French guidelines for enhanced recovery after elective colorectal surgery

Area of Science:

• Colorectal Surgery
• Surgical Recovery Protocols
• Evidence-Based Medicine

Background:

• Enhanced recovery after surgery (ERAS) programs aim to mitigate surgical stress and improve patient recovery.
• ERAS protocols are adaptable to specific procedures like colorectal surgery, encompassing pre-, intra-, and postoperative care.
• Existing ERAS programs may not fully implement all evidence-based parameters.

Purpose of the Study:

• To assess the impact of ERAS parameters on colorectal surgery outcomes, including surgical stress, postoperative ileus, and complications.
• To validate the efficacy of individual ERAS parameters for successful rapid rehabilitation.
• To establish expert panel guidelines for optimizing ERAS in colorectal surgery.

Main Methods:

• Systematic literature analysis to identify 19 key ERAS parameters.
• Application of GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology for evidence and recommendation strength.
• Expert panel consensus utilizing the Delphi technique to refine 35 formal recommendations.

Main Results:

• 19 parameters identified as potentially impacting colorectal surgery recovery.
• 35 formal recommendations developed, with 28 (80%) achieving strong agreement.
• Key consensus areas include pre-operative carbohydrate intake, intra-operative fluid management, early oral feeding, gum chewing, and early mobilization.
• Futility of bowel preparation, nasogastric tubes, and surgical drains confirmed.

Conclusions:

• Expert guidelines provide a framework for optimizing ERAS programs in colorectal surgery.
• Implementation of specific, evidence-based interventions can significantly improve patient recovery and reduce complications.
• The guidelines clarify the value of various ERAS components, confirming the ineffectiveness of certain traditional practices.