Enhanced Recovery After Surgery (ERAS) Implementation of a Protocol in Laparoscopic Colectomy, Initial Experience in a Single Institution in Argentina

Abstract

Background: An ERAS protocol is a set of guidelines to improve perioperative care. Its application in conventional colorectal surgery should be considered the new standard; its advantages in laparoscopic surgery are discussed. Objectives: To evaluate the applicability of ERAS in laparoscopic colorectal surgery. Secondary objective: comparative analysis of early results. Setting: Hospital Britanico de Buenos Aires (British Hospital of Buenos Aires). Design: Retrospective. Population: 35 patients operated on by laparoscopy within the ERAS protocol (A), compared to a similar control group (B), outside the ERAS protocol. Period: March 2011 to August 2012. Method: the applicability of all steps of the protocol was evaluated. The variables compared were fluid management, tolerance of diet, intestinal transit, length of hospital stay, complications, mortality and readmission rate. Results: Group A: 8.57% referred not to have fully understood the protocol, 25.71% did not meet preoperative indications. 28.5% had no epidural catheter. 80% of patients received adequate hydration. 43% did not ingest the preparation of carbohydrates. 80% received early feeding; mobilisation was delayed in 28.5%. Intraoperative fluid infusion in group A was significantly lower than in controls. Group A tolerated liquids and solids earlier than controls. In group B, one more litre of parenteral hydration was used during hospitalisation. Passage of stool occurred earlier in group A than in controls. Overall morbidity was not significant. The length of stay was significantly lower in group A. Readmission was similar. There was no mortality. Conclusion: It is possible and safe to apply an ERAS protocol in laparoscopic colectomy with an acceptable compliance in our hospital, with a faster discharge and the same rate of readmissions.