Department of Surgery, Pineta Grande Hospital, ItalyFulltext PDF
Background: The Enhanced Recovery after Surgery (ERAS) program was first introduced by Kehlet in 1999 to minimize stress response to surgery and accelerate the length of postoperative functional recovery. ERAS is a multidisciplinary program designed to improve organ function recovery adopting perioperative standardized care. In particular it consists of pre-, intra- and post-operative interventions which have the aim of reducing postoperative complications and obtaining a patient’s faster recovery. Use of this protocol is spread in different surgical specialties (urology, gynecology, gastro-intestinal) but the better evidence of ERAS outcomes is described in colorectal surgery. Methods: In this study we describe the experience of Department of General and Oncological Surgery, “A.Tortora” in Pagani (Salerno), where ERAS protocols were introduced in July 2018. From this date to March 2020, it was applied to 120 patients undergoing elective laparoscopic colorectal surgery for neoplastic or diverticular diseases. Modified ERAS protocols (using bowel preparation) were adopted in all patients, who were informed about and accept it. Shorter mouths come such as hospital stay and on set of complications have been analyzed. Results: The median hospital stay was of 4 (3 to 23) days in the whole series with a morbidity rate of 9.1% (11/120); three patients experienced major complications (Clavien-Dindo ≥ IIIa); and only one anastomotic leak was observed. One 30-day readmission and no perioperative mortality were recorded. At the univariate analysis, the presence of complications was the only predictive factor for prolonged hospital stay (p\0.001). Conclusion: This study analyses impact of fast-track protocols’ introduction in laparoscopic colorectal surgery at Pagani’ Surgical Unit. Patient, undergoing to ERAS protocols, after colorectal surgery start: Early mobilization and walking, early fluid and oral diet, and interruption of intravenous infusions. All this leads to a faster recovery of physiological homeostasis and thus the recovery of the patient. A good ERAS adherence is associated with cost reduction compared to traditional perioperative care. Our experience of a series of 120 patients undergoing to colorectal elective surgery and ERAS protocols report morbidity and a Length of Hospital Stay (LOS)’s reduction.
Bernardino R. Laparoscopic Colorectal Surgery and Enhanced Recovery after Surgery (ERAS) Program: Experience with 120 Cases from a Single Italian Center. Clin Surg. 2022; 7: 3536..