Evaluation of a Mobile Application Based on Enhanced Recovery After Surgery Recommendations to Support Patients Undergoing Colorectal Surgery: A Pilot Study

Background Perioperative care in colorectal surgery is systematically established in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improved perioperative colorectal care in a multidisciplinary and multimodal manner, simulating early and safe hospital discharge. In general, compliance with the ERAS protocol is adequate; however, there is still room for improvement in compliance by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could be improved by actively involving patients in the ERAS colorectal care pathway using a patient-centred mobile application. Methods This multicentre, randomised controlled trial was conducted in accordance with the CONSORT statement. Patients aged 18 years or older who underwent elective colorectal surgery and had a smartphone were included. Patients in the intervention group used a mobile application combined with an activity tracker to be guided and simulated through the ERAS pathway. Patients in the control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with the selected active elements of the ERAS protocol. Secondary outcomes included length of hospital stay, number of complications, reintervention, and readmission rates, and patient-reported outcome measures (PROMs) such as quality of life, and patient satisfaction with received care. Results Between October 2019 and September 2022, 170 participants were enrolled and randomised to either the intervention (n=84) or control (n=86) groups. Thirty participants (17.6%) were lost to follow-up and 140 participants were included in the primary outcome analysis. Compliance with the selected active ERAS elements was 76.8% and 63.7% in the intervention and control groups, respectively (p<0.001). Complications or patient reported outcomes did not differ between the groups. Conclusion A patient-centred mobile application improved compliance with the active elements of the ERAS protocol. The implementation of this mobile application is recommended for patients undergoing elective colorectal surgery.

The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application. This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol. In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups. The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410).

Enhanced recovery: joining the dots

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Objective To analyze the feasibility and safety of enhanced recovery after surgery (ERAS) in colorectal surgery in municipal hospitals. Methods The clinical data of patients with colorectal cancer in Zhangzhou Affiliated Hospital of Fujian Medical University from June 2016 to December 2018 were retrospectively analyzed. A total of 50 patients who underwent laparoscopic surgery combined with ERAS in the perioperative period were selected as the ERAS group, and 50 patients who underwent laparoscopic surgery combined with conventional methods in the perioperative period were treated as the control group. The general data were compared in the two groups, including age, gender, body mass index and the tumor site. The postoperative recovery was compared including fart time, defecation time, total fluid food intake time, nutritional indexes, postoperative leaving hospital time. And the postoperative complications were also compared, including wound infection, lung infection, anastomotic fistula, abdominal infection as well as the urinary infection. Results The first fart time and total fluid food intake time in the ERAS group were earlier than those in the control group [(1.5±0.5) d vs. (2.1±0.8) d, (2.2± 0.8) d vs. (3.4±1.6) d], and the differences were statistically significant (t = 4.907, t = 4.604, both P < 0.01). The albumin and hemoglobin in the ERAS group were higher than those in the control group [(32.7±3.1) g/L vs. (30.9±2.1) g/L, t = -3.188, P = 0.002; (115±3) g/L vs. (103± 16) g/L, t = -3.916, P < 0.01], and the postoperative hospital stay in the ERAS group was shorter than that in the control group, and the difference was statistically significant [(7.2±1.2) d vs. (9.5±3.6) d; t = 4.095, P = 0.001]. And the incidence of postoperative complications in the ERAS group was lower than that in the control group, and the differences were statistically significant [14% (7/50) vs. 38% (19/50), χ2 = 7.484, P = 0.008]. Conclusions ERAS combined with laparoscopic colorectal cancer surgery can accelerate the postoperative rehabilitation, shorten the length of hospital stay, and reduce postoperative complications. It has high feasibility and safety in the application of colorectal surgery in municipal hospitals, but the individualized treatment must be taken into consideration. Key words: Colorectal neoplasms; Enhanced recovery after surgery; Laparoscopic surgery

