Warning: fopen(/home/virtual/colon/journal/upload/ip_log/ip_log_2025-12.txt): failed to open stream: Permission denied in /home/virtual/lib/view_data.php on line 95 Warning: fwrite() expects parameter 1 to be resource, boolean given in /home/virtual/lib/view_data.php on line 96 Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
Skip Navigation
Skip to contents

Ann Coloproctol : Annals of Coloproctology

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Ann Coloproctol > Volume 38(2); 2022 > Article
Original Article
 Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
Mayou Martin T. Tampo1, Mark Augustine S. Onglao1orcid, Marc Paul J. Lopez1, Marie Dione P. Sacdalan1, Ma. Concepcion L. Cruz2, Rosielyn T. Apellido1, Hermogenes J. Monroy III1
Annals of Coloproctology 2022;38(2):109-116.
DOI: https://doi.org/10.3393/ac.2020.09.02
Published online: September 18, 2020

1Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

2Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines

Correspondence to: Mark Augustine S. Onglao, M.D. Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila, Taft Ave, Ermita, Manila 1000, Philippines Tel: +63-9399148310, Fax: +63-85548400 E-mail: maconglao@gmail.com
• Received: May 16, 2020   • Revised: August 15, 2020   • Accepted: September 2, 2020

Copyright © 2022 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next
  • 7,226 Views
  • 312 Download
  • 8 Web of Science
  • 8 Crossref
  • 6 Scopus
Full Article

