2020 Jan;18(1):224-242. doi: 10.11124/JBISRIR-2017-003994. They are not indicated following routine colonic resection above the peritoneal reflection. View all of the ERAS Society guidelines by clicking here. However, the overall rate of readmission for patients managed with early discharge is comparable to patients with a longer median length of hospital stay [34].Regarding the economical issues, it must be pointed out that the increased cost in laparoscopic approach must be balanced with savings from a shorter length of hospital stay, lower morbidity and no differences in readmission rates. Antibiotic prophylaxis with single-dose antibiotic prophylaxis against both anaerobes and aerobes about one hour before surgery is recommended (grade A recommendation). Nowadays ERAS protocols, with little modifications to adapt them to each center´s functioning, are been applied in a great number of colorectal units worldwide. ... -IDENTIFY ERAS patients for protocol participation-DIET begins night of surgery-AMBULATION begins night of surgery-HOB at 30 degrees at all times-IVF = 1L/24hrs (70kg) Patient´s individualized Risk stratification is also important to make good patient information and treatment decision. 2019 Feb 1;62(1):25-32. doi: 10.1503/cjs.015617. If an open procedure is required, transverse incisions should be made preferentially to reduce postoperative pain. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Dexamethasone or 5HT3 receptor antagonist, droperidol or metoclopramide near the end of surgery are recomended. We share our knowledge and peer-reveiwed research papers with libraries, scientific and engineering societies, and also work with corporate R&D departments and government entities. USA.gov. Oral nutritional supplements should be prescribed (approximately 200 mL, energy dense, 2-3 times daily) from the day of surgery until normal food intake is achieved. The possibility of applying some components of fast-track programs in patients undergoing emergency colorectal surgery must be also evaluated, especially in order to reduce preoperative stress. ERAS is a multimodal, multidisciplinary approach that utilizes evidence based medicine to inform best practices during the perioperative period. ), different procedures (colon resection, pancreatic procedures, etc.) The confirmation of the initial results should prompt the ERAS methodology embracing in other kind of major surgical procedures as gastric or pancreatic procedures. Enhanced perioperative nutritional care for patients undergoing elective colorectal surgery at Calvary North Adelaide Hospital: a best practice implementation project. Extended periods of bed rest are recommended to facilitate abdominal wall healing. ... Wan KM, Carter J, Philp S. Predictors of early discharge after open gynecological surgery in the setting of an enhanced recovery after surgery protocol. See this image and copyright information in PMC. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Professor of Surgery. New and updated ERAS Society Colorectal Surgery Guidelines. Early resumption of oral intake is associated with fewer wound infections and shorter hospital admissions as well. ERAS programs are composed of preoperative, intra-operative and postoperative strategies combined to form a multimodal pathway: Pre-operative optimization: it is focused on targeting areas to optimize patient comorbidities (previous or related to the presenting complaint) such as anemia, diabetic and blood pressure control, optimizing cardiovascular disease treatments, respiratory functioning,…. Enhanced Recovery After Surgery. The overall metabolic changes in the stress response involve protein and fat catabolism to provide energy.