IntroductionIn Africa, where access to timely and safe surgical care remains limited, postoperative complications and prolonged hospital stays continue to challenge health systems. The Enhanced Recovery After Surgery (ERAS) protocol has been shown to improve perioperative outcomes by reducing hospital length of stay (LOS) and complications, but compliance remains inconsistent.ObjectiveTo determine whether improving ERAS compliance in Ethiopia, through a “Triple Intervention Strategy” of early postoperative feeding, ambulation, and urinary catheter removal, could reduce hospital LOS for patients undergoing laparotomy and cesarean section (CS).MethodsThis study was designed as a cluster-randomized clinical trial conducted across 10 hospitals within the National Perioperative Quality Improvement Network (NaPQIN) in Ethiopia. Hospitals were randomly assigned to either the intervention group (n=5), which received structured ERAS training reinforced through continuous monitoring and supervision, or the control group (n=5), which continued standard perioperative care without additional reinforcement. The primary outcome was hospital LOS, and secondary outcomes included compliance with the ERAS components, determinants of LOS, and postoperative complications. Data were managed through the NaPQIN platform and analyzed using R statistical software.ResultsA total of 8,256 patients were enrolled, with 5,887 (71.3%) in the intervention group and 2,369 (28.7%) in the control group. Full compliance with the ERAS bundle improved to 76.5% in the intervention group compared to 57.9% in controls (p < 0.001). Patients in the intervention group had a significantly shorter LOS (mean 80.75 vs. 89.24 hours; p < 0.001). The intervention group also had significantly fewer postoperative complications (2.1% vs 4.8%; p < 0.001), and more patients were discharged without any complications.Conclusions and RelevanceThis pragmatic trial, enabled by a national perioperative data system, demonstrated that the targeted implementation of postoperative ERAS elements, early oral feeding, mobilization, and timely urinary catheter removal significantly improved compliance and reduced hospital stay without requiring additional resources. While full ERAS pathways remain the ideal, focused, context-adapted strategies can offer scalable benefits in LMIC settings burdened by surgical backlogs and limited perioperative capacity. Broader adoption should prioritize tailored integration, ongoing evaluation, and provider engagement to maximize system-wide impact.Trial Registration:pactr.samrc.ac.za identifierPACTR202502863551536

Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway

Enhanced recovery after surgery (ERAS®) in gynecologic oncology - Practical considerations for program development.

Enhanced recovery after surgery (ERAS) protocols have been widely validated in colorectal surgery; however, few data exist on loop ileostomy closure. The aim of this study was to compare clinical outcomes before and after introduction of ERAS for loop ileostomy closure. Data on outcomes after loop ileostomy closure were retrospectively collected before ERAS was applied at our department (control group). These results were compared to results of patients undergoing loop ileostomy closure within the original colorectal ERAS pathway (ERAS 1 group); after analysis of these results, adaptations were made to the ERAS pathway regarding the postoperative diet, and this second category of patients was analyzed (ERAS 2 group). Forty-eight patients in the control group were compared to 46 ERAS 1 and 69 ERAS 2 patients. First stool was significantly faster in ERAS 2 group versus control and ERAS 1 group [median 1 (range 1-2) days vs 2 (2-3) days p value 0.01]. The incidence of vomiting increased from 26% in the control group to 45% in ERAS 1 group, and then decreased to 29% in the ERAS 2 group (p value 0.41). Length of stay was significantly shorter during the ERAS 2 protocol: median 4 (range 3-6) days versus 5 (4-8) days in the control group (p value < 0.01). After application of the 'colorectal' ERAS pathway to loop ileostomy closure, results were initially not improved. Minor corrections were sufficient to avoid increased incidence of vomiting and to allow for reduced hospital stay. Uncritical extrapolation of an ERAS colorectal protocol to other types of surgery should be monitored and needs audit for corrections.

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.

Early Mobilization in the Intensive Care Unit: To Rest or to Test?

Health-related Quality of Life after Laparoscopic Hysterectomy following Enhanced Recovery after Surgery Protocol or a Conventional Recovery Protocol

Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations — Part I

Objective To explore whether it is beneficial to improve the short-term prognosis of patients undergoing colorectal surgery when enhanced recovery after surgery (ERAS) program was adopted before, during, and after the operation. Methods A total of 411 patients with colorectal cancer who underwent surgeryat our department from May 1st, 2015 to April 30th, 2018 were collected. An ERAS program and its implementation strategies were developed. The concept of compliance was defined. The baseline demographic data and adherence data of ERAS sub-scenarios were prospectively collected. A binary logistic regression analysis was used to assess the relationship between optimal recovery and compliance with ERAS entries. The independent effects of preoperative, intraoperative, and postoperative care compliance on optimal recovery were assessed in a separate model. Results The patients undergoing laparoscopic surgery had high adherence to the ERAS regimen, with a statistical difference from the patients undergoing open surgery (P<0.01) . The adherence rate of the implementation plan after the operation was only 40.6%. In the case of patient basic characteristics and disease distribution correction, optimal recovery correlated with overall compliance with the use of laparoscopic methods, anesthesia scores, and ERAS protocols. The compliance of the ERAS protocol after the operation was the key to the success of the entire ERAS protocol, with a 7-folded correlation with optimal recovery [OR = 7.039 (4.481 to 11.060) , P<0.001]. Conclusion The ERAS program after oepration is the most important part of the ERAS concept implementation. The ERAS concept can promote patient recovery both during and after laparoscopic surgery, but the ERAS concept combined with laparoscopic surgery can benefit patients more. Key words: Colorectal cancer; Enhanced recovery after surgery; Hospitalization time; Compliance