Download PDF Download PDF

  • Purpose
    This study aims to evaluate surgical outcomes (i.e. length of stay [LOS], 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the Enhanced Recovery After Surgery (ERAS) pathway, and determine its association with the rate of compliance to the different ERAS components.
  • Methods
    This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS.
  • Results
    A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92.0% (SR, 91.8%; CR, 93.1%; RR, 90.7%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.1±6.7 days vs. 10.0±5.4 days, P=0.002) and RR (19.9±11.4 days vs. 16.9±10.5 days, P=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar.
  • Conclusion
    Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.
  • Keywords: Enhanced Recovery After Surgery; Length of stay; Compliance
The concept of “fast-track surgery” or “Enhanced Recovery After Surgery (ERAS)” was pioneered in the 1990s by Professor Henrik Kehlet, an anesthesiologist from Denmark. It is a bundle of “best evidence-based practices” delivered by a multi-professional health care team, with the intention of assisting patients to recuperate expeditiously after surgery [1, 2]. Clinical (or critical) pathways have been described to improve outcomes in various fields of surgery [3-16], including colorectal surgery [17-23]. Clinical pathways designed for the colorectal surgery patient have resulted in decreased hospital length of stay (LOS) and cost; and decreased, or no difference, in morbidity rates when compared to conventional care [17-21, 23-26].
From the year 2010 to 2014, the Division of Colorectal Surgery at the Philippine General Hospital performed an average of 147 stoma closures, 118 colonic surgeries, and 72 rectal surgeries annually. For patients undergoing stoma reversal (SR), the mean hospital LOS was 17.9 days, while the mean postoperative LOS was 9.1 days. The leak rate was 5.47% [27]. With an average of 1,436 admissions per year to be accommodated to an allotted 14 hospital beds [28], prolonged patient hospital stay greatly impacts on the unit’s capacity to cater to a greater number of patients and contributes to delays in admission and eventual management.
The objective of this study was to determine the association of compliance to the ERAS pathway and surgical outcomes and to compare them with outcomes before ERAS implementation for patients undergoing stoma closure and elective colorectal resections within a resource-limited environment.
Study design
This was a prospective cohort study of adult surgical patients admitted by the Division of Colorectal Surgery who underwent any of the following procedures on an elective basis: SR, colon resection (CR), and rectal resection (RR). All patients aged 18 years and above are included in the study. Patients who underwent emergency surgery, had metastatic disease, underwent multivisceral resection, and those undergoing palliative and incomplete tumor resection were excluded from the study. An approval for this study was obtained from the Institutional Ethics and Review Board Committee of Philippine General Hospital (No. (SUR) 2017-087-01) with a waiver for informed consent.
The ERAS pathway
A detailed ERAS pathway was constructed specifically for SR, CR, and RR. All patients were referred to a multidisciplinary team that involved surgeons, anesthesiologists, nurses, nutritionists, and rehabilitation medicine practitioners. Each health care provider accomplished a checklist for the different ERAS components as recommended by the ERAS Society [29, 30]. However, the investigators agreed on some modifications to fit the setting and limitations of our institution. The components of the ERAS pathway with the investigators’ modifications are summarized in Supplementary Fig. 1.
Data collection
Nonsurgical staff research personnel were specifically trained to fill out and complete the data collection form. The data were recorded on an Excel spreadsheet containing information on compliance to ERAS elements, perioperative, and follow-up data. All patients enrolled in the study were followed up until 30 days after discharge to check for development of complications, readmission, reoperation, or unexpected demise.
Outcome
The primary endpoint was to determine the association of compliance to the ERAS pathway and surgical outcomes that included LOS, morbidity, mortality, readmission, and reoperation rates. Secondary endpoint was to retrospectively compare the same outcomes from patients before (pre-ERAS group) and after (ERAS group) the implementation of the ERAS pathway.
Data analysis
A minimum sample size requirement of 89 patients for each procedure was needed to achieve an 80% power and a level of significance of 10% for a 2-sided test of hypothesis using simple logistic regression analysis. This computation was based on a 50% expected probability of having a disease postoperatively among patients who were noncompliant to ERAS and a corresponding odds ratio (OR) of 0.33 (describing the odds of having a disease postoperation among ERAS compliant patients). The computation was performed using PASS 2008 (NCSS, LLC, Kaysville, Utah, USA). Descriptive statistics were used to summarize the demographic and clinical characteristics of the patients. Frequency and proportion were used for categorical variables, and mean and standard deviation for normally distributed continuous variables. The ORs and corresponding 95% confidence intervals (CIs) from binary logistic regression were computed to determine if ERAS percent compliance was associated with multiple outcomes such as prolonged LOS, prolonged preoperative stay, prolonged postoperative stay, and morbidity. Null hypotheses were rejected at 0.05 α-level of significance. Stata ver. 13.1 (Stata Corp., College Station, TX, USA) was used for data analysis. The Student t-test, Fisher exact, and 2× 2 chi-square test were used, as appropriate, to determine statistical difference between the pre-ERAS and the ERAS groups.
A total of 267 patients were enrolled in the ERAS pathway. Eighty-nine patients were enrolled for each surgical type—SR, CR, and RR. The mean age for SR, CR, and RR were 48, 55, and 59 years, respectively. The patients who underwent CR and RR were mostly cancer patients (CR, 86 of 89; RR, 89 of 89). An open procedure was done on all SR patients, 73.0% for CR, and 75.3% for RR. For SR, majority were ileostomy closure (70.8%). Majority of SR patients had no malnutrition risk (62.9%), CR patients mostly had a mild malnutrition risk (85.4%), and RR patients mostly had a moderate risk (80.9%). Majority of SR and CR (57.3%, respectively) were performed by senior residents; they are the residents of Department of General Surgery who are in the 4th and 5th year of their training. The rest of SR were performed by junior residents (33.7%); they are the residents of Department of General Surgery in their 3rd year of training. For CR, 38.2% were performed by Fellows; they are colorectal specialists in training. These cases were mostly laparoscopic cases. For RR, majority (70.8%) was performed by colorectal specialists-in-training. The consultants are colorectal specialists and they are mostly in supervisory roles during the procedures. The rest of the demographics and clinical profiles of the patients included in the study are shown in Table 1.
The average compliance of all patients to the ERAS pathway was 92.1% (SR, 91.8%; CR, 93.1%; and RR, 90.7%) and is summarized in Table 2. Logistic regression analysis (Table 3) showed that there was an associated decrease in morbidity rates in SR, CR, and RR, as compliance to the different ERAS elements increased with an OR of 0.96 (95% CI, 0.92–0.99; P=0.012). The compliance for each ERAS category is shown in Table 4.
The outcomes obtained after ERAS implementation was compared retrospectively to the outcomes before ERAS. This includes hospital LOS, overall morbidity rate, reoperation rate, mortality rate, and readmission rates. Comparing the 2 time periods, there was a significant reduction in the overall total LOS (15.9±9.9 days vs. 13.7±8.3 days, P=0.002) and postoperative LOS (7.9±5.6 days vs. 5.8±4.4 days, P<0.001) after ERAS implementation. The overall morbidity rate was noted to be increased (5.2% vs. 29.2%, P<0.001), however, the reoperation rate (5.2% vs. 7.5%, P=0.20) and mortality rate (0.4% vs. 0.4%, P>0.99) had no significant difference. These findings are summarized in Table 5.
