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Review
. 2022 Jun 23:17:Doc10.
doi: 10.3205/dgkh000413. eCollection 2022.

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery

Wolfgang Schwenk  1
Affiliations
Review

Optimized perioperative management (fast-track, ERAS) to enhance postoperative recovery in elective colorectal surgery

Wolfgang Schwenk. GMS Hyg Infect Control. .

Abstract
in English, German

Aim: This manuscript provides information on the history, principles, and clinical results of Fast-track or ERAS concepts to optimize perioperative management (OPM).

Methods: With the focus on elective colorectal surgery description of the OPM concept and its elements for with special attention to the prevention of infectious complications and clinical results compared to traditional care will be given using recent systematic literature reviews. Additionally, clinical results for other major abdominal procedures are given.

Results: An optimized perioperative management protocol for elective colorectal resections will currently consist of 25 perioperative elements. These elements include the time from before hospital admission (patient education, screening, and treatment of possible risk factors like anemia, malnutrition, cessation of nicotine or alcohol abuse, optimization of concurrent systemic disease, physical prehabilitation, carbohydrate loading, adequate bowel preparation) to the preoperative period (shortened fasting, non-sedative premedication, prophylaxis of PONV and thromboembolic complications), intraoperative measures (systemic antibiotic prophylaxis, standardized anesthesia, normothermia and normovolemia, minimally invasive surgery, avoidance of drains and tubes) as well as postoperative actions (early oral feeding, enforced mobilization, early removal of a urinary catheter, stimulation of intestinal propulsion, control of hyperglycemia). Most of these elements are based on high-level evidence and will also have effects on the incidence of postoperative infectious complications.

Conclusion: Optimized perioperative management should be mandatory for elective surgery today as it enhances postoperative patient recovery, reduces morbidity and infectious complications.

Zielsetzung: Dieses Manuskript informiert über die Geschichte, Prinzipien und klinischen Ergebnisse von Fast-Track- oder ERAS-Konzepten zur Optimierung des perioperativen Managements (OPM).

Methoden: Mit dem Schwerpunkt elektiver kolorektaler Operationen werden das OPM-Konzept und seine Elemente mit besonderem Augenmerk auf die Vermeidung infektiöser Komplikationen und die klinischen Ergebnisse im Vergleich zur traditionellen Versorgung anhand einer aktuellen Literaturübersicht beschrieben. Zusätzlich werden klinische Ergebnisse für andere größere abdominale Eingriffe angegeben.

Ergebnisse: Ein Protokoll zum optimierten perioperativen Management für elektive kolorektale Resektionen besteht derzeit aus 24 perioperativen Elementen. Diese Elemente umfassen von der Zeit vor der Krankenhausaufnahme (Patientenaufklärung, Screening und Behandlung möglicher Risikofaktoren wie Anämie, Mangelernährung, Beendigung des Nikotin- oder Alkoholmissbrauchs, Optimierung gleichzeitiger systemischer Erkrankungen, körperliche Prähabilitation, Kohlenhydratbelastung, adäquate Darmvorbereitung) über die unmittelbare präoperative Phase (verkürztes Fasten, nicht-sedative Prämedikation, Prophylaxe von PONV und thromboembolischen Komplikationen), die intraoperativen Maßnahmen (systemische Antibiotikaprophylaxe, standardisierte Anästhesie, Normothermie und Normovolämie, minimalinvasive Chirurgie, Vermeidung von Drainagen und Schläuchen) und die postoperativen Elementen (frühzeitige orale Ernährung, forcierte Mobilisierung, frühzeitige Entfernung eines Harnkatheters, Stimulation des Darmtransports, Kontrolle der Hyperglykämie). Die meisten dieser Elemente beruhen auf wissenschaftlichen Studien mit hohem Evidenzlevel und wirken sich auch auf das Auftreten postoperativer infektiöser Komplikationen aus.

Schlussfolgerung: Das optimierte perioperative Management sollte heute bei elektiven in allen Bereichen der Chirurgie obligatorisch sein, da es die postoperative Genesung des Patienten fördert, die Morbidität senkt und dabei auch die Häufigkeit infektiöser Komplikationen verringert.

Keywords: ERAS; enhanced recovery after surgery; enhanced recovery protocols; fast-track surgery; morbidity; optimized perioperative management; perioperative medicine.

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Conflict of interest statement

The author declares that he has no competing interests.

Figures

Table 1
Table 1. Protocol for OPM in elective colorectal surgery (adapted from [3])
Table 2
Table 2. OPM elements during the preadmission period, level of evidence, grade of recommendation (according to [3]) and effect on postoperative infections.
Table 3
Table 3. OPM elements during the preoperative period, level of evidence, grade of recommendation (according to [3]) and effect on postoperative infections.
Table 4
Table 4. OPM elements during the intraoperative period, level of evidence, grade of recommendation (according to [3]) and effect on postoperative infections.
Table 5
Table 5. OPM elements during the postoperative period, level of evidence, grade of recommendation (according to [3]), and effect on postoperative infections.
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