Outcomes of an enhanced recovery program after colorectal surgery: a single-center experience

Background
Successful care of postoperative patients is dependent on optimal nutritional supports, which enhance wound healing and immune response. Enhanced recovery program (ERP) after surgery employs a multimodal perioperative care pathway with the aim of improving the stress response to surgery and outcomes across a range of participation from the patients, surgeons, anesthesiologists, pain specialists, and nursing staff.
Objective
The aim was to evaluate the outcome of fast-track rehabilitation program versus delayed oral feeding, regular forms of mobilization, and pain control in patients who underwent colorectal surgery.
Design
This is a prospective study.
Patients and methods
The present study included 60 patients who were admitted to the Ain Shams University Hospitals between September 2014 and April 2016. We prospectively compared 30 patients: group A submitted for ERP with 30 patients and group B submitted for conventional rehabilitation program for patient outcomes as regards hospital stay, rehabilitation, hospital readmission, and complications.
Results
Postoperative vomiting in group A occurred in eight (26.7%) patients, while 17 (56.7%) patients in group B without statistical significance, similar was the case with abdominal distention. The overall compliance in group A was better than in group B. Regarding pain control, only nine patients were in need for additional analgesia, while in group B no one was pain free, so additional analgesia was needed in 11 patients. During the hospital stay, only pulmonary complications and hypokalemia were statistically significant between the two groups (=0.001 and 0.003, respectively). In group A, the mean total postoperative hospital stay was 4.2±1.56 days while in group B it was 8.4±1.6 days (=0.0001).
Conclusion
ERP is safe and tolerable after colorectal surgery with no increase in postoperative morbidity and mortality. ERAS protocols should be implemented as the standard approach for perioperative care in colorectal surgery.