Colorectal Enhanced Recovery after Surgery: Do Patients Have Better Outcomes?

Purpose: Enhanced Recovery after Surgery (ERAS) was initiated in the 1990’s by Dr. Henrik Kehlet, a Copenhagen surgeon³. He created a multimodal analgesia program including preoperative patient education, a team approach directed at better pain control, reduced length of stay, decreased post-operative complications and a more satisfied patient¹.  A 642 bed academic level one trauma hospital located in the South-Central US developed a Colorectal ERAS Program in October 2016 with aims to modify the patient’s physiological and psychological responses to surgery. The goals of which included reductions in complications, hospital length of stay and readmissions. This ERAS program helps patients have earlier returns of both bowel function and normal activities.

Objective: An ERAS program prepares patients by emphasizing expectations that improve their surgical outcomes making them better equipped for discharge. During our ERAS pre-surgical class, the patients learn what is expected through a multi-disciplinary team approach: nutrition from a Dietitian, activity pre and post-surgery by a Physical Therapist, respiratory exercises by the Nurse Clinician, pain control plan with “functional” pain expectations by the Pain Nurse, and ostomy/stoma care by the Wound Ostomy Continence Nurse². The Nurse Clinician is the team member who coordinates the patient’s care through the continuum. The phases of the program include all care from surgical scheduling through post discharge recovery with a constant patient centric approach⁴.

Outcomes: Our Colorectal ERAS program has been in effect for one year with greater than 300 patients participating. Length of stay has been reduced by one full day. The surgical site infection rate has seen a significant reduction from 1.19 to 0.78, a greater than 34% reduction. Pre ERAS our readmission rate was 17%, the current rate is below 11%, a greater than 35% reduction.