Clinical pathways provide detailed guidance in every step in the management of patients with a specific condition over a given time period, and include progress and outcome details. These aim to improve the continuity and coordination of care across varying disciplines and sectors within the hospital setting. Focus is given to quality and coordination of care among members of a multidisciplinary team [31].
The ERAS protocol was developed in Europe in 2001 and formed the ERAS Study Group. Their goal was to improve not the speed, but the quality of recovery. This concept used a multidisciplinary approach, using scientific and evidence-based protocols, followed by a change in management with an interactive and continuous audit [32]. The combination of these various methods was assumed to lead to earlier postoperative recovery, avoidance of medium-term sequelae of conventional postoperative care, and reduction of hospital stay leading to a decrease in the cost of hospitalization [18]. Applying these principles to clinical practice, meta-analyses by Varadhan et al. [24] and Zhuang et al. [26] have demonstrated that the use of an ERAS protocol versus conventional perioperative care among colorectal patients has reduced hospital LOS, without resulting in differences in complication, readmission, and mortality rates.
The utility of clinical pathways results in standardization of patient care, reduction of hospital LOS, more judicious allocation of resources, and decreased costs without compromising outcome. Compared to conventional practice, which is largely a conundrum of handed-down practices supported by experiential substantiation, the processes involved in a clinical pathway present a more logical, holistic, and evidence-based practice. Evidence of an effective and beneficial clinical pathway process may allow for not only improved patient outcomes, but improved delivery of limited health services as well—a concern that is very much felt in our setting. The Division of Colorectal Surgery handles 1,436 admissions per year with a limited capacity of 14 elective beds [28]. The decreased LOS that can be gained by following the ERAS pathway provides a safe and faster turn-over rate to help our unit cater to more patients and increase our efficiency, particularly in cancer care.
A source of apprehension in implementing ERAS and facilitating earlier patient discharge, particularly for patients who have complications that may have only appeared after they have been sent home, is the potential for readmission. Delaney et al. [33] demonstrated that patients with high levels of comorbidity who underwent complex colorectal surgery have benefited from an ERAS program, with rapid recovery and early discharge with low complication and readmission rates.
In our study, the majority of the patients enrolled under the ERAS protocol were with significant comorbidities and underwent major abdominal and pelvic resections. All patients enrolled in our study were well-informed by a nurse navigator of symptoms that should alert them to seek immediate medical consult, prior to their discharge. Medical care is made accessible to the patient and the caregiver such that in the event that a complication or morbidity is suspected, they can easily contact the nurse navigator and an immediate consult is scheduled for prompt patient assessment by the surgical team. Our results showed a complication rate of 29.2%, a readmission rate of 10.9%, and a reoperation rate of 7.5% (Table 5).
Better outcomes were also observed with better compliance to the ERAS protocol [34, 35]. Our study showed that there was an associated decrease in morbidity rates across all types of surgery as compliance to the different ERAS elements increased (Table 3). Patients that were ≥ 90% adherent to ERAS were less likely to have morbidity. Looking at the compliance of each individual ERAS component (Table 4), the authors believe that had the most important components that have the most impact on outcomes were compliance to standard anesthetic protocol, drainage of peritoneal cavity, and preoperative fluid management.
The implementation of an ERAS protocol has been repeatedly cited in the literature to reduce hospital stay [36-39]. In this study, the mean hospital LOS after ERAS implementation (total LOS, 13.7±8.3 days) was higher compared to the ones reported in the literature by Miller et al. [40] (4.6±3.6 days) and Thiele et al. [41] (6±4.2 days). A primary reason is the patient’s need for admission for supervised implementation of a nutritional plan as many of our patients are in a state of malnutrition on initial presentation. Also, our patients cannot afford nutritional supplements at home, but they can get them for free if they are admitted. This is especially true for patients undergoing CRs. The longer hospital stay may be further explained by certain inefficiencies inherent to our system. Our hospital does not offer a same-day admission and operation. The patients are required to be admitted one to 2 days prior to surgery before they can be scheduled in the operating room. There is also the problem of limited slots in the operating room schedule. There are situations where a patient’s scheduled surgery may be deferred if the early morning cases were extended beyond the allotted time.
On the other hand, the postoperative LOS seems to be improved. The patients after ERAS implementation had a mean postoperative LOS of 5.8±4.4 days. This is slightly higher compared to 4.1 days reported by Sarin et al. [42], and almost similar to 5.66±4.8 days reported by Wahl et al. [43].
Comparing hospital LOS between the 2 time periods (before ERAS vs. after ERAS implementation), it was noted that the overall hospital stay was significantly reduced after ERAS implementation (15.9±9.9 days vs. 13.7±8.3 days, P=0.002). The postoperative LOS was also significantly reduced (7.9±5.6 days vs. 5.8±4.4 days, P<0.001) and was also observed across all types of surgery (SR: 6.25 days vs. 5.10 days, P=0.04; CR: 9.42 days vs. 5.98 days, P<0.001; RR: 8.63 days vs. 6.53 days, P=0.001). This finding is proof that, at least in our institution, ERAS implementation had a significant impact in terms of hospital LOS. A shorter hospital LOS, theoretically, translates to a faster turnaround time for managing patients by the hospital’s colorectal unit.
It was also widely demonstrated in the literature that implementation of ERAS decreased complications after colorectal surgery [24]. This was also confirmed with a meta-analysis as reported by Greco et al. [44]. In our study, overall complications increased after ERAS implementation as compared to our data before ERAS. This is because the ERAS pathway provided a platform for caregivers to be more vigilant in detecting surgical morbidities. As part of the protocol, patients enrolled in the ERAS pathway have a checklist that was filled out by the different members of the ERAS team before, during, and after operation. Moreover, an ERAS nurse navigator is in constant communication with the patients even after the patients are discharged from the hospital. Strict adherence to this protocol led to an increased reporting of complications. In comparison with the records before ERAS, it was noted that during ERAS implementation, the documentation of surgical morbidities dramatically improved. Table 6 shows a summary of how morbidities were reported before and after ERAS.
Even with increased morbidity noted after ERAS, comparison of the reoperation rate before and after ERAS was noted to be similar (5.2% vs. 7.5%, P=0.20). The mortality rate was also similar (0.4% vs. 0.4%, P>0.99) (Table 5). In addition, before the ERAS was implemented, the data on patient readmission was not reported. With the ERAS pathway in place, we were able to document our readmission rates at 10.86%, which was only slightly higher (vs. 9.2%) than that reported in the literature [45].
In conclusion, increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

