This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The ASCRS Clinical Practice Guidelines Committee is composed of society members who are c

Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons.

Essential Elements of Multimodal Analgesia in Enhanced Recovery After Surgery (ERAS) Guidelines.

Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery

This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The Clinical Practice Guidelines Committee of the ASCRS is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. In a collaborative effort, the ASCRS Clinical Practice Guidelines Committee and members of the SAGES SMART (Surgical Multimodal Accelerated Recovery Trajectory) Enhanced Recovery Task Force and Guidelines Committee have joined together to produce this guideline written and approved by both societies. The combined ASCRS/SAGES panel worked together to develop the statements in this guideline and approved these final recommendations. Through this effort, the ASCRS and SAGES continue their dedication to ensuring highquality perioperative patient care. Previous guidelines on perioperative care for colon [1] and rectal [2] surgery included studies identified up to January 2012 with significant literature published since then. The combined ASCRS/SAGES committee was created to define current best quality care for enhanced recovery after colon and rectal surgery. This clinical practice guideline is based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It This article is being published concurrently in Diseases of the Colon and Rectum. The articles are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Either citation can be used when citing this article.

Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

OBJECTIVES Our institution implemented a protocol known as thoracic enhanced recovery with ambulation after surgery (T-ERAS) in thoracic operations. The objective was early ambulation starting in the postoperative ambulatory care unit. METHODS Video-assisted thoracoscopic surgery lobectomy patients are placed on a chair in the preoperative area and then walked to the operating room. Postoperatively, patients are placed on a chair as soon as possible. Our target ambulation goal was 250 feet within 1 h of extubation. Patients then walk to their hospital room. T-ERAS adoption and outcomes were compared to a pre-T-ERAS period, in addition to the comparing early and late T-ERAS cohorts. RESULTS Over 6 years, 304 patients on T-ERAS underwent a planned video-assisted thoracoscopic surgery lobectomy. Median age was 67 years (range 41-87 years). The target goal was achieved in 187 of 304 (61.5%) patients and 277 of 304 (91.1%) patients ambulated 250 feet at any time in the postoperative ambulatory care unit. The T-ERAS period had a median length of stay of 1 day vs 2 days in the pre-T-ERAS period (P < 0.001). There were low rates of pneumonia (2/304, 0.7%), atrial fibrillation (12/304, 4.0%) and no postoperative mortalities for T-ERAS. The target goal was achieved at a greater rate in the late (92/132, 72.0%) versus early (28/75, 37%) T-ERAS cohort. The mean time to ambulation was reduced in the late cohort (46-81 min). CONCLUSIONS Early postoperative ambulation was feasible and considered key in achieving low morbidity after video-assisted thoracoscopic surgery lobectomy. Adoption of T-ERAS improved over time. Further studies will help define adoptability at other sites and validate impact on improving outcomes.

/pdf/thoracic-enhanced-recovery-with-ambulation-after-surgery-a-6-2dyx83jcs1.pdf

Thoracic enhanced recovery with ambulation after surgery: a 6-year experience.

Aim
The aim of this randomized clinical trial was to compare patients treated using a multimodal approach [enhanced recovery after surgery (ERAS)], with a special focus on counselling, to patients treated in a standard conventional care pathway, who underwent elective colorectal resection.

Method
In a single-centre trial, adult patients eligible for open or laparoscopic colorectal resection were randomized to an ERAS programme or standard care. The primary end-point was postoperative total hospital stay. Identical discharge criteria were defined for both treatment groups. Secondary end-points included postoperative complications, postoperative C-reactive protein levels, postoperative hospital stay, readmission rate and mortality. All parameters were recorded before operation, on the day of surgery and daily thereafter until discharge.

Results
Total hospital stay was significantly shorter among patients randomized to ERAS than among the standard group [median 5 days (range 2–50 days) vs median 8 days (range 2–48 days); P = 0.001]. The two treatment groups exhibited similar outcomes regarding overall major and minor morbidity, reoperation rate, readmission rate and 30-day mortality. There were also no differences in tolerance of enteral nutrition or in the inflammatory response, as reflected by postoperative C-reactive protein levels.

Conclusion
ERAS care was associated with a significantly shorter length of hospital stay. Without any difference in surgical or general complications, tolerance of enteral nutrition or postoperative C-reactive protein levels, peri-operative information and guidance for ensuring that patients comply with the ERAS approach appear to be important factors to reduce the length of hospital stay.

Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial.

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Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial.