DOI: 10.1097/SLA.0b013e3181e9d947
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Issn Print: 0003-4932
Publication Date: 2010/08/01
Enhanced Recovery After Surgery (ERAS) Protocols Must Be Considered When Determining Optimal Perioperative Care in Colorectal Surgery
Sanket Srinivasa; Tarik Sammour; Arman Kahokehr; Andrew G. Hill
+ Author Information
Author Information: ahill@middlemore.co.nz
Excerpt
We read with interest the article by Arriaga et al concerning the implementation of perioperative “Evidence-Based Best-Practice” in Colorectal Surgery and its link to postoperative complications and surgical outcomes.1 Optimization of perioperative care in colorectal surgery has been extensively studied in Europe and elsewhere with the resultant introduction of Fast-Track Surgery or Enhanced Recovery After Surgery (ERAS) protocols, which have been shown to decrease morbidity and complications as well as reduce length of hospital stay.2–4 There is significant, high-level evidence behind the individual components of ERAS protocols, which have not been considered when best-practice has been determined in this study. For example, in an ERAS protocol, preoperative carbohydrate loading is used,5 mechanical bowel preparation is avoided,6 and in-dwelling catheters are removed on postoperative day 17 (instead of day 3 as stated by the study in question) with an emphasis on judicious fluid management8 and early mobilization9—the important facets of perioperative care that have not been incorporated into “Best-Practices” by Arriaga et al. Furthermore, ERAS protocols recognize the procedure-specific differences between colonic and rectal operations and alter aspects of perioperative care accordingly.10
ERAS protocols have successfully optimized perioperative care worldwide and are based on sound evidence that should be incorporated into any new perioperative protocol seeking to optimize outcomes in colorectal surgery.11 We would encourage Arriaga et al to update their best-practice components to reflect the current international gold-standard.
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