Care In Colorectal Surgery Research Articles

The EUropean PErioperative MEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study.

Despite consensus supporting enhanced recovery programs, their full implementation in such a context is difficult due to conventional practices within various groups of professionals. The goal of the EUropean PErioperative MEdical Networking (EUPEMEN) project was to bring together the expertise and experience of national clinical professionals who have previously helped deliver major change programs in their countries and to use them to spread enhanced recovery after surgery protocols (ERAS) in Europe. The specific aim of this study is to present and discuss the key points of the proposed recommendations for colorectal surgery. Five partners from university hospitals in four European countries developed the project as partners. Following a non-systematic review of the literature, the European consensus panel generated a list of recommendations for perioperative care in colorectal surgery. A list of recommendations was formulated and distributed to collaborators at each center to allow modifications or additional statements. These recommendations were then discussed in three consecutive meetings to share uniform ERAS protocols to be disseminated. The working group developed (1) the EUPEMEN online platform to offer, free of charge, evidence-based standardized perioperative care protocols, learning activities, and assistance to health professionals interested in enhancing the recovery of their patients; (2) the preparation of the EUPEMEN Multimodal Rehabilitation manuals; (3) the training of the trainers to teach future teachers; and (4) the dissemination of the results in five multiplier events, one for each partner, to promote and disseminate the protocols. The EUPEMEN project allowed the sharing of the expertise of many professionals from four different European countries with the objective of training the new generations in the dissemination of ERAS protocols in daily clinical practice through a new learning system. This project was proposed as an additional training tool for all the enhanced recovery program teams.

IColon, a patient-focused mobile application for perioperative care in colorectal surgery: Results from 444 patients.

The aim of this study is to assess if a patient-focused mobile application can increase compliance with active Enhanced Recovery After Surgery (ERAS) items and thereby improve surgery-related outcomes and patient satisfaction. This is a prospective observational study of patients admitted for elective colorectal surgery, under the ERAS protocol, and having access to the mobile application iColon during all perioperative phases. The 444 participants were included in the study. The overall adherence to the use of iColon was 62.4%. The overall adherence to active ERAS items was 74.1%. Adherence to the use of iColon significantly impacted adherence to active ERAS items. The use of the application was negatively related with factors such as age, type of disease, and postoperative complications. In the postdischarge phase, low adherence to active ERAS items typically indicates an increased likelihood of readmission; however, the use of iColon correlated significantly with a reduction in the 30-day readmission rate. A survey regarding patient satisfaction and confidence in using iColon resulted in positive feedback in more than 94% of cases, while 92.7% reported better quality of care. Our findings suggest that digital health tools are beneficial and effective in the follow up of patients after early discharge. Our mobile application, iColon, represents user-friendly technology that is well-accepted. It has real-world implications in increasing adherence to active ERAS items, which results in an improvement in perceived quality of care by its users.

A socioecological qualitative analysis of barriers to care in colorectal surgery

BackgroundAlthough specific social determinants of health have been associated with disparities in surgical outcomes, there exists a gap in knowledge regarding the mechanisms of these associations. Gaining perspectives from multiple socioecological levels can help elucidate these mechanisms. Our study aims to identify social determinants of health that act as barriers or facilitators to surgical care among colorectal surgery stakeholders. MethodsWe recruited participants representing 5 socioecological levels: patients (individual); caregivers/surgeons (interpersonal); and leaders in hospitals (organizational), communities (community), and government (policy). Patients participated in focus groups, and the remaining participants underwent individual interviews. Semistructured interview guides were used to explore barriers and facilitators to surgical care at each socioecological level. Transcripts were analyzed by 3 coders in an inductive thematic approach with content analyses. The intercoder agreement was 93%. ResultsSix patient focus groups (total n = 18) and 12 key stakeholder interviews were conducted. The mean age of patients was 54.7 years, 66% were Black, and 61% were female. The most common diseases were colorectal cancer (28%), inflammatory bowel disease (28%), and diverticulitis (22%). Key social determinants of health impacting surgical care emerged at each level: individual (clear communication, mental stress), interpersonal (provider communication and trust, COVID-related visitation restrictions), organizational (multiple forms of contact, quality educational materials, scheduling systems, discrimination), community (community and family support and transportation), and policy (charity care, patient advocacy organizations, insurance coverage). ConclusionKey social determinants of health-impacting care among colorectal surgery patients emerged at each socioecological level and may provide targets for interventions to reduce surgical disparities.

