The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital

Abstract

Introduction: The benefits of the multimodal Enhanced Recovery After Surgery® (ERAS) program have been described all over the world. The adoption of several perioperative strategies translates into an improvement in the quality of the healthcare provided. The aim of this study was to report the results of the implementation of the ERAS® program for colorectal surgery in a tertiary hospital.Material and Methods: In this single-center observational study, 534 patients who underwent colorectal surgery between December 2018 and May 2021 were included. Two groups were considered: before and after the implementation of the ERAS® program. The primary outcome measure was 30-day morbidity. The length of hospital stay, readmission rate, reintervention and mortality among the two groups were also evaluated.Results: The pre-ERAS group included 102 patients and the ERAS group included 432 patients. There was a statistically significant reduction in morbidity at 30 days (37.3% vs 26.5%, p < 0.05), length of stay (7 days vs 5 days, p < 0.001) and readmission rate (12.9% vs 6%, p < 0.05) after the implementation of the ERAS program.Conclusion: The ERAS® protocol for colorectal surgery was successfully and safely implemented in our hospital, contributing to an improvement in perioperative care provided to patients.

Challenges and Elements Hindering the Adoption of Enhanced Recovery After Surgery (ERAS) Protocols in Colorectal Surgery and Their Resolutions: A Systematic Review

“…It consists of a series of evidence-based guidelines covering the whole perioperative period [2]. This protocol has been established to reduce mortality in hospital length of stay (LOS) and improve recovery after colorectal patients [3][4][5][6]. The first ERAS protocol was drafted in the early 2000s for colon surgery initially and rectal surgery, after which other surgical specialties adopted this.…”

“…This paper will review the various setbacks to implementing the protocol and possible core aspects of the ERAS protocol. Complete adherence to the ERAS protocol is nearly impossible due to variations in setting, healthcare provider, and patient factors; however, without full adherence, partial implementation continues to provide benefits [6,14,15]. By analyzing the existing evidence, this research paper seeks to identify methods to improve adherence to the ERAS protocols and seek ways to optimize patient outcomes.…”

Procalcitonin and C-reactive protein as early predictors in patients at high risk of colorectal anastomotic leakage

“…5 The current implementation of enhanced recovery after surgery (ERAS) and multimodal rehabilitation protocols has successfully facilitated early discharge for patients who undergo colorectal surgery. [6][7] As a result, there is a growing interest in identifying a dependable diagnostic method to predict AL in its early stages, prior to the onset of sepsis symptoms. Early identification of AL would enable safe and early discharge without increasing the risk of a late AL diagnosis, which can be associated with severe consequences.…”