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

Authors

  • Catarina Lopes 1. Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. 2. Faculty of Medicine. University of Coimbra. Coimbra. Portugal.
  • Mariana Vaz Gomes Anaesthesiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal. https://orcid.org/0000-0001-6894-775X
  • Manuel Rosete Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculty of Medicine. University of Coimbra. Coimbra.
  • Ana Almeida Anaesthesiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra.
  • Luisa Isabel Silva Anaesthesiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0002-4574-819X
  • José Guilherme Tralhão Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculty of Medicine. University of Coimbra. Coimbra. Coimbra Institute for Clinical and Biomedical Research. Area of Environment Genetics and Oncobiology. Faculty of Medicine. University of Coimbra. Coimbra.

DOI:

https://doi.org/10.20344/amp.18284

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.

 

 

 

Downloads

Download data is not yet available.

References

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152:292–8.

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr.2012;31:783–800.

Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, et al. Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31:801-16.

Kaye A, Urman R, Rappaport Y, Siddaiah H, Cornett E, Belani K, et al. Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings. J Anaesthesiol Clin Pharmacol. 2019;35:40.

Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60:289–334.

Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol. 2014;20:13950–5.

Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146:571–7.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.

Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015;34:367-76.

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784–91.

Ban K, Berian J, Ko C. Does implementation of Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery improve patient outcomes? Clin Colon Rectal Surg. 2019;32:109–13.

Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ, et al. Enhanced Recovery after Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59:1212–31.

Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Enhanced Recovery After Surgery (ERAS) protocols for colorectal cancer in Japan. BMC Surg. 2015;15:90.

Tavis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg. 2016;29:246-52.

Harnsberger C, Maykel J, Alavi K. Postoperative ileus. Clin Colon Rectal Surg. 2019;32:166–70.

Pak H, Maghsoudi LH, Soltanian A, Gholami F. Surgical complications in colorectal cancer patients. Ann Med Surg. 2020;55:13–8.

Ju YU, Min BW. A review of bowel preparation before colorectal surgery. Ann Coloproctology. 2021;37:75–84.

Toh JW, Harlaar J, Di Re A, Pathmanathan N, El Khoury T, Ctercteko G. Understanding the role of mechanical bowel preparation and oral antibiotics prior to elective colorectal surgery. Ann Laparosc Endosc Surg. 2019;4:47.

Liu H, Yang P, Han S, Zhang Y, Zhu H. The application of enhanced recovery after surgery and negative-pressure wound therapy in the perioperative period of elderly patients with colorectal cancer. BMC Surg. 2021;21:336.

Ceretti AP, Maroni N, Longhi M, Giovenzana M, Santambrogio R, Barabino M, et al. Risk factors for prolonged postoperative ileus in adult patients undergoing elective colorectal surgery: an observational cohort study. Rev Recent Clin Trials. 2018;13:295–304.

Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41.

Ripollés-Melchor J, Fuenmayor-Varela ML de, Criado Camargo S, Jerez Fernández P, Contreras del Barrio Á, Martínez-Hurtado E, et al. Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study. Braz J Anesthesiol Engl Ed. 2018;68:358–68.

Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9.

Schenning KJ, Deiner SG. Postoperative delirium in the geriatric patient. Anesthesiol Clin. 2015;33:505–16.

Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, et al. Standardization of care: Impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220:430–43.

Carrão A, Ribeiro D, Manso M, Oliveira J, Féria L, Ghira M, et al. ERAS® program in a Portuguese hospital: results from elective colorectal surgery after one year of implementation. Acta Med Port. 2020;33:568–75.

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–40.

Batool F, Collins SD, Albright J, Ferraro J, Wu J, Krapohl GL, et al. A regional and national database comparison of colorectal outcomes. JSLS. 2018;22:e2018.00031.

Zhuang C Le, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a metaanalysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78.

Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 Cases. Dis Colon Rectum. 2012;55:1300–10.

Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, et al. A randomised controlled trial of the efficacy of ultrasoundguided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013;27:2366–72.

Barletta JF, Asgeirsson T, Senagore AJ. La influencia de las dosis de opioides por via intravenosa sobre la oclusión intestinal postoperatoria. Ann Pharmacother. 2011;45:916–23.

Arrick L, Mayson K, Hong T, Warnock G. Enhanced recovery after surgery in colorectal surgery: Impact of protocol adherence on patient outcomes. J Clin Anesth. 2019;55:7–12.

Downloads

Published

2022-10-04

How to Cite

1.
Lopes C, Vaz Gomes M, Rosete M, Almeida A, Silva LI, Tralhão JG. The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital. Acta Med Port [Internet]. 2022 Oct. 4 [cited 2024 Dec. 23];36(4):254-63. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/18284

Issue

Vol. 36 No. 4 (2023): April

Section

Original

License

Copyright (c) 2022 Acta Médica Portuguesa

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.

It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.

Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.

After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.

Crossref
Scopus
Google Scholar
Europe PMC