|| Checking for direct PDF access through Ovid
Instead of implementing a more complex multimodal ERAS (enhanced recovery after surgery)protocol, many surgical units are introducing selected parts of theprotocol mixed with traditional care. This study reports the impact of improved adherence to an evidence-based ERAS-protocol, and the effects of various ERAS-elements on outcomes.The effect of improved adherence to the ERAS-protocol on postoperative symptoms, complications and length of stay following major colo-rectal cancer surgery was studied. Four hundred and sixty-four consecutive patients treated in 2002-2004 were compared to 489 consecutive patients treated in 2005-2007, i.e. before and after reinforcement of an ERAS-protocol. All clinical data (114 variables) wereprospectively recorded.The overallpreoperative adherence to the ERAS-protocol improved to 80.6% in 2005- 2007 from 54.0% in 2002-2004 (P < 0.001). Both postoperative complications 165 (33.7%) vs 203 (43.8%), OR 0.73 (95% CI 0.55-0.98) and symptoms, 247 (50.5%) vs 307 (66.2%), OR 0.53 (95% CI 0.40-0.70) were less common in 2005-2007 compared to 2002-2004. Peroperative intravenous fluid volumes andpreoperative carbohydrate drink were major independentpredictors of these improvements in clinical outcomes.Improved adherence to the ERAS-protocol resulted in improved clinical outcomes following major colo-rectal cancer surgery.