Enhanced Recovery After Surgery (ERAS) protocols have been hyped as “simple solutions” for accelerating recovery after colonic resection, although the quantity and quality of evidence supporting their ability to improve periopertive care and decrease postoperative complications is limited, Dr. Mary-Anne Aarts said in a presentation at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in San Antonio last week.
One ERAS metric that shows consistent improvement across the available studies, however, is hospital length of stay, said Dr. Aarts who, along with her colleagues in the department of surgery at the University of Toronto, have identified (via a retrospective study of 366 consecutive colorectal resection patients at seven University of Toronto hospitals) the five “most important” ERAS strategies that contribute to the success in this domain.
- Preoperative counseling regarding early discharge.
- Omission of an oral bowel movement preparation.
- Use of a laparoscopic approach.
- Initiation of clear fluids on day of surgery.
- Early discontinuation of the Foley catheter.
While the identification of these strategies does not address the quality of care and complication issues that have to be evaluated in large, prospective, collaborative studies before ERAS protocols will be widely accepted, it offers specific targets for investigation, which in turn could streamline research efforts, according to Dr. Aarts.