Introducing a Colorectal Enhanced Recovery After Surgery (ERAS) Protocol

Abstract

Colorectal surgery is used for managing different diseases that affect the colon and the rectum. This surgery has been historically associated with high morbidity and mortality rates. Therefore, new management guidelines to improve postoperative outcomes were developed with specific protocols under the name Enhanced Recovery After Surgery (ERAS). ERAS protocols are evidence-based, multimodal perioperative care pathways that span the entire perioperative period. The aims of this project were to develop a comprehensive colorectal ERAS pathway at the American University of Beirut Medical Center (AUBMC), propose a plan for protocol implementation and evaluation, and highlight the key role of the ERAS clinical nurse specialist (CNS) coordinator for successful pathway implementation. As part of the assessment of the need for the development of the ERAS pathway for colorectal patients, a retrospective chart review of 100 cases was conducted at AUBMC over a six month period. This analysis showed complication rates ranging between 4% and 41.4% and length of stay that are higher than published data. In addition, bivariate analyses revealed significant patient and surgery related factors to be significantly correlated with postoperative outcomes, thus identifying some patient groups at high risk for surgical complications. These results and the lack of standardized treatment of colorectal patients at AUBMC, supported the need to introduce an ERAS protocol coordinated by CNS at AUBMC. The literature on evidence-based guidelines for enhanced recovery after colorectal surgery, the cost effectiveness of ERAS protocols, barriers and facilitators to their implementation, and the role of the CNS coordinator in ERAS implementation were reviewed. Accordingly, protocol and order sets were developed covering all surgical phases. Moreover, a thorough implementation plan was developed including the multidisciplinary team, protocol incorporation into the hospital’s electronic medical record system (EPIC), education of healthcare workers, and execution of the pathway. Moreover, evaluation, cost estimation and sustainability plans were also proposed. The proposed colorectal ERAS clinical pathway provides a structured framework and a roadmap for healthcare professionals to deliver the highest quality of care, in alignment with AUBMC’s mission and vision. Adopting this colorectal ERAS at the AUBMC is expected to yield optimal postoperative outcomes.