Amino Acid-Based Enteral Nutrition Enhances Postoperative Recovery in Colorectal Cancer Patients: A Randomized Controlled Trial

Enhanced Recovery After Lung Resection Surgery: Knowing What We Can Do… and Doing It

Enhanced recovery after surgery (ERAS) protocol is a perioperative management theory aimed at reducing the injury of surgical patients and accelerating postoperative recovery. It has been widely recognized and applied in elective surgery. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis. We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to August 2021. Among the 126 patients, 70 were included in the ERAS group and 56 in the traditional group. We analyzed the clinical data and postoperative indicators of the 2 groups. No significant differences were observed regarding the general characteristics of the 2 groups (P > .05). The ERAS group had significantly earlier time to first flatus, time to first ambulation, and time to solid intake, compared with the traditional group (P < .001); additionally, the ERAS group had significantly shorter stay and gentler feeling of postoperative pain (P < .001). Furthermore, the ERAS group had significant incidences of lower postoperative lung (P = .029) and abdominal cavity infection (P = .025) compared to the traditional group. No significant difference was observed regarding the incidences of other postoperative complications between the 2 groups (P > .05). The ERAS protocol helps reduce elderly patients' stress reactions and accelerate postoperative recovery. Thus, it is effective and beneficial to implement the ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.

Enhanced recovery: joining the dots

Background ERAS (Enhanced Recovery After Surgery) protocol is a multimodal pathway of perioperative surgical care consisting of evidence-based procedures. ERAS protocol is hardly accepted by medical staff because it often opposes well established practice. Methods We analyzed length of hospital stay, postoperative complications, time until first stool passage and introduction of normal nutrition in patients undergoing elective colorectal resection surgery in University Hospital Center Split from October 2016. to October 2018. Patients were divided into 4 groups considering operation type (open/laparoscopic) and application of ERAS protocol (good/poor). Application of 60% or more ERAS steps was considered as well performed protocol. Results Groups Laparoscopy/ERAS and Open/ERAS had shorter postoperative hospital stay (Median, IQR; days) than groups Laparoscopy/non-ERAS and Open/non-ERAS (LE 5, 4-8 , OE 6, 5-9 vs LNE 7, 5-8,5 , ONE 7, 6-12). Similar difference was shown in times until first stool passage. Patients operated laparoscopically had shorter times until normal food tolerance (Median, IQR; days): LE 3, 2-3, LNE 3, 2-4 than patients who underwent open surgery (OE 3, 3-4, ONE 4, 3-5). In addition, laparoscopically operated patients had lower overall morbidity (P<0.001). Incidence of unplanned operations and hospital readmissions did not differ significantly among groups. Conclusions Well performed ERAS protocol can improve length of hospital stay and time until first stool passage in both open and laparoscopic types of operation. Optimal combination for colorectal resection is laparoscopic surgery with ERAS protocol. If open surgery is done, it should be preferably applied with ERAS protocol as well.

Impact of ERAS in breast reconstruction with a latissimus dorsi flap, compared to conventional management

Enhanced recovery after surgery (ERAS) can decrease complications and reduces hospital stay. Less certain is whether elderly patients can fully adhere to and benefit from ERAS. We aimed to determine the safety, feasibility and efficacy of enhanced recovery after colorectal surgery in patients aged ≥65years old. A systematic search of Medline, EMBASE and Cochrane was performed to identify (i) studies comparing elderly patients managed with ERAS vs traditional care, (ii) cohort studies of ERAS with results of elderly vs younger patients and (iii) any case series of ERAS in elderly patients. End-points of interest were length of hospital stay, complications, mortality, readmission and re-operation, and ERAS protocol adherence. Sixteen studies were included. Two randomized controlled trials demonstrated shorter hospital stay in elderly patients with ERAS compared with elderly patients with non-ERAS (9 vs 13.2days, P<0.001; 5.5 vs 7days, P<0.0001). Fewer complications occurred with ERAS in both randomized controlled trials (27.4% vs 58.6%, P<0.0001; 5% vs 21.1%, P=0.045). The majority of observational studies did not show differences in outcome between elderly and younger patients in terms of hospital stay, morbidity or mortality. Inconsistent findings between cohort studies may reflect the disparities in ERAS protocol definitions or differences in study populations. ERAS can be safely applied to elderly patients to reduce complications and shorten length of hospital stay. Further studies are required to assess whether elderly patients are able to adhere to, and benefit from, ERAS protocols to the same extent as younger patients.

