Copyright
©The Author(s) 2019.
World J Gastrointest Surg. Feb 27, 2019; 11(2): 41-52
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.41
Published online Feb 27, 2019. doi: 10.4240/wjgs.v11.i2.41
ERAS elements | Lohsiriwat[8] | Wisely et al[10] | Shida et al[11] | Shang et al[12] |
Preoperative phase | ||||
Education and detailed counseling | Y | Y | Y | Y |
Medical optimization | Y | |||
No bowel preparation | Y | Y | Y | Y |
No pre-anesthetic medication | Y | Y | Y | Y |
Intraoperative phase | ||||
Use of epidural analgesia | Y | Y | ||
Active warming | Y | Y | Y | |
Avoid sodium/fluid overload | Y | Y | Y | Y |
Prophylaxis of nausea and vomiting | Y | Y | Y | |
No intraabdominal drainage | Y | Y | ||
Postoperative phase | ||||
Opioid-sparing multimodal analgesia | Y | Y | Y | Y |
Early removal of nasogastric tube | Y | Y | Y | Y |
Early feeding | Y | Y | Y | Y |
Early removal of urinary catheter | Y | Y | Y | Y |
Use of laxatives | Y | Y | Y | |
Early mobilization | Y | Y | Y | Y |
Lohsiriwat[8] | Wisely et al[10] | Shida et al[11] | Shang et al[12] | |
Characteristics | ||||
Country, year | Thailand, 2014 | Australia, 2016 | Japan, 2017 | China, 2018 |
Study design | Match case-control | Pre-Post ERAS | Pre-Post ERAS | Match case-control |
ERAS/non-ERAS | 20/40 | 80/97 | 42/80 | 318/318 |
Inclusion criteria | Obstructing colorectal cancer | Benign diseases and malignancy | Obstructing colorectal cancer | Obstructing colorectal cancer |
Exclusion criteria | No bowel resection, concomitant bowel perforation | Laparoscopic surgery | No bowel resection, concomitant bowel perforation | Recurrent tumor, no bowel resection, concomitant bowel perforation |
Clinical outcomes | ||||
GI recovery time | Sig. decreased | NA | NA | Sig. decreased |
Complication | Decreased | Sig. decreased | Decreased | Sig. decreased |
Hospital stay | Sig. decreased | Same | Sig. decreased | Sig. decreased |
30-d mortality | Same | Same | Same | Same |
30-d readmission | Same | Same | Same | Same |
30-d reoperation | NA | Same | Same | Same |
Interval between surgery and chemotherapy | sig. decreased | NA | NA | sig. decreased |
ERAS item | Recommendation |
Preoperative phase | |
Education and detailed counseling | Patients should routinely receive concise and practical preoperative education including stoma counseling |
Medical optimization | Preoperative risk stratification and “targeted” optimization of general conditions are recommended |
Glycemic control | Perioperative blood glucose should be maintained between 140 and 180 mg/dL |
Intraoperative phase | |
Use of epidural analgesia | Thoracic epidural analgesia may be used in patients with stable hemodynamic and no bleeding tendency |
GDFT | GDFT may be beneficial in patients with high-predicted postoperative mortality |
Prevention of hypothermia | All measures should be done to prevent or reverse intraoperative hypothermia |
PONV | A multimodal prophylaxis of PONV should be used in all patients based on their risk factors for PONV |
Minimally invasive surgery | Laparoscopy may be performed in selected patients by experienced surgeons |
Avoidance of intraperitoneal drains | Intraabdominal and pelvic drains should not be used routinely |
Postoperative phase | |
Multimodal analgesia | Opioid-sparing multimodal analgesia should be tailored to the individual and the operation involved |
Early removal of NGT | NGT can be removed safely on postoperative day 1-2 unless paralytic ileus is evident |
Early feeding | Oral intake can resume in stabilized patients and should progress moderately if patients can tolerate |
Early removal of urinary catheter | Urinary catheter can be removed safely on postoperative day 1-2 |
Breathing and coughing exercise | Patients are encouraged to have sessions of deep breathing and coughing exercise postoperatively |
Early mobilization | Patients are encouraged to have early independent mobilization as a part of physiotherapy and rehabilitation program |
- Citation: Lohsiriwat V, Jitmungngan R. Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices. World J Gastrointest Surg 2019; 11(2): 41-52
- URL: https://www.wjgnet.com/1948-9366/full/v11/i2/41.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v11.i2.41