FUNDING

None.

Supplementary materials for this study are presented online (available at https://doi.org/10.3393/ac.2020.09.02).

Supplementary Fig. 1.

Philippine General Hospital-Enhanced Recovery After Surgery (PGH-ERAS) modifications used in the study
ac-2020-09-02-suppl.pdf
Table 1.
Demographic and clinical profile of patient under the ERAS pathway (University of the Philippines-Philippine General Hospital in 2015–2018)
Variable Stoma closure Colon surgery Rectal surgery
No. of patients 89 89 89
Age (yr) 48.7 ± 15.6 55.4 ± 55.4 59.4 ± 11.5
Sex
 Male 53 (59.6) 44 (49.4) 55 (61.8)
 Female 36 (40.4) 45 (50.6) 34 (38.2)
Operative time (min) 98.6 ± 83.4 221.1 ± 286.3 258.7 ± 121.9
Estimated blood loss (mL) 42.5 ± 82.3 314.0 ± 360.8 441.1 ± 514.5
Surgical approach
 Ileostomy, parastomal 53 (59.6) 0 (0) 0 (0)
 Ileostomy, midline 10 (11.2) 0 (0) 0 (0)
 Colostomy, parastomal 17 (19.1) 0 (0) 0 (0)
 Colostomy, midline 4 (4.5) 0 (0) 0 (0)
 Hartmann reversal 5 (5.6) 0 (0) 0 (0)
 Laparoscopic 0 (0) 24 (27.0) 22 (24.7)
 Open 0 (0) 65 (73.0) 67 (75.3)
Diagnosis
 Benign 53 (59.6) 2 (2.2) 0 (0)
 Malignant 36 (40.4) 87 (97.8) 89 (100)
Age-combined comorbidity index
 0 46 (51.7) 1 (1.1) 0 (0)
 1 17 (19.1) 0 (0) 0 (0)
 2 18 (20.2) 29 (32.6) 25 (28.1)
 3 5 (5.6) 20 (22.5) 32 (36.0)
 4 2 (2.2) 23 (25.8) 26 (29.2)
 5 1 (1.1) 17 (19.1) 6 (6.7)
Nutritional status
 Underweight 3 (3.4) 5 (5.6) 3 (3.4)
 Normal 56 (62.9) 64 (71.9) 59 (66.3)
 Overweight 25 (28.1) 18 (20.2) 17 (19.1)
 Obese 6 (6.7) 2 (2.2) 10 (11.2)
Malnutrition risk
 None 56 (62.9) 0 (0) 0 (0)
 Mild 33 (37.1) 76 (85.4) 16 (18.0)
 Moderate 0 (0) 8 (9.0) 72 (80.9)
 Severe 0 (0) 5 (5.6) 1 (1.1)
Surgeon level
 Junior 30 (33.7) 4 (4.5) 0 (0)
 Senior 51 (57.3) 51 (57.3) 26 (29.2)
 Fellow 8 (9.0) 34 (38.2) 63 (70.8)
 Consultant 0 (0) 0 (0) 0 (0)

Values are presented as number only, mean±standard deviation, or number (%).

ERAS, Enhanced Recovery After Surgery.

Table 2.
Compliance rate of patients under the ERAS pathway (University of the Philippines-Philippine General Hospital in 2015–2018)
Compliance rate (%) Stoma reversal (n = 89) Colon resection (n = 89) Rectal resection (n = 89) Overall (n = 267)
< 50 0 (0) 0 (0) 0 (0) 0 (0)
50–69 0 (0) 0 (0) 1 (1.1) 1 (0.4)
70–89 21 (23.6) 21 (23.6) 20 (22.5) 62 (23.2)
90–100 68 (76.4) 68 (76.4) 68 (76.4) 204 (76.4)
Mean compliance rate (%) 91.8 93.1 90.7 92.1

Values are presented as number (%).

ERAS, Enhanced Recovery After Surgery.

Table 3.
Logistic regression of percent adherence to ERAS protocol to predict morbidity
Adherence Morbidity
 OR (95% CI) P-value
Positive Negative
All patients 79 150
 Actual percent adherence 90.2 ± 7.8 93.0 ± 7.5 0.96 (0.92–0.99) 0.012*
 > 90% adherence 53 (67.1) 122 (81.3) 0.47 (0.25–0.87) 0.017*
 < 90% adherence 26 (32.9) 28 (18.7) 2.14 (1.15–3.99) 0.017*
Colon 25 64
 Actual percent adherence 91.1 ± 6.4 93.9 ± 6.7 0.94 (0.88–1.01) 0.085
 > 90% adherence 17 (68.0) 51 (79.7) 0.54 (0.19–1.53) 0.247
 < 90% adherence 8 (32.0) 13 (20.3) 1.85 (0.65–5.21) 0.247
Rectal 20 25
 Actual percent adherence 88.6 ± 8.5 92.3 ± 9.5 0.95 (0.89–1.02) 0.180
 > 90% adherence 11 (55.0) 21 (84.0) 0.23 (0.06–0.93) 0.039*
 < 90% adherence 9 (45.0) 4 (16.0) 4.30 (1.07–17.17) 0.039*
Stoma 34 61
 Actual percent adherence 90.6 ± 8.2 92.3 ± 7.3 0.97 (0.92–1.03) 0.290
 > 90% adherence 25 (73.5) 50 (82.0) 0.61 (0.22–1.67) 0.336
 < 90% adherence 9 (26.5) 11 (18.0) 1.64 (0.60–4.46) 0.336

Values are presented as number only, mean±standard deviation, or number (%).

ERAS, Enhanced Recovery After Surgery; OR, odds ratio; CI, confidence interval.

*P<0.05.

Table 4.
Compliance rate for each ERAS component (University of the Philippines-Philippine General Hospital in 2015–2018)
No. ERAS component Stoma reversal (%) Colon resection (%) Rectal resection (%)
1 Preoperative information, education, counseling 98.8 100 98.8
2 Preoperative optimization 97.8 95.5 95.5
3 Preoperative bowel preparation 96.6 96.6 100
4 Preoperative fasting/carbohydrate treatment 95.5 97.8 100
5 Preanesthetic medication 96.6 95.5 97.8
6 Prophylaxis against thromboembolism 21.3 69.7 65.0
7 Antimicrobial prophylaxis/skin prep 100 98.8 100
8 Standard anesthetic protocol 82.0 93.3 92.1
9 Postoperative nausea and vomiting 93.3 97.8 96.6
10 Lap/modifications of surgical access 78.7 91.0 87.6
11 Nasogastric intubation 95.5 96.6 93.3
12 Preventing intraoperative hypothermia 91.0 83.1 92.1
13 Perioperative fluid management 94.4 92.1 92.1
14 Drainage of peritoneal cavity 46.1 92.1 67.4
15 Urinary drainage 95.5 95.5 89.9
16 Prevention of postop ileus 93.3 92.2 93.3
17 Postoperative analgesia 93.3 94.4 94.4
18 Early oral intake 95.5 92.2 86.5
19 Perioperative nutritional care 100 100 95.5
20 Postoperative glucose control 98.8 97.8 96.1
21 Early mobilization 97.8 100 98.8

ERAS, Enhanced Recovery After Surgery.