Colorectal cancer (CRC) represented a significant global health burden, contributing to approximately 10% of all cancer-related mortality worldwide. While surgery remained the primary treatment for resectable CRC, the postoperative period was often characterized by prolonged recovery and complications. Enhanced Recovery After Surgery (ERAS) protocols emerged as a multimodal approach to mitigate these challenges by attenuating surgical stress, optimizing nutritional status, minimizing opioid consumption, promoting early mobilization, and improving psychological well-being. This study aimed to compare the postoperative outcomes between colorectal cancer patients who underwent surgery with ERAS protocols and those who followed traditional non-ERAS recovery pathways. A retrospective cohort study was conducted at a single academic institution. The study population comprised 201 adult patients who underwent surgical resection for colorectal cancer between January 2020 and December 2024. Patients were categorized into two groups: the ERAS group (n=135), who were managed according to a standardized ERAS protocol, and the non-ERAS group (n=66), who received traditional postoperative care. Statistical analysis involved independent samples t-tests for continuous variables and chi-square tests for categorical variables, with a significance level set at p &lt; 0.05. The ERAS group demonstrated a statistically significant reduction in the mean length of hospital stay compared to the non-ERAS group (7.67 days vs. 8.83 days, p &lt; 0.001). While the ERAS group exhibited slightly higher mean hemoglobin levels postoperatively (11.29 g/dL vs. 11.14 g/dL, p = 0.56), this difference was not statistically significant. Notably, the incidence of postoperative complications was lower in the ERAS group (1 case) compared to the non-ERAS group (4 cases), with a p-value of 0.051, indicating a trend towards significance. In conclusion, the implementation of an ERAS protocol was associated with improved postoperative outcomes in colorectal cancer patients, specifically a significant decrease in the length of hospital stay and a trend towards a lower rate of complications. These findings supported the integration of ERAS pathways into the standard of care for colorectal cancer surgery to enhance patient recovery, potentially reduce healthcare costs, and improve overall patient outcomes.

The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. Aprospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. Atotal of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. Asignificantly lower incidence of paralytic ileus (20.9% vs. 3%) and ashorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

Introduction: Postoperative recovery is a significant challenge in abdominal surgeries due to the complications associated with surgical trauma. The Enhanced Recovery After Surgery (ERAS) protocol was developed as a multimodal approach to optimize perioperative management, reduce complications, and accelerate hospital discharge. However, the variability of results between different types of surgery and patient populations suggests the need for a systematic review to consolidate the available evidence. Methodology: This systematic review followed the PRISMA guidelines for article selection, using the acronym PICO to formulate the research question: "Is the ERAS protocol effective in postoperative recovery of patients undergoing abdominal surgery compared to conventional care?". The search was carried out in databases such as PubMed, Cochrane and SciELO, including randomized controlled trials and cohort studies published in the last ten years. The methodological quality of the articles was analyzed based on established criteria, and the agreement between reviewers was evaluated by the Kappa index. Results: The studies analyzed demonstrated that the application of the ERAS protocol is associated with a significant reduction in the length of hospital stay, ranging from 2.5 to 3.5 days compared to the control group. In gastrointestinal surgeries, the complication rate was 15% in the ERAS group versus 30% in the control group. In procedures such as hepatectomy, the adoption of the protocol resulted in a decrease in postoperative complications and a reduced length of hospital stay (p &lt; 0.001). However, some surgeries, such as hysterectomies and pancreaticoduodenectomy, did not show significant differences between the groups. The rate of hospital readmission presented conflicting findings, being reduced in some studies, but without statistical difference in others. Discussion: The findings confirm that the ERAS protocol has a positive impact on reducing postoperative complications, length of hospital stay, and improving functional recovery. The observed benefits are attributed to strategies such as early mobilization, optimized analgesia management, and reduction in opioid use. However, the variability of results between different types of surgery suggests that the effectiveness of ERAS depends on the complexity of the procedure and the clinical status of the patient. In addition, the hospital readmission rate still does not present a clear consensus, which reinforces the need for studies with prolonged follow-up to assess the safety of the protocol. Conclusion: The systematic review demonstrates that the ERAS protocol is effective in postoperative recovery from abdominal surgeries, especially in gastrointestinal and hepatic procedures. However, its applicability should be adjusted according to the surgical complexity and the individual conditions of the patient. The heterogeneity of the studies analyzed highlights the importance of robust randomized controlled trials and long-term studies to refine the implementation of ERAS and consolidate its clinical advantages.

