Compliance with enhanced recovery programmes in elective colorectal surgery.
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols are often criticized for being difficult to implement outside clinical trials. This audit evaluated compliance with an ERAS protocol and compared it with that during a trial.


METHODS
Compliance was audited by case-note review of 100 consecutive patients undergoing colorectal surgery. This was compared with the compliance in a group of 95 patients who participated in a clinical trial.


RESULTS
Fewer patients in the audit group than in the study group received preoperative oral carbohydrate loading (61.0 versus 96 per cent; P < 0.001), a transverse incision (25.0 versus 39 per cent; P = 0.037), early fluid and diet reintroduction (73.0 versus 99 per cent; P < 0.001), and non-opiate postoperative oral analgesia (70.0 versus 99 per cent; P < 0.001). Lower non-opiate oral analgesia use in the audit group was not associated with a commensurate increase in opiate use (P = 0.061). There was no difference between groups in length of hospital stay (median (interquartile range) 7 (5-8) versus 6 (5-7) days respectively), septic morbidity or 30-day mortality rates.


CONCLUSIONS
Observance to some aspects of the ERAS protocol was lower outside the clinical trial. However, this made little difference to patient outcome.
Combined Gastroenterology Research Unit, Scarborough Hospital, Woodlands Drive, Scarborough YO12 6QL, UK.
J
J
Ahmed
S
S
Khan
M
M
Gatt
R
R
Kallam
J
J
MacFie
D000368:Aged; D015179:Colorectal Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004326:Drinking; D017558:Elective Surgical Procedures / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012189:Retrospective Studies
D004040:Dietary Carbohydrates