Outcomes of ERAS in Colorectal Surgery

黄建宏

Outcomesof ERAS in Colorectal Surgery

Enhanced Recovery After Surgery (ERAS) forelective colorectal surgery  wasinitially developed by Kehlet (1). Many studies including randomized orclinical controlled tri als (CCTs) had been published. A systemic review had demonstratedthe benefits of ERAS in colorectal surgical patients (2). The review hadincluded randomized or clinical controlled tri als (CCTs)  with a prospective intervention group that com paredan ERAS perioperative programme with traditional care in adult patientsundergoing open or laparoscopic elec tive colorectal surgery. The authors hadreviewed 59 relevant studies, including six RCTs and seven CCTs.

Results:

Length of hospital stay

Eleven studies reported onprimary hospital stay, ten of which reportedstatistically significant reductions in duration of inpatient stays in the ERASgroups compared with more traditional care. A meta-analysis of the datademonstrated that patients who underwent major open colorectal surgery managedwith ERAS protocols had a reduction in primary hospital stay of 2.53 days lessthan those managed with traditional care pathways (2).

Postoperative complications

Two RCT and one CCT revealeda statistically significant difference in morbidity rates that favoured theERAS protocol. All other reviewed studies showed a favorable trend in reducedmorbidity rates in the ERAS groups that lacked statistical significance (2).

Readmission

Readmission rates ranged from0% to 24% for the ERAS protocol groups and for the traditional care groups itranged from 0% to 20% (2).

Mortality

Eight studies reported onmortality rates. Within ERAS protocol groups, mortality ranged from 0% to 5%,while mortality rates in the traditional care group ranged from 0% to 9%. Nostatistical difference was identified be tween the two groups (2).

Conclusions:

ERAS protocols significantly reducepatient morbidity with reductions in length of hospital stays. ERAS protocolsshould now be implemented as the standard approach to perioperative care incolorectal surgery.

References:

1. KehletH, Wilmore DW. Multimodal strategies to improve surgical outcome. AmJ Surg 2002; 183: 630–641.

2. RawlinsonA, Kang P, Evans J, Khanna A:  Asystematic review of enhanced recovery protocols in colorectal surgery.  Ann R Coll Surg Engl 2011;93: 583–588

黄建宏

I will publish the series introduction of Enhanced Recovery After Surgery (ERAS). This post is the third in the series.