Elsevier

Clinical Nutrition

Volume 31, Issue 6, December 2012, Pages 783-800
Clinical Nutrition

Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations

https://doi.org/10.1016/j.clnu.2012.08.013Get rights and content

Summary

Background

This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

Methods

Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

Results

For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system).

Conclusions

Based on the evidence available for each item of the multimodal perioperative-care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.

Introduction

The delay until full recovery after major abdominal surgery has been greatly improved by the introduction of a series of evidence-based treatments covering the entire perioperative period and formulated into a standardised protocol. Compared with traditional management, Enhanced Recovery After Surgery (ERAS®) represents a fundamental shift in perioperative care.1, 2, 3, 4 The ERAS-care pathways reduce surgical stress, maintain postoperative physiological function, and enhance mobilisation after surgery. This has resulted in reduced rates of morbidity, faster recovery and shorter length of stay in hospital (LOSH) in case series from dedicated centres1, 2, 3, 4 and in randomised trials.5, 6

Several versions of Enhanced-Recovery Programmes have been published over the years.7, 8, 9

This article represents the joint efforts of the ERAS Society (www.erassociety.org), International Association for Surgical Metabolism and Nutrition (IASMEN; www.iasmen.org) and The European Society for Clinical Nutrition and Metabolism (ESPEN) to present an updated and expanded consensus review of perioperative care for colonic surgery based on current evidence.

Section snippets

Literature search

The authors met in April 2011 and the topics for inclusion were agreed and allocated. The principal literature search utilised MEDLINE, Embase and Cochrane databases to identify relevant contributions published between January 1966 and January 2012. Medical Subject Headings terms were used, as were accompanying entry terms for the patient group, interventions and outcomes. Key words included “colon”, “enhanced recovery” and “fast track”. Reference lists of all eligible articles were checked for

Preadmission information, education and counselling

Detailed information given to patients before the procedure about surgical and anaesthetic procedures may diminish fear and anxiety and enhance postoperative recovery and quicken hospital discharge.14, 15 A preoperative psychological intervention, aimed at decreasing patient anxiety, may also improve wound healing and recovery after laparoscopic surgery.16, 17 Personal counselling, leaflets or multimedia information containing explanations of the procedure along with tasks that the patient

Eras versus traditional care in elective colonic surgery: clinical outcomes

Several studies have demonstrated that the ERAS programmes compared with traditional perioperative care is associated with earlier recovery and discharge after colonic resection.1, 2, 217, 218, 219, 220, 221, 222 Recently, the effect of perioperative treatment with the ERAS protocol on four outcome parameters (mortality, morbidity, LOSH, hospital readmissions) after mainly colonic surgery was reported in two systematic reviews: Spanjersberg et al.,223 and Varadhan et al.213 Different variations

Comment

The practice of surgery and anaesthesia is continuously changing. This creates the need for regular updates of the knowledge base and for continuous training of those involved in the treatment of surgical patients. The ERAS Society for Perioperative Care (www.erassociety.org) was initiated by the former ERAS Study Group and was formed in 2010 to support these processes. The Society participates in the improvement of perioperative care by developing new knowledge through research, education and

Funding source

The ERAS Society has support from Nutricia Research via an unrestricted educational grant.

Statement of authorship

Scientific input, critical revision and final approval of manuscript: all authors coordinated writing and revision and edited this contribution.

Conflicts of Interests

The ERAS Society® receives an unrestricted grant from Nutricia

OL has served as an external advisor to Nutricia and has occasionally received travel and lecture honoraria from Nutricia, Fresenius-Kabi, Braun, Baxter and Nestle. OL also previously held a patent for a preoperative carbohydrate drink formerly licenced to Nutricia. OL initiated a company that runs the ERAS society data by contract with the ERAS society. DNL has received unrestricted research funding, travel grants and speaker's

Acknowledgements

The ERAS Society has support from Nutricia Research via an unrestricted educational grant.

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  • The guidelines are published as a joint effort between the Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, The European Society for Clinical Nutrition and Metabolism (ESPEN) and The International Association for Surgical Metabolism and Nutrition (IASMEN) and copyrights for this publication is shared between the three societies. The guidelines are published jointly in World Journal of Surgery (IASMEN) and Clinical Nutrition (ESPEN), and will also be available on the ESPEN (http://www.espen.org) and ERAS Society websites (http://www.erassociety.org).

    q

    On behalf of the ERAS® Society, the European Society for Clinical Nutrition and Metabolism and the International Association for Surgical Nutrition and Metabolism.

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