Role of Enhanced Recovery After Surgery (ERAS) Protocols in General Surgery
Keywords:
Enhanced Recovery After Surgery, ERAS compliance, General surgery, Postoperative outcomes, Length of stay
Abstract
Enhanced Recovery After Surgery (ERAS) protocols are designed to improve perioperative care by reducing surgical stress, accelerating functional recovery, and minimizing unnecessary hospitalization. This study evaluated the role of ERAS protocol adherence in elderly patients undergoing elective general surgery, with emphasis on compliance patterns, postoperative complications, and hospital utilization. The analysis included 188 patients managed within a standardized ERAS pathway. Compliance was assessed for early oral intake, early mobilization, suspension of intravenous fluids, urinary catheter removal, epidural anesthesia, drainage avoidance, and overall global adherence. Postoperative outcomes included Clavien-Dindo complications, ileus, anastomotic leakage, reoperation, mortality, hospital length of stay, and 30-day readmission. Global ERAS compliance was achieved in 56.0% of patients, while early oral intake and mobilization showed the highest adherence. Compliance was significantly lower among rectal surgery patients and those requiring stoma formation. Patients achieving global compliance had a shorter median hospital stay than those without full compliance. Differences in major complications, postoperative ileus, and anastomotic leakage were not statistically significant. Overall, ERAS adherence was most clearly associated with reduced hospitalization, supporting its value as a structured perioperative strategy in general and general surgical practice.
References
1. Abraham, N., & Albayati, S. (2011). Enhanced recovery after surgery programs hasten recovery after general resections. World Journal of Gastrointestinal Surgery, 3(1), 1.
2. Bona, S., Molteni, M., Rosati, R., Elmore, U., Bagnoli, P., Monzani, R., et al. (2014). Introducing an enhanced recovery after surgery program in general surgery: A single center experience. World Journal of Gastroenterology, 20(46), 17578.
3. Burch, J. (2013). Promoting enhanced recovery after general surgery. British Journal of Nursing, 22(5), S4.
4. Eskicioglu, C., Forbes, S. S., Aarts, M. A., Okrainec, A., & McLeod, R. S. (2009). Enhanced recovery after surgery (ERAS) programs for patients having general surgery: A meta-analysis of randomized trials. Journal of Gastrointestinal Surgery, 13(12), 2321-2329.
5. Evans, J., & Kennedy, R. H. (2011). Enhanced recovery after surgery. In Fundamentals of Surgical Practice: A Preparation Guide for the Intercollegiate MRCS Examination (p. 181).
6. Feldheiser, A., Aziz, O., Baldini, G., Cox, B. P. B. W., Fearon, K. C. H., Feldman, L. S., et al. (2016). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: Consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica, 60(3), 289-334.
7. Feldman, L. S., Lee, L., & Fiore, J., Jr. (2015). What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways? Canadian Journal of Anesthesia, 62(2), 120-130.
8. Fierens, J., Wolthuis, A. M., Penninckx, F., D'Hoore, A. D., & D'Hoore, A. (2012). Enhanced recovery after surgery (ERAS) protocol: Prospective study of outcome in general surgery. Acta Chirurgica Belgica, 112(5), 355-358.
9. Geltzeiler, C. B., Rotramel, A., Wilson, C., Deng, L., Whiteford, M. H., & Frankhouse, J. (2014). Prospective study of general enhanced recovery after surgery in a community hospital. JAMA Surgery, 149(9), 955-961.
10. Gonzalez-Ayora, S., Pastor, C., Guadalajara, H., Ramirez, J. M., Royo, P., Redondo, E., et al. (2016). Enhanced recovery care after general surgery in elderly patients: Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. International Journal of General Disease, 31, 1625-1631.
11. Gustafsson, U. O., Hausel, J., Thorell, A., Ljungqvist, O., Soop, M., Nygren, J., & Enhanced Recovery After Surgery Study Group. (2011). Adherence to the enhanced recovery after surgery protocol and outcomes after general cancer surgery. Archives of Surgery, 146(5), 571-577.
12. Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS Society) recommendations. World Journal of Surgery, 37(2), 259-284.
13. Hoffmann, H., & Kettelhack, C. (2012). Fast-track surgery-conditions and challenges in postsurgical treatment: A review of elements of translational research in enhanced recovery after surgery. European Surgical Research, 49(1), 24-34.
14. Kelliher, L. J. S., Jones, C. N., & Fawcett, W. J. (2015). Enhanced recovery for gastrointestinal surgery. BJA Education, 15(6), 305-310.
15. Lassen, K., Soop, M., Nygren, J., Cox, P. B. W., Hendry, P. O., Spies, C., et al. (2009). Consensus review of optimal perioperative care in general surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Archives of Surgery, 144(10), 961-969.
16. Lohsiriwat, V. (2014a). Enhanced recovery after surgery vs conventional care in emergency general surgery. World Journal of Gastroenterology, 20(38), 13950.
17. Lohsiriwat, V. (2014b). The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for general cancer surgery. Techniques in Coloproctology, 18(11), 1075-1080.
18. Lv, L., Shao, Y. F., & Zhou, Y. B. (2012). The enhanced recovery after surgery (ERAS) pathway for patients undergoing general surgery: An update of meta-analysis of randomized controlled trials. International Journal of General Disease, 27(12), 1549-1554.
19. Melnyk, M., Casey, R. G., Black, P., & Koupparis, A. J. (2011). Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Canadian Urological Association Journal, 5(5), 342.
20. Miller, T. E., Gan, T. J., & Thacker, J. K. (2014). Enhanced recovery pathways for major abdominal surgery. Anesthesiology News, 1-8.
21. Moydien, M. R., Oodit, R., Chowdhury, S., Edu, S., Nicol, A. J., & Navsaria, P. H. (2016). Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma: A prospective single-center pilot study. South African Journal of Surgery, 54(4), 7-10.
22. Mwanga, V. (2016). Fast track (enhanced recovery program) in general surgery: A literature review.
23. Sarin, A., Litonius, E. S., Naidu, R., Yost, C. S., Varma, M. G., & Chen, L. L. (2015). Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after general surgery. BMC Anesthesiology, 16(1), 55.
24. Scott, M. J., Baldini, G., Fearon, K. C. H., Feldheiser, A., Feldman, L. S., Gan, T. J., et al. (2015). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations. Acta Anaesthesiologica Scandinavica, 59(10), 1212-1231.
25. Steenhagen, E. (2016). Enhanced recovery after surgery: It's time to change practice! Nutrition in Clinical Practice, 31(1), 18-29.
26. Teeuwen, P. H., Bleichrodt, R. P., Strik, C., Groenewoud, J. J. M., Brinkert, W., Van Laarhoven, C. J. H. M., et al. (2010). Enhanced recovery after surgery (ERAS) versus conventional postoperative care in general surgery. Journal of Gastrointestinal Surgery, 14(1), 88-95.
27. Varadhan, K. K., Neal, K. R., Dejong, C. H., Fearon, K. C., Ljungqvist, O., & Lobo, D. N. (2010). The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open general surgery: A meta-analysis of randomized controlled trials. Clinical Nutrition, 29(4), 434-440.
28. Wind, J., Polle, S. W., Fung Kon Jin, P. H. P., Dejong, C. H. C., von Meyenfeldt, M. F., Ubbink, D. T., Gouma, D. J., & Bemelman, W. A. (2006). Systematic review of enhanced recovery programmes in colonic surgery. British Journal of Surgery, 93(7), 800-809.
2. Bona, S., Molteni, M., Rosati, R., Elmore, U., Bagnoli, P., Monzani, R., et al. (2014). Introducing an enhanced recovery after surgery program in general surgery: A single center experience. World Journal of Gastroenterology, 20(46), 17578.
3. Burch, J. (2013). Promoting enhanced recovery after general surgery. British Journal of Nursing, 22(5), S4.
4. Eskicioglu, C., Forbes, S. S., Aarts, M. A., Okrainec, A., & McLeod, R. S. (2009). Enhanced recovery after surgery (ERAS) programs for patients having general surgery: A meta-analysis of randomized trials. Journal of Gastrointestinal Surgery, 13(12), 2321-2329.
5. Evans, J., & Kennedy, R. H. (2011). Enhanced recovery after surgery. In Fundamentals of Surgical Practice: A Preparation Guide for the Intercollegiate MRCS Examination (p. 181).
6. Feldheiser, A., Aziz, O., Baldini, G., Cox, B. P. B. W., Fearon, K. C. H., Feldman, L. S., et al. (2016). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: Consensus statement for anaesthesia practice. Acta Anaesthesiologica Scandinavica, 60(3), 289-334.
7. Feldman, L. S., Lee, L., & Fiore, J., Jr. (2015). What outcomes are important in the assessment of Enhanced Recovery After Surgery (ERAS) pathways? Canadian Journal of Anesthesia, 62(2), 120-130.
8. Fierens, J., Wolthuis, A. M., Penninckx, F., D'Hoore, A. D., & D'Hoore, A. (2012). Enhanced recovery after surgery (ERAS) protocol: Prospective study of outcome in general surgery. Acta Chirurgica Belgica, 112(5), 355-358.
