Prehabilitation is a strategy to increase reserve in anticipation of an upcoming stressor. Patients with poor baseline functional capacity are at increased risk of complications and prolonged recovery (1,2). Emerging evidence suggests that a 4-week period of prehabilitation can increase walking capacity in colorectal cancer patients, and deconditioned patients in general make the biggest gains. […]
Mechanical bowel preparation has long been thought to reduce infectious complications after colorectal resection. However, mechanical bowel preparation is uncomfortable and results in fluid losses. For colon resection, meta-analyses of randomized trials conclude that mechanical bowel preparation does not decrease infectious complications or leak (1). However, these trials did not include oral antibiotics with the […]
Traditionally patients are “NPO after midnight” to reduce the risk of aspiration of gastric contents at induction of anesthesia. This results in a long period without hydration or nutrition, especially for cases booked later the following day. Oral intake of clear fluids up to 2 hours before surgery does not increase the risk of aspiration […]
Carbohydrate drink: The administration of a complex carbohydrate-rich drink before surgery (100gm the evening before surgery and 50gm 2-3 hours preop) may increase insulin sensitivity but does not reduce complications or significantly improve other outcomes when compared to placebo fluids (1). Larger trials are required to establish impact on protein catabolism and on clinical outcomes. […]
As with any quality improvement initiative, having data about both processes and outcomes is critical. Data collection should ideally begin when the ERP team is assembled, to show the team where they are starting. Length of stay is an easy way to monitor outcomes within an institution as it relates to recovery, organization, complications and […]
Long acting benzodiazepines are avoided. Short-acting agents to reduce anxiety during induction of anesthesia or insertion of epidurals are used selectively. « Carbohydrate drinkLaparoscopic surgery »
Patient and caregiver preparation is an essential part of an ERP. The goal is to better prepare patients to play an active role in their recovery. Benefits of preoperative information include shorter hospital stay, less demand for analgesia and increased patient satisfaction (1). Developing effective patient education materials is a science as well as an […]
After colorectal surgery, metaanalyses comparing early nutrition (within 24 hours) compared to traditional step-wise introduction of oral intake after return of bowel function conclude that early feeding decreases complications without increasing the risk of leak or affecting bowel function; NG tube reinsertion was not significantly increased (10% versus 7%) (1). After laparoscopic bowel surgery, patients […]
Both laparoscopic surgery and ERPs result in improved outcomes when used in isolation. But additional benefits are seen when they are combined. In a large multicenter trial where patients were allocated to four groups combining surgical approach (laparoscopic or open) and perioperative care (enhanced recovery or standard), the combination of MIS and ERP resulted in […]
Multiple elements of the pathway may have an impact in supporting normal bowel function including laparoscopic surgery, fluid balance and opioid sparing analgesia. Chewing sugar free gum is a simple low cost intervention that decreases time to first flatus, bowel movement and hospital stay after colorectal surgery overall and reduces time to first BM when […]