Enhanced recovery after non-elective colorectal surgery: Is it time for emergency general surgeons to follow suit?

BACKGROUND

Surgical dogma suggests that enhanced recovery (ERAS) pathways are not feasible in the non-elective setting. This study challenges that dogma with the implementation of ERAS in non-elective colorectal surgery.

METHODS

Single center review of all colorectal operations was performed following implementation of ERAS in non-elective colorectal surgery. Compliance and outcomes between elective and non-elective operations were compared.

RESULTS

142 elective and 116 non-elective operations were performed with a compliance rate of 84 ​% and 46 ​%, respectively. Acceptable compliance was achieved with 7 metrics in the non-elective cohort. Elective operations were associated with an average LOS of 3 days and a 1 ​% SSI rate, compared to 8 days and 15 ​% in the non-elective group. On multivariate analysis, five ERAS metrics were associated with SSI.

CONCLUSIONS

ERAS pathways are often neglected in non-elective surgery. Acute Care Surgeons should recognize the ERAS principles that are appropriate for their patient population and implement these strategies into practice.