9. Geltzeiler, C. B., Rotramel, A., Wilson, C., Deng, L., Whiteford, M. H., & Frankhouse, J. (2014). Prospective study of general enhanced recovery after surgery in a community hospital. JAMA Surgery, 149(9), 955-961.
10. Gonzalez-Ayora, S., Pastor, C., Guadalajara, H., Ramirez, J. M., Royo, P., Redondo, E., et al. (2016). Enhanced recovery care after general surgery in elderly patients: Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. International Journal of General Disease, 31, 1625-1631.
11. Gustafsson, U. O., Hausel, J., Thorell, A., Ljungqvist, O., Soop, M., Nygren, J., & Enhanced Recovery After Surgery Study Group. (2011). Adherence to the enhanced recovery after surgery protocol and outcomes after general cancer surgery. Archives of Surgery, 146(5), 571-577.
12. Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., et al. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS Society) recommendations. World Journal of Surgery, 37(2), 259-284.
13. Hoffmann, H., & Kettelhack, C. (2012). Fast-track surgery-conditions and challenges in postsurgical treatment: A review of elements of translational research in enhanced recovery after surgery. European Surgical Research, 49(1), 24-34.
14. Kelliher, L. J. S., Jones, C. N., & Fawcett, W. J. (2015). Enhanced recovery for gastrointestinal surgery. BJA Education, 15(6), 305-310.
15. Lassen, K., Soop, M., Nygren, J., Cox, P. B. W., Hendry, P. O., Spies, C., et al. (2009). Consensus review of optimal perioperative care in general surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Archives of Surgery, 144(10), 961-969.
16. Lohsiriwat, V. (2014a). Enhanced recovery after surgery vs conventional care in emergency general surgery. World Journal of Gastroenterology, 20(38), 13950.
17. Lohsiriwat, V. (2014b). The influence of preoperative nutritional status on the outcomes of an enhanced recovery after surgery (ERAS) programme for general cancer surgery. Techniques in Coloproctology, 18(11), 1075-1080.
18. Lv, L., Shao, Y. F., & Zhou, Y. B. (2012). The enhanced recovery after surgery (ERAS) pathway for patients undergoing general surgery: An update of meta-analysis of randomized controlled trials. International Journal of General Disease, 27(12), 1549-1554.
19. Melnyk, M., Casey, R. G., Black, P., & Koupparis, A. J. (2011). Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Canadian Urological Association Journal, 5(5), 342.
20. Miller, T. E., Gan, T. J., & Thacker, J. K. (2014). Enhanced recovery pathways for major abdominal surgery. Anesthesiology News, 1-8.
21. Moydien, M. R., Oodit, R., Chowdhury, S., Edu, S., Nicol, A. J., & Navsaria, P. H. (2016). Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma: A prospective single-center pilot study. South African Journal of Surgery, 54(4), 7-10.
22. Mwanga, V. (2016). Fast track (enhanced recovery program) in general surgery: A literature review.
23. Sarin, A., Litonius, E. S., Naidu, R., Yost, C. S., Varma, M. G., & Chen, L. L. (2015). Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after general surgery. BMC Anesthesiology, 16(1), 55.
24. Scott, M. J., Baldini, G., Fearon, K. C. H., Feldheiser, A., Feldman, L. S., Gan, T. J., et al. (2015). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations. Acta Anaesthesiologica Scandinavica, 59(10), 1212-1231.
25. Steenhagen, E. (2016). Enhanced recovery after surgery: It's time to change practice! Nutrition in Clinical Practice, 31(1), 18-29.
26. Teeuwen, P. H., Bleichrodt, R. P., Strik, C., Groenewoud, J. J. M., Brinkert, W., Van Laarhoven, C. J. H. M., et al. (2010). Enhanced recovery after surgery (ERAS) versus conventional postoperative care in general surgery. Journal of Gastrointestinal Surgery, 14(1), 88-95.
27. Varadhan, K. K., Neal, K. R., Dejong, C. H., Fearon, K. C., Ljungqvist, O., & Lobo, D. N. (2010). The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open general surgery: A meta-analysis of randomized controlled trials. Clinical Nutrition, 29(4), 434-440.
28. Wind, J., Polle, S. W., Fung Kon Jin, P. H. P., Dejong, C. H. C., von Meyenfeldt, M. F., Ubbink, D. T., Gouma, D. J., & Bemelman, W. A. (2006). Systematic review of enhanced recovery programmes in colonic surgery. British Journal of Surgery, 93(7), 800-809.
Published
2017-08-17
How to Cite
Dr. Rambabu Garg. (2017). Role of Enhanced Recovery After Surgery (ERAS) Protocols in General Surgery. Revista Electronica De Veterinaria, 10-19. https://doi.org/10.69980/redvet.vi.2507
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