BMC Surgery 2011, 11:9


Enhanced recovery in colorectal surgery: a multicentre study

José M Ramírez1, Juan A Blasco2, José V Roig3, Sergio Maeso-Martínez2*, José E Casal4, Fernando Esteban5, Daniel Callejo Lic2 and for Spanish working group on fast track surgery

Received 30 January 2013; accepted 29 August 2013; Accepted Article online 25 October 2013


Background Background: Major colorectal surgery usually requires a hospital stay
of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated
with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program
based on previously published protocols.

Methods This prospective study, performed at 12 Spanish hospitals in 2008 and 2009,
involved 300 patients. All patients underwent elective colorectal resection for cancer following an enhanced recovery program.
The main elements of this program were: preoperative advice, no colon preparation, provision of carbohydrate-rich drinks one day
prior and on the morning of surgery, goal directed fluid administration, body temperature control during surgery, avoiding drainages
and nasogastric tubes, early mobilisation, and the taking of oral fluids in the early
postoperative period. Perioperative morbidity and mortality data were collected and the length of hospital stay and protocol
compliance recorded.

Results The median age of the patients was 68 years. Fifty-two % of the patients
were women. The distribution of patients by ASA class was: I 10%, II 50% and III 40%. Sixty-four % of interventions were
laparoscopic; 15% required conversion to laparotomy. The majority of patients underwent sigmoidectomy or right hemicolectomy.
The overall compliance to protocol was approximately 65%, but varied widely in its different components. The median length of
postoperative hospital stay was 6 days. Some 3% of patients were readmitted to hospital after discharge; some
7% required repeat surgery during their initial hospitalisation or after readmission. The most common complications were
surgical (24%), followed by septic (11%) or other medical complications (10%). Three patients (1%) died during follow-up.
Some 31% of patients suffered symptoms that delayed their discharge, the most common being vomiting or nausea (12%), dyspnoea
(7%) and fever (5%).

Conclusion Conclusion: The following of this enhanced recovery program posed no
risk to patients in terms of morbidity, mortality and shortened the length of their hospital stay. Overall compliance
to protocol was 65%. The following of this program was of benefit to patients and reduces costs by shortening the length
of hospital stay. The implantation of such programmes is therefore highly recommended.