Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Abstract

Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

“…The ERAS Society recently published three guidelines on perioperative care focused on colonic,5 rectal/pelvic6 and pancreatic and gastric resection 7. Previous versions of such guidelines have been shown to impact on daily practice 4, 8…”

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

“…DUMC, Duke University Medical Center; ACS NSQIP, American College of Surgeons National Surgery Quality Improvement Program; ERP, enhanced recovery pathway; SSIB, preventive surgical site infection bundle. 7,8,13 Major components of the ERP are shown in Figure 2. Briefly, in the preoperative period, measures are taken to ensure preoperative medical and nutritional optimization.…”

“…[3][4][5] In colorectal surgery (CRS), engaged surgeons have focused on implementing systems of care designed to reliably provide evidence-supported practices as a mechanism to improve postoperative outcomes. 6 Two prominent systems of care are the enhanced recovery pathway (ERP) 7,8 and the preventive surgical site infection bundle (SSIB). The ERP is a comprehensive perioperative CRS care pathway that has been shown to reduce postoperative morbidity and length of hospitalization.…”

Experimental study of diclofenac and its biliary metabolites on anastomotic healing

“…Non‐steroidal anti‐inflammatory drugs (NSAIDs) have been related to increased leak rates in both animal and retrospective human studies2, 3, 4. This is worrisome because NSAIDs are recommended as postoperative analgesics in current guidelines5. Clinical evidence is not considered sufficient to ban postoperative use of NSAIDs, as some studies do not report adverse effects5 6.…”

“…This is worrisome because NSAIDs are recommended as postoperative analgesics in current guidelines5. Clinical evidence is not considered sufficient to ban postoperative use of NSAIDs, as some studies do not report adverse effects5 6. Further research is required to delineate the role of NSAIDs in clinical anastomotic leakage4 7.…”