P486 Improving enhanced recovery after surgery (ERAS): the effect of a patient-centred mobile application on patient participation in colorectal surgery

Abstract 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.

Kritički osvrt na koncept ubrzanog oporavka nakon operacije u vaskularnoj hirurgiji - ERAS protokol u vaskularnoj hirurgiji

The concept of enhanced recovery after surgery (Enhanced Recovery After Surgery-ERAS) represents a multimodal approach to surgical treatment of patients, based on evidence, starting preoperatively and continuing postoperatively. The concept aims to improve patient recovery while reducing complications and reducing length of hospital stay. The ERAS concept has become the standard of care in colorectal surgery. It is also used in vascular surgery, especially aortic and carotid surgery. In 2022, the Society for Vascular Surgery and the ERAS Society published the latest recommendations for vascular surgery for patients undergoing open aortic surgery. The study included 590 abstracts. The recommendations refer to the period before the admission of the patient, as well as to the preoperative, intraoperative and postoperative period. Among the most important recommendations are the introduction of preoperative patient education, screening of anemia and nutritional status, optimization of risk factors, reduction of the use of nasogastric tubes and drainage, use of multimodal analgesia, targeted replacement of fluid, early removal of urinary catheters, active and early mobilization, and early enteral nutrition. There is more and more evidence about the importance of the ERAS protocol in elective vascular surgery, as well as its impact on reducing the length of hospital stay, reducing complications and better recovery of patients, lower treatment costs. Its application depends on the medical staff, so the education of healthcare workers is needed in this field.

Immediate versus early (24-hours) urinary catheter removal after elective minimally invasive colonic resection: study protocol for a randomized, multicenter, non-inferiority trial

BackgroundEnhanced Recovery After Surgery (ERAS) represents the standard of care in colorectal surgery. Among ERAS items, early removal of urinary catheter (UC) is considered a key issue, though adherence to this specific item still varies among centers. UC placement allows for monitoring of post-operative urinary output but relates to an increased risk of urinary tract infection (UTI), reduced mobility, and patient’s discomfort. Several studies investigated the role of early UC removal specifically looking at the rate of acute urinary retention (AUR) but most of them were retrospective, single-center, underpowered, cohort studies. The main purpose of this study is to compare the rate of AUR after immediate (at the end of the surgery) versus early (within 24 h from the completion of surgery) removal of UC in patients undergoing minimally invasive colonic resection (MICR). The secondary outcomes focus on goals that could be positively impacted by the immediate removal of the UC at the end of the surgery. In particular, the rate of UTIs, perception of pain, time-to-return of bowel and physical functions, postoperative complications, and length of hospital stay will be measured.MethodsThis is a prospective, randomized, controlled, two-arm, multi-center, study comparing the rate of AUR after immediate versus early removal of UC in patients undergoing MICR. The investigators hypothesize that immediate UC removal is non-inferior to 24-h UC removal in terms of AUR rate. Randomization is at the patient level and participants are randomized 1:1 to remove their UC either immediately or within 24 h from the completion of surgery. Those eligible for inclusion were patients undergoing any MICR with an anastomosis above the peritoneal reflection. Those patients who need to continue urinary output monitoring after the surgery will be excluded. The number of patients calculated to be enrolled in each group is 108 based on an expected AUR rate of 3% for the 24-h UC removal group and considering acceptable an AUR of 9% for the immediate UC removal group.DiscussionThe demonstration of a non-inferiority of immediate versus 24-h removal of UC would call into question the usefulness of urinary drainage in the setting of MICR.Trial registrationClinicalTrials.gov NCT05249192. Prospectively registered on February 21, 2022.

