What are the discharge and follow-up components of enhanced recovery after surgery (ERAS) programs for emergency GI surgical procedures?

Updated: Jan 20, 2021
  • Author: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed); Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

Answer

By enhancing patients' recovery, an ERAS protocol prepares them for early discharge. No fixed protocol has yet been established for discharge in emergency ERAS. At the authors' center, discharge criteria have included absence of complications necessitating hospital admission, tolerance of solid diet, pain control with oral analgesics, and ability to mobilize independently (see the image below). [1, 2]

Enhanced Recovery After Surgery (ERAS): discharge Enhanced Recovery After Surgery (ERAS): discharge criteria.

Evaluation of complications and assessment for readmission are carried out through preestablished follow-up of patients after discharge, which provides feedback for any necessary improvements and changes in the existing protocols. Once discharged, patients can be placed on a regimen of oral analgesics on demand, along with with supportive antisecretory PPI therapy if necessary. Effective preoperative and postoperative counseling is necessary to lower readmission rates and reduce repeat patient visits to the hospital after discharge.

A comparison of various studies on ERAS protocols in emergency GI surgery is provided in Table 1 below. [5, 1, 2, 6, 7, 39, 40, 41]

Table-1: Comparison of Studies on ERAS Protocols in Emergency Gastrointestinal Surgery (Open Table in a new window)

Author (y)

Operative Procedure

Study Design

Total No. of Patients

Length of Hospital Stay (d)

Total Postoperative Complications (%)

Need for Readmission (%)

Need for Reexploration

(%)

Roulin et al (2014) [7]

Colonic resection

Prospective cohort

28

8

64

-

-

Lohsiriwat et al (2014) [39]

Colorectal resection

Case control

20* vs 40

5.5* vs 7.5

25* vs 48

Nil

-

Gonenc et al (2014) [5]

Laparoscopic Graham patch repair

RCT

21* vs 26

3.8* vs 6.9

23* vs 26 (P = .804)

19* vs 7 (P = .471)

9* vs 7 (P = .823)

Wisely et al (2015) [6]

Major abdominal surgery

Retrospective cohort

370

8

31; reduced (P = .002)

9 (P = .88)

9 (P = .89)

Mohsina et al (2017) [1]

Simple closure of perforated peptic ulcer

RCT

50* vs 49

5.3* vs 9.7

18* vs 63

Nil

-

Shida et al (2017) [40]

Surgery for obstructed colorectal cancer

Retrospective cohort

80* vs 42

7* vs 10

10* vs 15

1.3* vs 0

0* vs 2.5

Shang et al (2018) [41]

Surgery for obstructed colorectal cancer

Retrospective cohort

318* vs 318

6* vs 9

33.6* vs 45

7.9* vs 8.8

2.5* vs 2.8

Saurabh et al (2020) [2]

Small-bowel surgery

RCT

35* vs 35

8* vs 10

23* vs 37

-

-

* ERAS vs standard care.

RCT = randomized controlled trial.


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