title: Enhanced recovery after surgery vs conventional care in emergency colorectal surgery.
abstract: OBJECTIVE
  To investigate the feasibility and beneficial effects of enhanced recovery after surgery (ERAS) programme in the setting of emergency colorectal surgery.
  
  
  METHODS
  Between January 2011 and October 2013, patients undergoing emergency resection for obstructing colorectal cancer at the Faculty of Medicine Siriraj Hospital, Bangkok, Thailand using ERAS programme were compared with those using conventional care (1:2 ratio). They were matched for their age, gender, ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity score, and type of surgery. Primary outcomes were length of hospital stay and postoperative morbidity. Secondary outcomes included gastrointestinal recovery, 30-d readmission, and time interval from surgery to chemotherapy.
  
  
  RESULTS
  Twenty patients treated with ERAS programme were compared with 40 patients receiving conventional postoperative care. Median of hospital stay was shorter in the ERAS group: 5.5 d (range: 3-16) vs 7.5 d (range: 5-25), P = 0.009. The ERAS group had a non-significant reduction in the incidence of postoperative complication (25% vs 48%, P = 0.094). No 30-d mortality and readmission occurred. Patients with ERAS programme had a shorter time to first flatus (1.6 d vs 2.8 d, P < 0.001) and time to resumption of normal diet (3.5 d vs 5.5 d, P = 0.002). Time interval between operation and initiation of adjuvant chemotherapy was significantly shorter in the ERAS group (37 d vs 49 d, P = 0.009).
  
  
  CONCLUSIONS
  The ERAS programme in the setting of emergency colorectal surgery was safe and feasible. It achieved significantly shorter hospitalisation and faster recovery of bowel function.
authors.affiliation: Varut Lohsiriwat, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000534:rehabilitation*; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal cancer; Emergency surgery; Enhanced recovery after surgery; Enhanced recovery programme; Obstruction; Outcome