Does enhanced recovery reduce postoperative ileus after colorectal surgery?

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Gastrointestinal Physiology

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are established to improve surgical outcomes in colorectal procedures.
• The specific impact of ERAS on the recovery of bowel motility remains incompletely understood.
• Variability in defining postoperative ileus complicates literature interpretation.

Purpose of the Study:

• To evaluate the effect of ERAS protocols on the recovery of bowel motility after colorectal surgery.
• To analyze how different definitions of postoperative ileus influence reported incidence rates.

Main Methods:

• A prospective, single-center observational study included patients undergoing colorectal resection with anastomosis.
• Global Resumption of Intestinal Transit (GROT) was defined as the combined passage of stool and tolerance of solid food.
• Patient adherence to 19 ERAS protocol items was assessed over a 17-month period.

Main Results:

• Higher adherence to ERAS protocols correlated with reduced time to passage of flatus (P<0.001) and GROT (P=0.04).
• The incidence of postoperative ileus varied widely (1.5% to 61.8%) based on the definition used (1-7 day cut-offs).
• Adherence to ≥85% of ERAS items was associated with protection against prolonged ileus (lasting ≥4 days; OR=0.35).

Conclusions:

• Implementation and adherence to ERAS protocols can accelerate the recovery of bowel motility, specifically the time to GROT.
• A standardized, consensual definition for postoperative ileus is necessary for consistent reporting and research.