Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices

Abstract

Enhanced recovery after surgery (ERAS), a multidisciplinary program designed to minimize stress response to surgery and promote the recovery of organ function, has become a standard of perioperative care for elective colorectal surgery. In an elective setting, ERAS program has consistently been shown to decrease postoperative complication, reduce length of hospital stay, shorten convalescence, and lower healthcare cost. Recently, there is emerging evidence that ERAS program can be safely and effectively applied to patients with emergency colorectal conditions such as acute colonic obstruction and intraabdominal infection. This review comprehensively covers the concept and application of ERAS program for emergency colorectal surgery. The outcomes of ERAS program for this emergency surgery are summarized as follows: (1) The ERAS program was associated with a lower rate of overall complication and shorter length of hospital stay – without increased risks of readmission, reoperation and death after emergency colorectal surgery; and (2) Compliance with an ERAS program in emergency setting appeared to be lower than that in an elective basis. Moreover, scientific evidence of each ERAS item used in emergency colorectal operation is shown. Perspectives of ERAS pathway in emergency colorectal surgery are addressed. Finally, evidence-based ERAS protocol for emergency colorectal surgery is presented.

Feasibility and effects of enhanced recovery vs. conventional care after emergency colon surgery for patients with left colon perforation

“…The ERAS group also www.nature.com/scientificreports www.nature.com/scientificreports/ exhibited a significantly shorter length of postoperative hospital stay. These results are in accordance with previous systematic revision series 15,17,18 .…”

“…Thus, compliance greater than 70% results in benefits for patients; in contrast, compliance lower than 50% does not result in any benefit for patients. In the series by Loshiriwat 18 with patients with intra-abdominal infection, compliance was 50%; in our series, global compliance was 62%, probably due to the patients being more homogeneous and selected. Regarding the different periods of the ERAS protocol, compliance greater than 70% was observed in preoperative items 5 and 6 and in postoperative items 5 and 7; only intraoperative items 2 and 7 showed compliance greater than 60%.…”

Acerto Project: Impact on Assistance of a Public Emergency Hospital

“…There was a decrease in the length of hospital stay of 8.5 vs. 6.1 days (p=0.008) without statistical increase in morbidity and mortality. This data is in agreement with the current literature when it says that there is a reduction in the length of hospital stay without increasing morbidity to surgical patients submitted to fast-trac protocols 4 , 8 , 14 .…”

Enhanced Recovery After Surgery in Emergency Resection for Obstructive Colorectal Cancer: A Systematic Review and Meta-analysis

“…Similarly, the impact of laparoscopy is not known because only one study in this meta-analysis included patients who underwent laparoscopic surgery in their 'modified' ERAS protocol (and only 4 patients were included) [11]. Although studies of elective colorectal surgery found a significant benefit of laparoscopy combined with ERAS with markedly improved surgical outcomes and patient recovery [28,29], the benefit of laparoscopy may not be translated into emergency setting as the conversion rate is still relatively high [27]. Tables Table 1 Main characteristics of the cohort studies included in the meta-analysis Lohsiriwat [10] Shida et al [11] Shang et al [ Abbreviation: ASA = American society of Anesthesiologists, BMI = body mass index, CRC = colorectal cancer, ERAS = enhanced recovery after surgery, LOHS = length of hospital stay, n/a = not available Forest plots of the comparisons of time to start adjuvant chemotherapy between ERAS and conventional care.…”