Enhanced recovery for colorectal surgery: Practical hints, results and future challenges

Table 2 Clinical characteristics of studies examined

Ref.	Type of study	Patients (n)	Sex (males%)	Age (yr)	Type of surgery	Approach	Length of stay (d)	Morbidity	Mortality	Readmission	Comments
King et al[14]	Prospective case series	60	31 (52)	72 ± 11		ERAS	5.8	11 (18%)	2 (3%)	7 (12%)	ERAS ↓ hospital stay
		86	45 (52)	70 ± 11		Conventional	10.7 (P < 0.001)	24 (28%)	6 (7%)	8 (9%)
Maessen et al[20]	Observational study	425	-	-	Resections above peritoneal reflection	ERAS	5 d	-	-	-	Delay in discharge was due to the development of major complications
Maessen et al[21]	Case series	121	67 (55)	66 ± 12	Resections above peritoneal reflection without stoma	ERAS	Discharge delay = 1 d	-	-	-	↓ in hospital stay may relate to changes in organization of care and not to a shorter recovery period
		52	22 (42)	64 ± 12	Resections above peritoneal reflection without stoma	Conventional	Discharge delay = 2 d
Jottard et al[7]	Prospective ERAS group matched with historical data	36	-	-		ERAS	6 (3-27)	-	-	-	ERAS was implemented in a district general hospital
		92	-	-		Conventional	9 (3-64)	-	-	-
Hendry et al[23]	Prospective case series	1035	498 (48.10)	59 (69-78)		ERAS	6 (4-8)	294 (28.40%)	17 (1.60%)	86 (8.60%)	Higher ASA, advanced age, sex (male) and rectal surgery associated with delayed mobilization, morbidity and prolonged stay
Mohn et al[18]	Prospective ERAS group matched with historical data	94	40 (43)	66		ERAS		29 (31%)	1 (1%)	14 (15%)	ERAS ↓ hospital stay
		153	68 (44.40)	71 (15-90)		Conventional	11 (5-108)	27 (18%)	1 (1%)	-
Nygren et al[22]	Prospective ERAS group matched with historical data	99	-	-		ERAS	-	18%1	-	15%1	ERAS ↓ time to resumption of oral diet, mobilization and passage of stool, improved lung function, ↓ morbidity and hospital stay but ↑ readmissions
		69	27	65 ± 2		Conventional	8.6 ± 0.6/7 for colonic resection	17 (37%) for colonic	0	2 (4%) for colonic
							12.7 ± 1.2/11 for rectal resection	12 (52%) for rectal resection		1 (4%) for rectal
Ahmed et al[24]	Retrospective case series	231	101 (44)	68 (56-76)	Elective open bowel resection	ERAS	6 (5-9)		-	-	Lower ASA grade, use of epidurals and avoidance of regular oral opiates are associated with an earlier discharge
Kahokehr[9]	Prospective case series	100	-	68 (31-92)		ERAS	4 (3-46)	-	-	-	Lower ASA score, transverse incision laparotomy and laparoscopy associated with earlier discharge
Teeuwen et al[17]	Prospective ERAS group matched with historical data	61	22 (36.1)	57 ± 17.6	elective open colonic or rectal resection	ERAS	6 (3- 50)	9 (14.8%)	0%	2 (3.3%)	ERAS ↓ morbidity and hospital stay
		122	-	-		Conventional	9 (3-138)	33.60%	1.60%	1.60%
Bryans et al[34]	Retrospective case series	20	-	-	Colorectal surgery with stoma (excluding abdominoperineal resection)	ERAS	mean = 7	-	-	-	ERAS ↓ hospital stay and ability to manage stoma
		20				Conventional	mean = 20
Kahokehr et al[8]	Prospective case series	74	-	-	Open right hemicolectomy	ERAS	Median (43-28)	-	-	-	No difference in morbidity or surgical recovery
		39			Laparoscopic right hemicolectomy	Conventional	5 (2-18)

¹Significant difference. ERAS: Enhanced recovery; ASA: American society of anesthesiologists score; QOL: Quality of life.