Aim The Enhanced Recovery After Surgery (ERAS) programme is a multimodal approach to improve peri--operative care in colon surgery. The aim of this study was to report on the adherence to and outcomes of ERAS in the first years after implementation. Multivariate analysis showed that age, laparoscopic surgery, removal of nasogastric tube before extubation, mobilization within 24 h after surgery, starting nonsteroidal anti-inflammatory drugs at day 1 and removal of thoracic epidural analgesia at day 2 were independent predictors of LOS. MethodConclusion Strict adherence to the ERAS protocol was associated with reduced LOS and improved outcome in elective colon surgery for malignancy. These benefits were lost when protocol adherence was lower. Embedding the ERAS protocol into an organization and repetitive education are vital to sustain its beneficial effects on LOS and outcome.

Visceral obesity leads to a longer hospital stay, higher morbidity and longer operative time after elective colon surgery. These findings show that the preoperative CT scan for detecting disseminated disease can be used to assess visceral obesity and helps in risk profiling patients undergoing elective colon surgery.

It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).

Sir,Groenen et al. are mistaken to suggest that urinary tract infection should only be diagnosed when symptoms as dysuria, frequency, urgency and suprapubic pain are coexistent with significant bacteriuria. Such complaints are non-specific immediately after prolapse surgery, especially during or after bladder catheterisation.1 Therefore, we decided to measure only the objective outcome of significant bacteriuria.It is also wrong to state that we provide no data of bacteriuria in patients after recatheterisation. We would like to refer to the Materials and methods as well as Table 2, where these are noted.We agree that it would be interesting to find an optimum duration of catheterisation with respect to infection and recatheterisation. We demonstrated in our study that 60% of patients do not need any prolonged catheterisation at all, so that seems to be the optimum for them. In future studies we are focussing on the remaining 40% of patients to identify them immediately after surgery. We will then evaluate if our current protocol of three days prolongation is adequate for such high risk patients. We hope to present these results soon. References1. Tambyah PA, Maki DG. Catheter-associated urinary tract infection is rarely symptomatic. A prospective study of 1497 catheterized patients.