Enhanced recovery protocols (ERPs) refer to perioperative care pathways designed to minimize the physiologic stress of surgery and accelerate post operative recovery. Common pathway elements include comprehensive patient education, multimodal opioid-sparing analgesic techniques, and early postoperative mobilization and feeding. Enhanced recovery protocols permit standardization of perioperative care with evidence-based practices and can promote an interdisciplinary approach. Numerous randomized trials have demonstrated that ERP implementation is associated with decreased hospital length of stay and, in most studies, decreased complications. Recognizing the benefits of ERPs, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) released novel ERP variables in July 2014. The enhanced recovery in NSQIP variables was optional, and included both process measures related to ERP adherence as well as recovery-specific outcomes.”
“Colorectal ERP implementation is becoming widespread, and a key component of ERPs is preoperative patient education, which sets patient expectations and facilitates a team approach to recovery. This study provides a description of expected colorectal surgery outcomes in the setting of ERPs for different diagnoses. Patients with IBD have higher odds of adverse outcomes, including prolonged length of stay, death/serious morbidity, and readmission, and take longer to achieve PO pain control and to tolerate a diet. In particular, in the setting of ERPs, knowledge of expected outcomes for patients with different diagnoses may affect patient education and clinician and patient expectations in the postoperative period. These findings suggest that future ERPs may benefit from tailoring education and expectations differently for patients with IBD.”
Ban KA, Berian JR, Liu JB, Ko CY, Feldman LS, Thacker JKM. Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum. 2018 Jul;61(7):847-853. Full Text for Emory Users
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