IColon, a patient-focused mobile application for perioperative care in colorectal surgery: results from the first 300 patients

Objectives: To ensure high compliance with active ERAS elements, patients must be educated to actively participate in the perioperative care pathway. iColon is a mobile application designed by the Operative Unit of General Surgery of IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella, which is specifically targeted at patients undergoing elective colorectal surgery. We hypothesized that by providing a patient-focused mobile application, the compliance with active ERAS elements could be improved.

New Challenges in Surgical Approaches for Colorectal Cancer during the COVID-19 Pandemic

(1) Background: The COVID-19 pandemic put a great burden on national healthcare systems, causing delays and disruptions in the medical care of non-COVID-19 patients. This paper aims to analyze the COVID-19 pandemic impact upon the quality of care in colorectal surgery. (2) Materials and Methods: We performed a retrospective study on the colorectal cancer cases operated in the Fourth Department of General Surgery, Emergency Hospital Bucharest Romania, over the period March 2020–February 2021 (pandemic group) vs. March 2019–February 2020 (non-pandemic group). (3) Results: The number of patients in the pandemic group decreased by 70% (36 vs. 118 patients), with lower accessibility from rural areas (11.1% vs. 37.2%, p = 0.035). Most cases in the pandemic group were emergencies (69% vs. 37.3%, p = 0.009), admitted for bowel obstruction (63.8% vs. 27.9%, p = 0.008). There was no in-hospital COVID-19 infection in patients operated for colorectal cancer. The 30-day mortality was significantly higher in the pandemic group (25% vs. 6.7%, p = 0.017), mostly due to septic shock (36.1% vs. 5%, p = 0.0001). (4) Conclusions: Colorectal cancer surgery may be performed safely during the COVID-19 pandemic, with strict adherence to the SARS-CoV-2 prevention protocols. However, the significant increase in colorectal cancers in the emergency was associated with worse outcomes and higher mortality during the COVID-19 pandemic.

Enhanced Recovery After Colo-Rectal Surgeries (ERAS) V.S Conventional Care A systematic review and meta-analysis

Abstract Background ERAS programs are not only used in abdominal surgeries, they are also used in cardiothoracic, gynecology, urology, orthopedic, and neurosurgery. Many authors and surgeons worldwide have been adapting this program, also trying to modify it due to its promising outcomes and it’s low damage toit’s continence. Objective To present an updated assessment of perioperative care in colorectal surgery from the available evidence and Enhanced Recovery After Surgery (ERAS) group recommendations. Patients and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. An electronic search was conducted from the inception till March 2019 in the following bibliographic databases: Medline via PubMed, SCOPUS, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar to identify relevant articles. We used different combinations of the following queries: ("Colorectal Surgery"[Mesh]) AND ("Enhanced recovery" OR "conventional care"). The search have been done with no limit regarding the year publication or language. Results In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till March 2019. The search retrieved 2861 unique records. We then retained 41 potentially eligible records for full-texts screening. Finally, 28 reports of 25 RCTs were included in the present systematic review and meta-analysis Conclusion ERAS was proven to be feasible, minimally invasive, cheap, relatively easy, which is safe and effective at the same time. This program can be ideal for patients undergoing elective colo-rectal surgery, yet more studies should be conducted in Egypt to compare results regarding different approaches of this program with longer follow up and randomization of patients.

An international assessment of the adoption of enhanced recovery after surgery (ERAS®) principles across colorectal units in 2019-2020.

The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units. An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017. Subgroup analyses based on hospital characteristics were conducted. Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017. Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.

Implementation of a Bundle of Care in Colorectal Surgery to Reduce Surgical Site Infections Successfully at Cantonal Hospital Lucerne: Study Protocol for a Prospective Observational Study

Implementation of a Bundle of Care in Colorectal Surgery to Reduce Surgical Site Infections Successfully at Cantonal Hospital Lucerne: Study Protocol for a Prospective Observational Study

Robotics for Acute Care in Colorectal Surgery.