Table 5.
Comparison of outcomes before (2012–2014) and after (2015–2018) ERAS pathway implementation (University of the Philippines-Philippine General Hospital in 2015–2018)
Outcome Stoma reversal
 Colon resection
 Rectal resection
 Overall
Before ERAS (n=188) After ERAS (n=89) P-value Before ERAS (n=112) After ERAS (n=89) P-value Before ERAS (n=164) After ERAS (n=89) P-value Before ERAS (n=464) After ERAS (n=267) P-value
Total LOS (day) 12.06 ± 6.67 10.02 ± 5.43 0.01* 16.46 ± 9.83 14.53 ± 6.9 0.12 19.86 ± 11.38 16.85 ± 10.45 0.04* 15.90 ± 9.91 13.7 ± 8.31 0.002*
Postoperative LOS (day) 6.25 ± 4.31 5.10 ± 4.81 0.04* 9.42 ± 7.25 5.98 ± 3.86 0.001* 8.63 ± 5.27 6.53 ± 0.71 0.001* 7.86 ± 5.63 5.82 ± 4.36 0.001*
Overall morbidity 6 (3.2) 27 (30.3) 0.001* 9 (8.0) 21 (23.6) 0.003* 9 (5.5) 30 (33.7) 0.001* 24 (5.2) 78 (29.2) < 0.001*
Reoperation 6 (3.2) 4 (4.5) 0.73 9 (8.0) 6 (6.7) 0.079 9 (5.5) 10 (11.2) 0.01* 24 (5.2) 20 (7.5) 0.20
Mortality 0 (0) 0 (0) > 0.99 1 (0.9) 0 (0) > 0.99 1 (0.6) 1 (1.1) > 0.99 2 (0.4) 1 (0.4) > 0.99

Values are presented as mean±standard deviation or number (%).

ERAS, Enhanced Recovery After Surgery; LOS, length of stay.

*P<0.05.

Table 6.
Details of morbidities before and after ERAS pathway implementation (University of the Philippines-Philippine General Hospital in 2015–2018)
Morbidity Stoma reversal
 Colon resection
 Rectal resection
No. of cases CD classification No. of cases CD classification No. of cases CD classification
Before ERAS
 Anastomotic leak 6 III 6 III 8 III
 Stricture 1 III
After ERAS
 Ileus 15 I–II 10 I–II 15 I-II
 Anastomotic leak 4 III 5 III 3 III
 Urinary retention 2 II 1 II 3 II
 UTI 1 II
 Pneumonia 1 II
 SSSI 2 I
 Dehydration 1 I
 Diarrhea 1 I 1 I
 Stoma torsion 1 III
 Port site hematoma 1 I
 Seroma 1 I
 Delusion 1 I
 Pelvic abscess 3 III
 Coloanal dehiscence 3 III
 Skin dehiscence 1 III
1 I

ERAS, Enhanced Recovery After Surgery; CD, Clavien-Dindo; UTI, urinary tract infection; SSSI, superficial surgical site infection.

  • 1. Mythen MG, Swart M, Acheson N, Crawford R, Jones K, Kuper M, et al. Perioperative fluid management: consensus statement from the enhanced recovery partnership. Perioper Med (Lond) 2012;1:2. ArticlePubMedPMC
  • 2. Hoffmann H, Kettelhack C. Fast-track surgery: conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res 2012;49:24–34.ArticlePubMed
  • 3. Pande RU, Nader ND, Donias HW, D’Ancona G, Karamanoukian HL. Review: fast-tracking cardiac surgery. Heart Surg Forum 2003;6:244–8.PubMed
  • 4. Cerfolio RJ, Bryant AS, Bass CS, Alexander JR, Bartolucci AA. Fast tracking after Ivor Lewis esophagogastrectomy. Chest 2004;126:1187–94.ArticlePubMed
  • 5. Koval KJ, Chen AL, Aharonoff GB, Egol KA, Zuckerman JD. Clinical pathway for hip fractures in the elderly: the Hospital for Joint Diseases experience. Clin Orthop Relat Res 2004;(425):72–81.Article
  • 6. Rigberg DA, Dorafshar A, Sridhar A, Quinones-Baldrich W, Moore WS. Abdominal aortic aneursym: stent graft vs clinical pathway for direct retroperitoneal repair. Arch Surg 2004;139:941–6.ArticlePubMed
  • 7. Chang SS, Cole E, Smith JA Jr, Baumgartner R, Wells N, Cookson MS. Safely reducing length of stay after open radical retropubic prostatectomy under the guidance of a clinical care pathway. Cancer 2005;104:747–51.ArticlePubMed
  • 8. Soria V, Pellicer E, Flores B, Carrasco M, Candel Maria F, Aguayo JL. Evaluation of the clinical pathway for laparoscopic cholecystectomy. Am Surg 2005;71:40–5.ArticlePubMed
  • 9. Andtbacka RH, Babiera G, Singletary SE, Hunt KK, Meric-Bernstam F, Feig BW, et al. Incidence and prevention of venous thromboembolism in patients undergoing breast cancer surgery and treated according to clinical pathways. Ann Surg 2006;243:96–101.ArticlePubMedPMC
  • 10. Antevil JL, Rivera L, Langenberg BJ, Hahm G, Favata MA, Brown CV. Computed tomography-based clinical diagnostic pathway for acute appendicitis: prospective validation. J Am Coll Surg 2006;203:849–56.ArticlePubMed
  • 11. Madan AK, Speck KE, Ternovits CA, Tichansky DS. Outcome of a clinical pathway for discharge within 48 hours after laparoscopic gastric bypass. Am J Surg 2006;192:399–402.ArticlePubMed
  • 12. Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg 2006;102:1234–9.ArticlePubMed
  • 13. Ho DM, Huo MH. Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations? J Am Coll Surg 2007;205:97–100.ArticlePubMed
  • 14. Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR, et al. Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution: the first step in multidisciplinary team building. J Am Coll Surg 2007;204:917–24.ArticlePubMed
  • 15. Clarke T, Sohn H, Kelso R, Petrosyan M, Towfigh S, Mason R. Planned early discharge-elective surgical readmission pathway for patients with gallstone pancreatitis. Arch Surg 2008;143:901–6.ArticlePubMed
  • 16. Chase DM, Lopez S, Nguyen C, Pugmire GA, Monk BJ. A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology? Am J Obstet Gynecol 2008;199:541. Article
  • 17. Basse L, Jacobsen DH, Billesbølle P, Kehlet H. Colostomy closure after Hartmann’s procedure with fast-track rehabilitation. Dis Colon Rectum 2002;45:1661–4.ArticlePubMed
  • 18. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24:466–77.ArticlePubMed
  • 19. Kremer M, Ulrich A, Büchler MW, Uhl W. Fast-track surgery: the Heidelberg experience. Recent Results Cancer Res 2005;165:14–20.ArticlePubMed
  • 20. Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007;245:867–72.ArticlePubMedPMC
  • 21. Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP. Standardized postoperative pathway: accelerating recovery after ileostomy closure. Dis Colon Rectum 2008;51:1786–9.ArticlePubMed
  • 22. Ludwig K, Enker WE, Delaney CP, Wolff BG, Du W, Fort JG, et al. Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg 2008;143:1098–105.ArticlePubMed
  • 23. Zargar-Shoshtari K, Connolly AB, Israel LH, Hill AG. Fast-track surgery may reduce complications following major colonic surgery. Dis Colon Rectum 2008;51:1633–40.ArticlePubMed
  • 24. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010;29:434–40.ArticlePubMed
  • 25. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011;(2):CD007635. Article
  • 26. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 2013;56:667–78.ArticlePubMed
  • 27. Department of Surgery, University of the Philippines-Philippine General Hospital (UP-PGH). ISIS: Integrated Surgical Information System [Internet]. Manila, UP-PGH; c2006 [cited 2020 May 16]. Available from: https://isis2.upm.edu.ph/isis/users/login
  • 28. Division of Colorectal Surgery, Department of Surgery, University of the Philippines-Philippine General Hospital (UP-PGH). Annual report 2018. Manila, UP-PGH. 2019.
  • 29. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg 2013;37:259–84.ArticlePubMed
  • 30. Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg 2013;37:285–305.ArticlePubMed
  • 31. Napolitano LM. Standardization of perioperative management: clinical pathways. Surg Clin North Am 2005;85:1321–7.ArticlePubMed
  • 32. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017;152:292–8.ArticlePubMed
  • 33. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH. ‘Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001;88:1533–8.ArticlePubMed
  • 34. Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011;146:571–7.ArticlePubMed
  • 35. Gustafsson UO, Oppelstrup H, Thorell A, Nygren J, Ljungqvist O. Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: a retrospective cohort study. World J Surg 2016;40:1741–7.ArticlePubMed
  • 36. Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017;60:761–84.ArticlePubMed
  • 37. Braga M, Pecorelli N, Scatizzi M, Borghi F, Missana G, Radrizzani D, et al. Enhanced recovery program in high-risk patients undergoing colorectal surgery: results from the PeriOperative Italian Society Registry. World J Surg 2017;41:860–7.ArticlePubMed
  • 38. Forsmo HM, Pfeffer F, Rasdal A, Østgaard G, Mohn AC, Körner H, et al. Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial. Colorectal Dis 2016;18:603–11.ArticlePubMed
  • 39. Nelson G, Kiyang LN, Crumley ET, Chuck A, Nguyen T, Faris P, et al. Implementation of Enhanced Recovery After Surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg 2016;40:1092–103.ArticlePubMed
  • 40. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg 2014;118:1052–61.ArticlePubMed
  • 41. Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, McMurry TL, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 2015;220:430–43.ArticlePubMed
  • 42. Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen LL. Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 2016;16:55. ArticlePubMedPMC
  • 43. Wahl TS, Goss LE, Morris MS, Gullick AA, Richman JS, Kennedy GD, et al. Enhanced Recovery After Surgery (ERAS) eliminates racial disparities in postoperative length of stay after colorectal surgery. Ann Surg 2018;268:1026–35.ArticlePubMed
  • 44. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 2014;38:1531–41.ArticlePubMed
  • 45. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 2015;261:1153–9.PubMed

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Enhanced recovery after surgery (ERAS) in stoma reversal surgery: a systematic review and meta-analysis
      Túlio Pimentel, Dante L. S. Souza, Ivonne Zuniga, Maria Clara Faveri, Julia Canfild, Paula Motta Pauperio, Hamza Guend
      Updates in Surgery.2025; 77(2): 297.     CrossRef
    • Surgical Enhanced Recovery: Where Are We Now?
      Anika Tahmeed, Juan P. Cata, Tong J. Gan
      International Anesthesiology Clinics.2025; 63(2): 62.     CrossRef
    • Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting
      Stephen Tolmay, Jamie‐Lee Rahiri, Kim Snoep, Gillian Fewster, Rachel Kee, Yukai Lim, Bridget Watson, Konrad Klaus Richter
      ANZ Journal of Surgery.2024; 94(5): 910.     CrossRef
    • Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
      Chungyeop Lee, In Ja Park
      The World Journal of Men's Health.2024; 42(2): 304.     CrossRef
    • Influence of additional prophylactic oral antibiotics during mechanical bowel preparation on surgical site infection in patients receiving colorectal surgery
      Hayoung Lee, Jong Lyul Lee, Ji Sung Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok‐Byung Lim
      World Journal of Surgery.2024; 48(6): 1534.     CrossRef
    • Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
      Ji Hyeong Song, Minsung Kim
      The Ewha Medical Journal.2024;[Epub]     CrossRef
    • The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
      Min Ki Kim
      The Ewha Medical Journal.2023;[Epub]     CrossRef
    • Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
      In Ja Park
      The Ewha Medical Journal.2023;[Epub]     CrossRef

    • Cite this Article
      Cite this Article
      export Copy Download
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
      Ann Coloproctol. 2022;38(2):109-116.   Published online September 18, 2020
      DOI: https://doi.org/10.3393/ac.2020.09.02
      Close
    • XML DownloadXML Download
    Related articles
    Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
    Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines
    Variable Stoma closure Colon surgery Rectal surgery
    No. of patients 89 89 89
    Age (yr) 48.7 ± 15.6 55.4 ± 55.4 59.4 ± 11.5
    Sex
     Male 53 (59.6) 44 (49.4) 55 (61.8)
     Female 36 (40.4) 45 (50.6) 34 (38.2)
    Operative time (min) 98.6 ± 83.4 221.1 ± 286.3 258.7 ± 121.9
    Estimated blood loss (mL) 42.5 ± 82.3 314.0 ± 360.8 441.1 ± 514.5
    Surgical approach
     Ileostomy, parastomal 53 (59.6) 0 (0) 0 (0)
     Ileostomy, midline 10 (11.2) 0 (0) 0 (0)
     Colostomy, parastomal 17 (19.1) 0 (0) 0 (0)
     Colostomy, midline 4 (4.5) 0 (0) 0 (0)
     Hartmann reversal 5 (5.6) 0 (0) 0 (0)
     Laparoscopic 0 (0) 24 (27.0) 22 (24.7)
     Open 0 (0) 65 (73.0) 67 (75.3)
    Diagnosis
     Benign 53 (59.6) 2 (2.2) 0 (0)
     Malignant 36 (40.4) 87 (97.8) 89 (100)
    Age-combined comorbidity index
     0 46 (51.7) 1 (1.1) 0 (0)
     1 17 (19.1) 0 (0) 0 (0)
     2 18 (20.2) 29 (32.6) 25 (28.1)
     3 5 (5.6) 20 (22.5) 32 (36.0)
     4 2 (2.2) 23 (25.8) 26 (29.2)
     5 1 (1.1) 17 (19.1) 6 (6.7)
    Nutritional status
     Underweight 3 (3.4) 5 (5.6) 3 (3.4)
     Normal 56 (62.9) 64 (71.9) 59 (66.3)
     Overweight 25 (28.1) 18 (20.2) 17 (19.1)
     Obese 6 (6.7) 2 (2.2) 10 (11.2)
    Malnutrition risk
     None 56 (62.9) 0 (0) 0 (0)
     Mild 33 (37.1) 76 (85.4) 16 (18.0)
     Moderate 0 (0) 8 (9.0) 72 (80.9)
     Severe 0 (0) 5 (5.6) 1 (1.1)
    Surgeon level
     Junior 30 (33.7) 4 (4.5) 0 (0)
     Senior 51 (57.3) 51 (57.3) 26 (29.2)
     Fellow 8 (9.0) 34 (38.2) 63 (70.8)
     Consultant 0 (0) 0 (0) 0 (0)
    Compliance rate (%) Stoma reversal (n = 89) Colon resection (n = 89) Rectal resection (n = 89) Overall (n = 267)
    < 50 0 (0) 0 (0) 0 (0) 0 (0)
    50–69 0 (0) 0 (0) 1 (1.1) 1 (0.4)
    70–89 21 (23.6) 21 (23.6) 20 (22.5) 62 (23.2)
    90–100 68 (76.4) 68 (76.4) 68 (76.4) 204 (76.4)
    Mean compliance rate (%) 91.8 93.1 90.7 92.1
    Adherence Morbidity
    		 OR (95% CI) P-value
    Positive Negative
    All patients 79 150
     Actual percent adherence 90.2 ± 7.8 93.0 ± 7.5 0.96 (0.92–0.99) 0.012*
     > 90% adherence 53 (67.1) 122 (81.3) 0.47 (0.25–0.87) 0.017*
     < 90% adherence 26 (32.9) 28 (18.7) 2.14 (1.15–3.99) 0.017*
    Colon 25 64
     Actual percent adherence 91.1 ± 6.4 93.9 ± 6.7 0.94 (0.88–1.01) 0.085
     > 90% adherence 17 (68.0) 51 (79.7) 0.54 (0.19–1.53) 0.247
     < 90% adherence 8 (32.0) 13 (20.3) 1.85 (0.65–5.21) 0.247
    Rectal 20 25
     Actual percent adherence 88.6 ± 8.5 92.3 ± 9.5 0.95 (0.89–1.02) 0.180
     > 90% adherence 11 (55.0) 21 (84.0) 0.23 (0.06–0.93) 0.039*
     < 90% adherence 9 (45.0) 4 (16.0) 4.30 (1.07–17.17) 0.039*
    Stoma 34 61
     Actual percent adherence 90.6 ± 8.2 92.3 ± 7.3 0.97 (0.92–1.03) 0.290
     > 90% adherence 25 (73.5) 50 (82.0) 0.61 (0.22–1.67) 0.336
     < 90% adherence 9 (26.5) 11 (18.0) 1.64 (0.60–4.46) 0.336
    No. ERAS component Stoma reversal (%) Colon resection (%) Rectal resection (%)
    1 Preoperative information, education, counseling 98.8 100 98.8
    2 Preoperative optimization 97.8 95.5 95.5
    3 Preoperative bowel preparation 96.6 96.6 100
    4 Preoperative fasting/carbohydrate treatment 95.5 97.8 100
    5 Preanesthetic medication 96.6 95.5 97.8
    6 Prophylaxis against thromboembolism 21.3 69.7 65.0
    7 Antimicrobial prophylaxis/skin prep 100 98.8 100
    8 Standard anesthetic protocol 82.0 93.3 92.1
    9 Postoperative nausea and vomiting 93.3 97.8 96.6
    10 Lap/modifications of surgical access 78.7 91.0 87.6
    11 Nasogastric intubation 95.5 96.6 93.3
    12 Preventing intraoperative hypothermia 91.0 83.1 92.1
    13 Perioperative fluid management 94.4 92.1 92.1
    14 Drainage of peritoneal cavity 46.1 92.1 67.4
    15 Urinary drainage 95.5 95.5 89.9
    16 Prevention of postop ileus 93.3 92.2 93.3
    17 Postoperative analgesia 93.3 94.4 94.4
    18 Early oral intake 95.5 92.2 86.5
    19 Perioperative nutritional care 100 100 95.5
    20 Postoperative glucose control 98.8 97.8 96.1
    21 Early mobilization 97.8 100 98.8
    Outcome Stoma reversal
    		 Colon resection
    		 Rectal resection
    		 Overall
    Before ERAS (n=188) After ERAS (n=89) P-value Before ERAS (n=112) After ERAS (n=89) P-value Before ERAS (n=164) After ERAS (n=89) P-value Before ERAS (n=464) After ERAS (n=267) P-value
    Total LOS (day) 12.06 ± 6.67 10.02 ± 5.43 0.01* 16.46 ± 9.83 14.53 ± 6.9 0.12 19.86 ± 11.38 16.85 ± 10.45 0.04* 15.90 ± 9.91 13.7 ± 8.31 0.002*
    Postoperative LOS (day) 6.25 ± 4.31 5.10 ± 4.81 0.04* 9.42 ± 7.25 5.98 ± 3.86 0.001* 8.63 ± 5.27 6.53 ± 0.71 0.001* 7.86 ± 5.63 5.82 ± 4.36 0.001*
    Overall morbidity 6 (3.2) 27 (30.3) 0.001* 9 (8.0) 21 (23.6) 0.003* 9 (5.5) 30 (33.7) 0.001* 24 (5.2) 78 (29.2) < 0.001*
    Reoperation 6 (3.2) 4 (4.5) 0.73 9 (8.0) 6 (6.7) 0.079 9 (5.5) 10 (11.2) 0.01* 24 (5.2) 20 (7.5) 0.20
    Mortality 0 (0) 0 (0) > 0.99 1 (0.9) 0 (0) > 0.99 1 (0.6) 1 (1.1) > 0.99 2 (0.4) 1 (0.4) > 0.99
    Morbidity Stoma reversal
    		 Colon resection
    		 Rectal resection
    No. of cases CD classification No. of cases CD classification No. of cases CD classification
    Before ERAS
     Anastomotic leak 6 III 6 III 8 III
     Stricture 1 III
    After ERAS
     Ileus 15 I–II 10 I–II 15 I-II
     Anastomotic leak 4 III 5 III 3 III
     Urinary retention 2 II 1 II 3 II
     UTI 1 II
     Pneumonia 1 II
     SSSI 2 I
     Dehydration 1 I
     Diarrhea 1 I 1 I
     Stoma torsion 1 III
     Port site hematoma 1 I
     Seroma 1 I
     Delusion 1 I
     Pelvic abscess 3 III
     Coloanal dehiscence 3 III
     Skin dehiscence 1 III
    1 I
    Table 1. Demographic and clinical profile of patient under the ERAS pathway (University of the Philippines-Philippine General Hospital in 2015–2018)

    Values are presented as number only, mean±standard deviation, or number (%).

    ERAS, Enhanced Recovery After Surgery.

    Table 2. Compliance rate of patients under the ERAS pathway (University of the Philippines-Philippine General Hospital in 2015–2018)

    Values are presented as number (%).

    ERAS, Enhanced Recovery After Surgery.

    Table 3. Logistic regression of percent adherence to ERAS protocol to predict morbidity

    Values are presented as number only, mean±standard deviation, or number (%).

    ERAS, Enhanced Recovery After Surgery; OR, odds ratio; CI, confidence interval.

    P<0.05.

    Table 4. Compliance rate for each ERAS component (University of the Philippines-Philippine General Hospital in 2015–2018)

    ERAS, Enhanced Recovery After Surgery.

    Table 5. Comparison of outcomes before (2012–2014) and after (2015–2018) ERAS pathway implementation (University of the Philippines-Philippine General Hospital in 2015–2018)

    Values are presented as mean±standard deviation or number (%).

    ERAS, Enhanced Recovery After Surgery; LOS, length of stay.

    P<0.05.

    Table 6. Details of morbidities before and after ERAS pathway implementation (University of the Philippines-Philippine General Hospital in 2015–2018)

    ERAS, Enhanced Recovery After Surgery; CD, Clavien-Dindo; UTI, urinary tract infection; SSSI, superficial surgical site infection.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Table 6.

    Ann Coloproctol : Annals of Coloproctology Twitter Facebook
    © Korean Society of Coloproctology.
    TOP