title: Multimodal approach in colorrectal surgery without mechanical bowel cleansing.
abstract: OBJECTIVE
  To evaluate the outcomes after the implementation of a multimodal protocol (ACERTO protocol) with patients undergoing colorectal operations.
  
  
  METHODS
  Fifty-three patients (37 M and 16 F; 57 [18-82] years old) submitted to various colorectal operations were prospectively studied in two different periods of time: from January 2004 through July 2005 (n=25, conventional group) and from August 2005 through June 2008 (n=28; ACERTO group). The patients received either the traditional perioperative management (including mechanical bowel cleansing) or a multidisciplinary protocol of perioperative care (without mechanical bowel cleansing) established by the ACERTO protocol. We looked at morbidity and mortality rates and length of hospital stay for comparisons between the groups.
  
  
  RESULTS
  Mortality was 3.8% (2 patients) without difference between groups. Preoperative fasting and postoperative feeding were shortened and intravenous fluids were diminished in patients operated under the ACERTO protocol (p<0.05). Postoperative morbidity (36% vs. 28.6%; p=0.56) and the incidence of anastomotic leak (12 vs. 10.7%; p=1.00) were similar. The number of complications per patient with any complication was lower in the ACERTO group (p=0.01). Changing protocols reduced the length of hospital stay by 4.5 days (12 [4-43] vs. 7.5 [3-47] days, p= 0.04).
  
  
  CONCLUSIONS
  The multidisciplinary routines of the ACERTO protocol are safe and enhanced recovery in colorectal surgery by reducing both hospitalization and the severity of postoperative morbidity.
authors.affiliation: Department of Surgery of Faculdade de Ciências Médicas da Universidade Federal do Mato Grosso, MT, Brazil. aguilar@terra.com.br
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: de Aguilar-Nascimento
authors.forename: Alberto
authors.initials: A
authors.lastname: Bicudo-Salomão
authors.forename: Cervantes
authors.initials: C
authors.lastname: Caporossi
authors.forename: Raquel de Melo
authors.initials: Rde M
authors.lastname: Silva
authors.forename: Eduardo Antonio
authors.initials: EA
authors.lastname: Cardoso
authors.forename: Tiago Pádua
authors.initials: TP
authors.lastname: Santos
authors.forename: Breno Nadaf
authors.initials: BN
authors.lastname: Diniz
authors.forename: Arthur André
authors.initials: AA
authors.lastname: Hartmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D055815:Young Adult