Robotic surgery is growing exponentially in elective colorectal procedures, but utilization of robotics in urgent and emergency procedures remains low. Robotic surgery can be safely utilized for the management of several acute colorectal operations such as anastomotic leaks, perforated diverticulitis, and more. This chapter discusses safe access principles and planning, as well as technical aspects of these complex procedures, and the pathway to building a 24/7 robotic access culture.

The impact of variations in care and complications within a colorectal Enhanced Recovery After Surgery program on length of stay.

PurposeEnhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS).MethodsThis study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed.ResultsERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS.ConclusionSeven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.

Opioid-free Anesthesia: Time to Regain Our Balance.

Opioid-free Anesthesia: Time to Regain Our Balance.

Implementation of a Bundle of Care in Colorectal Surgery to Reduce Surgical Site Infections Successfully at Cantonal Hospital Lucerne: Study Protocol for a Prospective Observational Study.

Background:Surgical site infections (SSIs) remain a relevant problem in colorectal surgery. The aim of this study is to implement a bundle of care in order to reduce SSIs in colorectal surgery.Methods:All patients undergoing colorectal surgery between October 2018 and December 2021 will be included in a prospective observational study. Since our colorectal bundle has been established gradually, patients will be grouped in a pre-implementation (2018–2019), implementation (2019–2020) and post implementation phase (2021), in order to assess the effectiveness of the actions undertaken. Primary endpoint of this study will be surgical site infection (SSI) rate, while secondary endpoints encompass potential risk factors for SSIs. We assume that obesity, age, diabetes, alcoholism and smoking may lead to a higher risk for SSIs.Discussion:This study aims to determine whether the colorectal bundle designed and implemented at Cantonal Hospital Lucerne, will lead to a significant reduction of SSIs. The impact of potential risk factors for SSIs will additionally be evaluated.Trial registration:ClinicalTrials.gov, ID: NCT04677686. Registered retrospectively 18 December 2020.Highlights:A bundle of care might reduce the occurence of surgical site infections after colorectal surgery.Analysis of risk factors may detect patient’s with high probability of developing surgical site infections.

Improving enhanced recovery after surgery (ERAS): ERAS APPtimize study protocol, a randomized controlled trial investigating the effect of a patient-centred mobile application on patient participation in colorectal surgery

BackgroundPerioperative care in colorectal surgery is systematically defined in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improves perioperative care in a multimodal way to enhance early and safe release from the hospital. Adequate compliance to the elements of the ERAS protocol is multifactorial. There are still opportunities to improve compliance of the protocol by actively involving the patient. The main objective of this study is to investigate whether compliance of selected items in the ERAS protocol can be improved through actively involving patients in the ERAS care pathway through the use of a patient-centred mobile application.MethodsA multicentre randomized controlled trial will be conducted. Patients undergoing elective colorectal surgery, who are 18 years or older and in possession of an eligible smartphone, will be included. Patients assigned to the intervention group will install a patient-centred mobile application to be guided through the ERAS care pathway. Patients in the control group will receive care as usual. Both groups will wear an activity tracker. The primary outcome is overall compliance to selected active elements of the ERAS protocol, as registered by the patient. Secondary outcomes include Patient Reported Outcome Measures (PROMs) such as health-related quality of life, physical activity, and patient satisfaction of received care. Care-related outcomes, such as length of hospital stay, number of complications, re-intervention, and readmission rates, will also be assessed.ResultsThe enrolment of patients will start in the second quarter of 2019. Data collection had not begun by the time this protocol was submitted.ConclusionWe hypothesize that by providing patients with a patient-centred mobile application, compliance to the active elements of ERAS protocol can be improved, resulting in an increased health-related quality of life, physical activity, and patient satisfaction.Trial registrationNetherlands Trial Register, NTR7314, prospectively registered on the 9th of November 2017 (http://www.trialregister.nl).

Feasibility of a tailored ERAS programme in octogenarian patients undergoing minimally invasive surgery for colorectal cancer.

The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients. The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme. Data on 162 consecutive patients aged ≥ 80years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008-2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes. The postoperative minor morbidity rate (Clavien-Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien-Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25kg/m2. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge. The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients. Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.

