A protocol is not enough to implement an enhanced recovery programme for colorectal resection.

Area of Science:

• Colorectal Surgery
• Perioperative Care
• Enhanced Recovery Pathways

Background:

• Multimodal perioperative care protocols show promise for enhanced recovery.
• International study assesses enhanced recovery programme implementation across five European centers.
• Investigates factors influencing patient recovery and hospital length of stay.

Purpose of the Study:

• To evaluate the implementation of an enhanced recovery programme in a multi-center setting.
• To identify determinants affecting patient recovery and length of hospital stay after colorectal resection.
• To compare outcomes between centers with varying experience in enhanced recovery protocols.

Main Methods:

• International observational study involving 425 patients undergoing elective open colorectal resection.
• Protocol adherence assessed across five European centers with differing prior experience.
• Data collected on perioperative care elements and patient recovery milestones.

Main Results:

• High protocol compliance pre- and intra-operatively, but low compliance post-operatively.
• Patients achieved recovery criteria in a median of 3 days, but discharge occurred at a median of 5 days.
• Delayed discharge and major complications prolonged hospital stay; prior fast-track experience correlated with shorter stays.

Conclusions:

• Functional recovery within 3 days post-colorectal resection is feasible in clinical practice.
• Enhanced recovery protocols require more than just adherence; experience and organization are key for timely discharge.
• Further optimization of care pathways is needed to align actual discharge with functional recovery.