A systematic review of enhanced recovery protocols in colorectal surgery

Abstract

INTRODUCTION Colorectal surgery has been associated with a complication rate of 15-20% and mean postoperative inpatient stays of 6-11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase ™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a Positive Impact on Non‐ERAS Liver Surgery Patients

“…Regarding the former, it was already established that the implementation of ERAS in colorectal surgery had a positive impact on patients with reduced complications and LoS [1][2][3][4][5] . In addition, ERAS in colorectal surgery was also proven to be cost-effective 13 .…”

Fast-Track Programs for Liver Surgery: A Meta-Analysis

“…[11][12][13][14][15][16][17][18][19][20][21] These previous studies certified that FT programs could decrease postoperative complications, postoperative length of stay (LoS), hospitalization costs, and improve patient satisfaction. [4][5][6][11][12][13][14][15][16][17][18][19][20][21] A good deal of publications has inspected the feasibility of FT programs for hepatic surgery, but the potency of these studies has not been discussed profoundly. As a consequence, we performed this meta-analysis for the sake of assessing the effects of implementation of FT programs on surgical outcomes compared with the traditional treatment plans following liver surgery.…”

Patients’ Perception of Information and Health-Related Quality of Life 1 Month After Discharge for Colorectal Cancer Surgery

“…An enhanced recovery programme (ERP) is now used more frequently to improve patients' postoperative outcomes and has reduced complications and the length of hospital stays [3]. But, shorter lengths of stay in hospital can also have consequences for patients' physical and cognitive status as well as affect their ability to assimilate information before discharge [2].…”