Outcomes of an enhanced recovery program after colorectal surgery: a single-center experience

Background Successful care of postoperative patients is dependent on optimal nutritional supports, which enhance wound healing and immune response. Enhanced recovery program (ERP) after surgery employs a multimodal perioperative care pathway with the aim of improving the stress response to surgery and outcomes across a range of participation from the patients, surgeons, anesthesiologists, pain specialists, and nursing staff. Objective The aim was to evaluate the outcome of fast-track rehabilitation program versus delayed oral feeding, regular forms of mobilization, and pain control in patients who underwent colorectal surgery. Design This is a prospective study. Patients and methods The present study included 60 patients who were admitted to the Ain Shams University Hospitals between September 2014 and April 2016. We prospectively compared 30 patients: group A submitted for ERP with 30 patients and group B submitted for conventional rehabilitation program for patient outcomes as regards hospital stay, rehabilitation, hospital readmission, and complications. Results Postoperative vomiting in group A occurred in eight (26.7%) patients, while 17 (56.7%) patients in group B without statistical significance, similar was the case with abdominal distention. The overall compliance in group A was better than in group B. Regarding pain control, only nine patients were in need for additional analgesia, while in group B no one was pain free, so additional analgesia was needed in 11 patients. During the hospital stay, only pulmonary complications and hypokalemia were statistically significant between the two groups (P=0.001 and 0.003, respectively). In group A, the mean total postoperative hospital stay was 4.2±1.56 days while in group B it was 8.4±1.6 days (P=0.0001). Conclusion ERP is safe and tolerable after colorectal surgery with no increase in postoperative morbidity and mortality. ERAS protocols should be implemented as the standard approach for perioperative care in colorectal surgery.

Shifting the paradigm of peri-oprative care in colorectal surgery in a Sri Lankan tertiary care unit

Enhanced recovery after colorectal surgery (ERAS) protocol is a multimodal perioperative care pathway aiming to reduce stress response to surgery. It helps to return to normal physiology at earliest with minimum complications compared to traditional care pathway in colorectal surgery. In order to have intended benefits of ERAS, accurate staging of the patients with colorectal cancer is invaluable. Pretreatment pelvic MRI scan is the gold standard in rectal cancer staging due to its proven benefits. While preoperative MRI scan in rectal cancer patients with internationally recognized reporting protocol has been encouraged, ERAS with some modifications (mERAS) has been introduced at the university surgical unit of the Colombo south teaching hospital to overcome the resource limitations at local setting. Modified ERAS protocol was well tolerated by our cohort of patients and the favourable outcomes of ERAS protocol in our centre are comparable with published data. Therefore mERAS would be a safe alternative to the traditional practice of colorectal surgery in Sri Lanka. This article describes the methods of mERAS implementation and the strategies adhered in shifting the paradigm of perioperative care in colorectal surgery at our centre.

Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study

BackgroundEnhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. MethodsSingle center observational study. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, 3 years before (Pre-ERAS) and 2 years after (Post-ERAS) the implementation of an ERAS protocol. Baseline characteristics of both groups were compared. The primary outcome was the number of patients with 180 days follow-up with moderate or severe complications; secondary outcomes were postoperative length of stay, and specific complications. Data were extracted from patient records. ResultsThere were 360 patients in the Pre-ERAS group and 319 patients in the Post-ERAS Group. 214 (59.8%) patients developed at least one complication in the pre ERAS group, versus 163 patients in the Post-ERAS group (51.10%). More patients in the Pre-ERAS group developed moderate or severe complications (31.9% vs. 22.26%, p=0.009); and severe complications (15.5% vs. 5.3%; p<0.0001). The median length of stay was 13 (17) days in Pre-ERAS Group and 11 (10) days in the Post-ERAS Group (p=0.034). No differences were found on mortality rates (4.7% vs. 2.5%; p=0.154), or readmission (6.39% vs. 4.39%; p=0.31). Overall ERAS protocol compliance in the Post-ERAS cohort was 88%. ConclusionsThe implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay.