title: Enhanced recovery implementation in colorectal surgery-temporary or persistent improvement?
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) implementation has proven to reduce complication rate and length of hospital stay. Little is known about the sustainability of these results over time. The study aim was to assess the application of ERAS pathway over the first 4 years after initial implementation.
  
  
  METHODS
  This retrospective study analyzed data collected prospectively from 482 consecutive elective colorectal patients operated in 2011 during the ERAS implementation process (n = 66), and after initial implementation in 2012 (n = 136), 2013 (n = 152), and 2014 (n = 128). Auditing ERAS was appraised from different perspectives: adherence with the ERAS protocol, clinical outcomes, and functional recovery. Patients were compared by year.
  
  
  RESULTS
  The groups were similar in terms of demographics and surgical strategies. Length of stay remained stable at 7 days without significant variation over time (p = 0.741). The 30-day complications and readmission rates were not statistically different (respectively p = 0.068 and p = 0.639). There was also no difference in functional recovery, more particularly, first flatus occurred at day 2 (p = 0.177), pain was adequately controlled with oral analgesics at day 2 (p = 0.111), and patients were mobilized more than 4 h the first postoperative day in more than 60 % of cases (p = 0.343). Overall adherence with the ERAS pathway was 73 % during implementation and, respectively, 73 and 77 % for 2012 and 2013 after initial implementation (p = 0.614). A significant decrease between 2013 (77 %) and 2014 (73 %) was observed (p = 0.032).
  
  
  CONCLUSIONS
  Application of the institutional ERAS pathway could be maintained in the first 4 years after implementation leading to sustained improved functional recovery and clinical outcome.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Roulin
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: Addor
authors.affiliation: Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland. demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003082:Colectomy; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal surgery; Enhanced recovery; Implementation; Sustainability