Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

INTRODUCTION Colorectal surgery has been associated with a complication rate of 15–20% and mean postoperative inpatient stays of 6–11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

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An Expanded Preoperative Component within an Enhanced Recovery Protocol Improves Outcomes in Colorectal Surgery

The American Surgeon ◽

10.1177/000313481708300849 ◽

2017 ◽

Vol 83 (8) ◽

pp. 928-934

Author(s):

Nathan M. Johnson ◽

Sandy L. Fogel

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Enhanced Recovery ◽

Statistical Significance ◽

Current Evidence ◽

P Value ◽

Postoperative Length ◽

Enhanced Recovery Protocol ◽

Recovery Protocols ◽

Colorectal Procedures

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

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Laparoscopic Colorectal Surgery: Summary of the Current Evidence

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x464757 ◽

2009 ◽

Vol 91 (7) ◽

pp. 541-544 ◽

Cited By ~ 38

Author(s):

Emad H Aly

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Laparoscopic Colorectal Surgery ◽

Cost Effective ◽

Current Evidence ◽

Rectal Cancer Surgery ◽

Port Site Recurrence ◽

Medline Search ◽

Recovery Protocols ◽

Randomised Controlled

INTRODUCTION Laparoscopic colectomy has not been accepted as quickly as laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomised controlled trials (RCTs) and initial reports on port-site recurrence after curative resection. The aim of this review is to summarise current evidence on laparoscopic colorectal surgery. PATIENTS AND METHODS Review of literature following Medline search using key words ‘laparoscopic’, ‘colorectal’ and ‘surgery’. CONCLUSIONS Laparoscopic colorectal surgery proved to be safe, cost-effective and with improved short-term outcomes. However, further studies are needed to assess the role of laparoscopic rectal cancer surgery and the value of enhanced recovery protocols in patients undergoing laparoscopic colorectal resections.

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Sex Comparisons in Opioid Use and Pain After Colorectal Surgery Using Enhanced Recovery Protocols

Journal of Surgical Research ◽

10.1016/j.jss.2020.03.040 ◽

2020 ◽

Vol 253 ◽

pp. 105-114

Author(s):

Katherine A. Hrebinko ◽

Sara P. Myers ◽

Wai Lok Tsang ◽

Luke Doney ◽

Sofiane Lazar ◽

...

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Opioid Use ◽

Recovery Protocols

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Patient Satisfaction and Quality of Life with Enhanced Recovery Protocols

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676480 ◽

2019 ◽

Vol 32 (02) ◽

pp. 138-144 ◽

Cited By ~ 7

Author(s):

Debbie Li ◽

Christine Jensen

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Postoperative Pain ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Future Research ◽

Widespread Implementation ◽

Recovery Protocols ◽

Eras Protocol

AbstractWhile studies have demonstrated the benefits of Enhanced Recovery after Surgery (ERAS) programs in reducing length of stay and costs without increasing complications, fewer studies have evaluated patient satisfaction and quality of life (QOL) with enhanced recovery protocols. The aim of this project was to summarize the literature comparing satisfaction and quality of life after colorectal surgery following treatment within an ERAS protocol to standard postoperative care. The available evidence suggests patients suffer no detriment to satisfaction or quality of life with use of ERAS protocols, and may suffer less fatigue and return to activities sooner. Most publications reported no adverse effects on postoperative pain. However, a limited number of studies suggest patients may experience increased early postoperative pain with ERAS pathways, particularly following open colorectal procedures. Future research should focus on potential improvements in ERAS protocols to better manage postoperative pain. Overall, the evidence supports more widespread implementation of ERAS pathways in colorectal surgery.

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