BackgroundEnhanced recovery after surgery (ERAS) (fast-track) programs are comprehensive multimodal perioperative pathways, which aim to reduce surgical stress, maintain postoperative physiological function, and enhance mobilisation after surgery.
Overview of evidence (non-systematic literature review)
No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.
- preoperative education and counselling
- preoperative optimisation
- perioperative nutritional supplements
- antimicrobial and prophylaxis
- venous thromboembolism prophylaxis
- multimodal antiemetics and analgesia
- avoidance of bowel preparation, nasogastric tubes and drains.
A meta-analysis of six randomised controlled trials (RCTs) on ERAS compared with standard care in patients undergoing open colorectal surgery has demonstrated that length of stay is reduced and postoperative morbidity almost halved. The benefits of ERAS programs are still demonstrated in laparoscopic surgery as in open surgery, with a recent systematic review and meta-analysis of three RCTs and six nonrandomised and observational studies and six clinical trials showing reduced morbidity and particularly reduced length of stay with the addition of ERAS to minimally invasive surgery.Successful ERAS programs appear to have multiple components, but need to be multidisciplinary, have ongoing education, regular audit, and be adequately resourced.
|Practice pointA recommendation on a subject that is outside the scope of the search strategy for the systematic review, based on expert opinion and formulated by a consensus process.|
Patients having elective surgery for colorectal cancer should be managed within an appropriately resourced enhanced recovery after surgery (ERAS) program.
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- Spanjersberg WR, van Sambeeck JD, Bremers A, Rosman C, van Laarhoven CJ. Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 2015 Dec;29(12):3443-53 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25801106.
- Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 2015 Jan;261(1):92-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24646564.