title: An enhanced-recovery protocol improves outcome after colorectal resection already during the first year: a single-center experience in 168 consecutive patients.
abstract: OBJECTIVE
  This study was designed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection.
  
  
  METHODS
  One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before (traditional, n = 69) and immediately after implementing enhanced recovery after surgery (n = 99). Rectal surgery was performed in 77 patients. Postoperative food and fluid intake, mobilization, physiologic function, and clinical outcome were measured prospectively.
  
  
  RESULTS
  Resumption of oral diet was achieved on postoperative day postoperative day 1 in the enhanced recovery after surgery group. In the enhanced recovery after surgery group, mobilization more than 6 hours daily was achieved on postoperative day 2 to 3 and passage of stool occurred on postoperative day 2 vs. postoperative day 5 in the traditional group (P < 0.0001). Muscle strength and lung function were less reduced in the enhanced recovery after surgery group (P < 0.05). Median hospital stay was reduced by 2 days (P < 0.01). Readmission rates increased (4 percent vs. 15 percent, P < 0.01) but total hospital stay was still lower in the enhanced recovery after surgery group (P < 0.01). After colonic resection, postoperative complications decreased in enhanced recovery after surgery (37 percent vs. 18 percent, P < 0.05), whereas no change was found after rectal resection.
  
  
  CONCLUSIONS
  Immediately after implementing enhanced recovery after surgery, recovery was improved and length of hospital stay was reduced. Notably, postoperative morbidity decreased only in patients undergoing colonic resection.
authors.affiliation: Center of Gastrointestinal Disease, Ersta Hospital and Karolinska Institutet, Institution of Clinical Sciences at Danderyds Hospital, Stockholm, Sweden. jonas.nygren@erstadiakoni.se
authors.forename: Jonas
authors.initials: J
authors.lastname: Nygren
authors.forename: Mattias
authors.initials: M
authors.lastname: Soop
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
authors.forename: Jonatan
authors.initials: J
authors.lastname: Hausel
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
mesh_terms: D000368:Aged; D001823:Body Composition; D002985:Clinical Protocols; D003108:Colonic Diseases / Q000534:rehabilitation / Q000601:surgery*; D003672:Defecation; D002149:Energy Intake; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D053580:Muscle Strength; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D012002:Rectal Diseases / Q000534:rehabilitation / Q000601:surgery*; D013548:Sweden; D016138:Walking