoperative intestinal preparation with MBP in combination with OBP and parenteral antibiotics on AL, length of stay and mortality. Therefore we strongly recommend the use of this regimen of preoperative BP in elective colorectal surgery.

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