Enhanced recovery after surgery for emergency colorectal surgery: Are there any differences between intra-abdominal infection and other indications?

Summary

Aim of the study

Enhanced recovery after surgery (ERAS) has become the standard of care for elective colorectal operations. However, there are few data regarding ERAS in emergency setting. This study aimed to evaluate the results of ERAS protocol for emergency colorectal resection and to compare its difference between patients with intra-abdominal infection (IAI) and those without.

Patients and methods

Patients undergoing emergency colectomy and/or proctectomy with ERAS protocol from 2011 to 2017 a university hospital was reviewed. Clinical outcomes and ERAS compliance were analyzed and compared depending on whether there was IAI.

Results

This study included 60 patients; 14 (23%) had IAI. Median ERAS compliance was 75% (IQR: 63–83). Rates of overall complication and severe complication were 35% and 15%, respectively. The 60-day mortality was 6.7%. Median length of postoperative stay was 5 days (IQR: 4–8). Thirty-three patients (55%) achieved targeted discharge within postoperative day 5. High adherence to ERAS protocol was associated with lower morbidity (P < 0.001) and shorter hospitalization (P = 0.006). Patients with IAI had less ERAS compliance (50% vs. 78%; P < 0.001), higher complication rates (64% vs. 26%; P = 0.009), and higher mortality (21% vs. 2%; P = 0.036), and longer time to first defecation (4 days vs. 3 days; P = 0.049). Of note, patients with IAI had significant lower compliance with preoperative optimization, scheduled removal of urinary catheter and early mobilization than the other group.

Conclusions

ERAS program is applicable for patients undergoing emergency colorectal surgery. In patients with intra-abdominal sepsis, the ERAS compliance was lower and the complications rate was higher.