PurposeCystectomy for bladder cancer is associated with a high risk of postoperative complications. Standardized perioperative protocols, such as enhanced recovery after surgery (ERAS) protocols, aim to improve postoperative outcome. Postoperative feeding strategies are an important part of these protocols. In this two-centre study, we compared complications and length of hospital stay (LOS) between an ERAS protocol with early oral nutrition and a protocol with early enteral feeding with a Bengmark nasojejunal tube.MethodsWe retrospectively reviewed 154 consecutive patients who underwent cystectomy for bladder cancer in two hospitals (Hospital A and B) between 2014 and 2016. Hospital A uses an ERAS protocol (n = 45), which encourages early introduction of an oral diet. Hospital B uses a fast-track protocol comprising feeding with a Bengmark nasojejunal tube (Bengmark-protocol, n = 109). LOS and complications according to Clavien classification were compared between protocols.ResultsOverall 30-day complication rates in the ERAS and Bengmark protocol were similar (64.4 and 67.0%, respectively; p = 0.463). The rate of postoperative ileus (POI) was significantly lower in the Bengmark protocol (11.9% vs. 34.4% in the ERAS protocol, p = 0.009). This association remained significant after adjustment for other variables (odds ratio 0.32, 95% confidence interval 0.11–0.96; p = 0.042). Median LOS did not differ significantly between protocols (10 days vs. 11 days in the ERAS and Bengmark protocols, respectively; p = 0.861).ConclusionsEarly oral nutrition in Hospital A was well tolerated. However, the Bengmark protocol was superior with respect to occurrence of POI. A prospective study may clarify whether the lower rate of POI was due to the use of early nasojejunal tube feeding or other reasons.

Introduction/BackgroundThe audit-and-feedback (A&F) approach is a key component of the perioperative protocol ERAS (Enhanced Recovery After Surgery) that is often neglected in practice. Few studies evaluated the effectiveness of implementing...

Enhanced Recovery After Surgery (ERAS) protocols constitute evidence-based intervention pathways prepared to decrease surgical stress, maintain physiological function, and improve recovery. This study aimed to systematically review the ERAS effect after primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) on patients' clinical outcomes. This systematic review was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online search was done through MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Ovid. The search included the time from 2018 to 2024. The inclusion criteria included prospective nonrandomized cohort studies and RCTs that compared adult patients undergoing primary THA or TKA with ERAS or traditional (control) protocols. Studies that were conducted among patients with trauma and malignancies were excluded. The primary outcome was the length of hospital stay. The secondary outcomes included operation time, readmission rate, and intraoperative blood losses. Of the 642 records identified, six studies met the inclusion criteria. In total, 7206 individuals were analyzed, of whom 2148 underwent ERAS (intervention), and 5058 underwent traditional care either as a control or a pre-intervention group. Narrative synthesis was performed, and the ERAS interventions were divided into preoperative, intraoperative, and postoperative interventions. The systematic review showed that ERAS protocols significantly reduced hospital length of stay. There was no significant effect on readmission rates. However, intraoperative blood losses significantly decreased with the application of ERAS protocols. Regarding THA and TKA, ERAS protocols significantly decreased the length of hospitalization. The effect of readmission was comparable between the intervention and control groups. The impact of ERAS on operation duration was inconclusive. Further research is needed to assess and analyze the definitive impact of each component of the ERAS protocol on total joint arthroplasty.

