title: Enhanced recovery after surgery protocols - compliance and variations in practice during routine colorectal surgery.
abstract: OBJECTIVE
  Although there are numerous studies on the efficacy of enhanced recovery after surgery (ERAS) protocols in reducing length of stay, the long-term compliance to such protocols in routine clinical practice has not been well documented. The aim of this study was to review the published literature on compliance to ERAS in patients undergoing colorectal surgery in routine clinical practice.
  
  
  METHODS
  Medline, Embase and PubMed databases were searched to identify studies that focused on compliance to ERAS protocols during routine clinical practice. Fourteen studies fulfilled the inclusion criteria and a total of 19 perioperative ERAS modalities were identified across these studies.
  
  
  RESULTS
  None of the studies used all 19 ERAS modalities within their ERAS protocols. Compliance to the various modalities varied considerably between studies and, in general, was poorest during the postoperative period. The use of epidural had the highest compliance (between 67 and 100%), whereas the use of transverse incisions (25%) had the lowest compliance. Length of stay in hospital ranged from 2 to 13 days. Higher compliance was associated with a reduced length of hospital stay. However, reduced length of hospital stay was associated with a high rate of readmission.
  
  
  CONCLUSIONS
  There is significant variation in the components of, as well as in compliance to, ERAS protocols in daily practice. This may contribute to the observed variation between the studies in length of hospital stay. A standardized and practically feasible ERAS protocol should be established in order to improve the implementation and optimal outcome.
authors: Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough, UK. drjag@hotmail.co.uk
authors: J
authors: J
authors: Ahmed
authors: S
authors: S
authors: Khan
authors: M
authors: M
authors: Lim
authors: T V
authors: TV
authors: Chandrasekaran
authors: J
authors: J
authors: MacFie
mesh_terms: D003107:Colorectal Surgery / Q000379:methods / Q000706:statistics & numerical data*; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D020127:Recovery of Function