Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration

Abstract

Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration C olorectal surgery may be associated with undesirable outcomes, including long length of stay in hospital, high rates of surgical site infection, perioperative nausea and vomiting, high readmission rates, and increased costs. Enhanced Recovery After Surgery (ERAS) has emerged worldwide as the new standard of care for patients undergoing elective colorectal surgery. The goal of ERAS is to reduce the patient's surgical stress response, optimize their physiologic function, and facilitate recovery by incorporating evidence-based interventions into patient management. A metaanalysis published in 2014 including 16 randomized controlled trials comparing the ERAS pathway to conventional perioperative care showed that the ERAS pathway reduced overall morbidity rates and shortened length of stay by 2.28 days, without increasing readmission rates. 1 A significant reduction in nonsurgical complications was noted, while the effect on surgical complications was less pronounced. An economic evaluation of the ERAS multisite implementation program for colorectal surgery in Alberta estimated the net health system savings to be $1768 per patient. 2 In terms of return on investment, for every $1 invested in ERAS, $3.80 could be expected in return. 2 Yet, despite the compelling evidence in support of ERAS, it has not been adopted widely. Results from a Canadian qualitative study suggest that although clinicians see the value in implementing an ERAS program, lack of nursing staff, lack of financial resources, resistance to change, and poor communication and collaboration are perceived as barriers to its adoption. 3 Enhanced Recovery Canada (ERC) is a project-based committee of the Canadian Patient Safety Institute (CPSI) that was formed as part of CPSI's commitment to influence improved surgical safety across the country. In 2017, ERC set out to develop a clinical pathway for elective colorectal surgery based on the key clinical elements of ERAS identified through implementation research, 4 including patient and family engagement, nutrition management, fluid and hydration management, mobility and physical activity, surgical

From clinical guidelines to practice: The nutrition elements for enhancing recovery after colorectal surgery

“…2,3 The individual elements vary with each of the disease-specific protocols; however, there are generally six core components: (1) patient and family engagement; (2) perioperative best practices; (3) nutrition management; (4) perioperative fluid and hydration man-© 2021 American Society for Parenteral and Enteral Nutrition agement; (5) multimodal opioid-sparing analgesia; and, (6) mobilization. 4 Collectively, these elements decrease the stress response to surgery, maintain energy reserves, and support normal physiological function to promote early recovery. 1,5 ERAS implementation is complex and requires a collaborative team approach.…”

“…The ERAS protocols are based on multimodal, evidence‐based processes that are bundled into >20 care elements 2,3 . The individual elements vary with each of the disease‐specific protocols; however, there are generally six core components: (1) patient and family engagement; (2) perioperative best practices; (3) nutrition management; (4) perioperative fluid and hydration management; (5) multimodal opioid‐sparing analgesia; and, (6) mobilization 4 . Collectively, these elements decrease the stress response to surgery, maintain energy reserves, and support normal physiological function to promote early recovery 1,5 …”

Application of multidisciplinary collaborative nursing with family care for enhanced recovery after surgery in children with inguinal hernia

“…Family care emphasizes humanistic care in nursing to eliminate children’s negative emotions. Multidisciplinary collaborative nursing for ERAS has been widely used in clinical practice, with significant results[ 7 , 8 ]. Family care is also widely recommended for pediatric diseases[ 9 , 10 ].…”