Enhanced Recovery After Surgery (ERAS) protocols have changed perioperative care, aiming to optimize patient outcomes. This study assesses ERAS implementation effects on postoperative complications, length of hospital stay (LOS), and mortality in colorectal cancer (CRC) patients. A retrospective real-world analysis was conducted on CRC patients undergoing surgery within a Northern Italian Cancer Registry. Outcomes including complications, re-surgeries, 30-day readmission, mortality, and LOS were assessed in 2023, the year of ERAS protocol adoption, and compared with data from 2022. A total of 158 surgeries were performed, 77 cases in 2022 and 81 in 2023. In 2023, a lower incidence of postoperative complications was observed compared to that in 2022 (17.3% vs. 22.1%), despite treating a higher proportion of patients with unfavorable prognoses. However, rates of reoperations and readmissions within 30 days post-surgery increased in 2023. Mortality within 30 days remained consistent between the two groups. Patients diagnosed in 2023 experienced a statistically significant reduction in LOS compared to those in 2022 (mean: 5 vs. 8.1 days). ERAS protocols in CRC surgery yield reduced postoperative complications and shorter hospital stays, even in complex cases. Our study emphasizes ERAS' role in enhancing surgical outcomes and recovery.

The enhanced recovery after surgery (ERAS)© concept, sometimes referred to as “fast track”, “accelerated,” or “Rapid Recovery” surgery, was first introduced in 1997. The concept of ERAS targets factors that delay postoperative recovery such as surgical stress and organ dysfunction. ERAS protocols or programs are a care package of evidence-based interventions used in a multimodal and coordinated clinical care pathway. They represent a multidisciplinary approach directed to reducing postoperative complications, shortening length of hospital stay, improving patient satisfaction, and accelerating recovery. ERAS was initially centered on abdominal and colorectal surgery patients; however, ERAS protocols have been widely extended to include other specialties. Orthopedic surgery, particularly elective hip and knee arthroplasty is one of such areas where ERAS principles have been adopted. It has been associated with reduced length of hospital stay, readmission rate, and improved functional recovery. The common interventions used in orthopedic ERAS programs have been divided into those performed in the preoperative, intraoperative, and postoperative phases of care. A PubMed literature search was performed for articles that included the terms enhanced recovery and orthopedic surgery. In this article, we summarized the clinical application of ERAS and highlighted the key elements that characterize an enhanced recovery program.

BackgroundPostoperative gastrointestinal dysfunction (PGID) is a common complication arising from colorectal cancer surgery. Attributing factors, such as anesthesia, surgical retraction, and early intake of water, can inhibit gastrointestinal motility, causing constipation, reduction or absence of bowel sounds, nausea, vomiting, and other symptoms. Delayed recovery in gastrointestinal function can lead to intestinal obstructions or paralysis, anastomotic leaks, and other complications, affecting the patient’s recovery and quality of life negatively. Due to its complex pathophysiology, treatment for PGID in colorectal patients has remained a challenge. Acupuncture is an alternative therapy commonly used for postoperative recovery. This study aims to evaluate the therapeutic efficacy and safety of acupuncture on PGID. Through the complementation of acupuncture and enhanced recovery after surgery (ERAS) protocols, the advantages of acupuncture treatments could be demonstrated to promote its application in future clinical practice.MethodsThe study design is a prospective randomized controlled trial (RCT). One hundred sixty postoperative colorectal cancer patients will be recruited from Cancer Hospital Chinese Academy of Medical Sciences (CICAMS). Subjects who fulfill inclusion criteria will be randomly assigned into the acupuncture group (AG) (n = 80) or control group (CG) (n = 80). AG will receive acupuncture treatment and perioperative care guided by ERAS protocols, and CG will only receive perioperative care guided by ERAS protocols. The intervention will begin on the first day post-surgery, continuing for 4 days, with a follow-up assessment in a month. Time of first postoperative flatus would be the primary outcome measure. Secondary outcome measures include the time of first postoperative defecation, time of first fluid intake, time of first ambulation, postoperative hospital stay, gastrointestinal reaction score, acupuncture sensation evaluation scale, laboratory tests, postoperative quality of life, readmission rate, and postoperative complications. All results are evaluated from baseline, post-treatment, and upon follow-up.DiscussionThe results of the study would help elucidate evidence of the therapeutic effects of acupuncture on the recovery of postoperative gastrointestinal function. The objective of the study aims for the eventual inclusion of acupuncture in the ERAS protocol, allowing for wider application in clinical practice.Trial registrationClinicalTrials.gov ChiCTR2000036351. Registered on August 22, 2020