A systematic review of the intervention components, adherence and outcomes of enhanced recovery programmes in older patients undergoing elective colorectal surgery

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.

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Defining standards in colorectal optimisation: a Delphi study protocol to achieve international consensus on key standards for colorectal surgery prehabilitation

BMJ Open ◽

10.1136/bmjopen-2020-047235 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047235

Author(s):

Iona Pearson ◽

Sue Blackwell ◽

Rebecca Fish ◽

Sarah Daniels ◽

Malcolm West ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Outcome Measures ◽

Delphi Study ◽

Public Involvement ◽

Healthcare Professionals ◽

Patient And Public Involvement ◽

International Consensus ◽

Elective Colorectal Surgery ◽

Patient Related Outcome

IntroductionPrehabilitation in colorectal surgery is evolving and may minimise postoperative morbidity and mortality. With many different healthcare professionals contributing to the prehabilitation literature, there is significant variation in reported primary endpoints that restricts comparison. In addition, there has been limited work on patient-related outcome measures suggesting that patients with colorectal cancer needs and issues are being overlooked. The Defining Standards in Colorectal Optimisation Study aims to achieve international consensus from all stakeholders on key standards to provide a framework for reporting future prehabilitation research.Methods and analysisA systematic review will identify key standards reported in trials of prehabilitation in colorectal surgery. Standards that are important to patients will be identified by a patient and public involvement (PPI) event. The longlist of standards generated from the systematic review and PPI event will be used to develop a three-round online Delphi process. This will engage all stakeholders (healthcare professionals and patients) both nationally and internationally. The results of the Delphi will be followed by a face-to-face interactive consensus meeting that will define the final standards for prehabilitation for elective colorectal surgery.Ethics and disseminationThe University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee has approved this protocol, which is registered as a study (200190120) with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of the standards developed by all stakeholders will increase the potential for comparative research that advances understanding of the clinical application of prehabilitation.PROSPERO registration numberCRD42019120381.

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Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature

Journal of Visceral Surgery ◽

10.1016/j.jviscsurg.2016.09.016 ◽

2017 ◽

Vol 154 (1) ◽

pp. 29-35 ◽

Cited By ~ 18

Author(s):

M.-V. Launay-Savary ◽

M. Mathonnet ◽

A. Theissen ◽

S. Ostermann ◽

A. Raynaud-Simon ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

The Elderly ◽

Review Of The Literature ◽

Recovery Programs ◽

Enhanced Recovery Programs

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Successful Implementation of Enhanced Recovery in Elective Colorectal Surgery is Variable and Dependent on the Local Environment

Annals of Surgery ◽

10.1097/sla.0000000000005069 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Chelsea P. Fischer ◽

Leandra Knapp ◽

Mark E. Cohen ◽

Clifford Y. Ko ◽

Elizabeth C. Wick

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Local Environment ◽

Successful Implementation ◽

Elective Colorectal Surgery

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A systematic review of enhanced recovery protocols in colorectal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x605219 ◽

2011 ◽

Vol 93 (8) ◽

pp. 583-588 ◽

Cited By ~ 84

Author(s):

A Rawlinson ◽

P Kang ◽

J Evans ◽

A Khanna

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Perioperative Care ◽

Enhanced Recovery ◽

Hospital Readmissions ◽

Cochrane Library ◽

Controlled Trials ◽

Hand Search ◽

Recovery Protocols ◽

Randomised Controlled

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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Does intra-operative cardiac output monitoring improve outcomes for patients undergoing elective colorectal surgery within an enhanced recovery programme?

Mini-invasive Surgery ◽

10.20517/2574-1225.2017.42 ◽

2018 ◽

Vol 2 (4) ◽

pp. 10

Author(s):

Muhammad Imran Aslam ◽

Harriet Smith ◽

Chelise Currow ◽

Nadia Akhtar ◽

Julia Merchant ◽

...

Keyword(s):

Cardiac Output ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Cardiac Output Monitoring ◽

Elective Colorectal Surgery ◽

Enhanced Recovery Programme ◽

Output Monitoring

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129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.008 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Brennan

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Intravenous Fluid ◽

Junior Doctors ◽

Intravenous Fluids ◽

Elective Colorectal Surgery ◽

Royal Hospital ◽

Elective Surgical Procedures ◽

Eras Protocol

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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