American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery

Abstract

The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

Integrating perioperative medicine with anaesthesia in India: Can the best be achieved? A review

“…[1819202122232425262728293031323334353637383940414243444546474849] American Society for Enhanced Recovery and Perioperative Quality Initiative has recently (2018) issued joint consensus statements on optimal analgesia, prevention of postoperative infection, patient-reported outcome and postoperative gastrointestinal dysfunction within an ERAS pathway for colorectal surgery which were hitherto grey areas of the ERAS protocol, ushering an era of evidence-based perioperative medicine. [53545556575859] Return to intended oncotherapy is another recent parameter and time to adjuvant chemotherapy post colorectal cancer surgery is associated with an improved survival rate. [60] Besides elective colorectal surgery, ERAS Society guidelines (19 in number; available free from http://erassociety.org website) are now available for pancreaticoduodenectomy, rectal/pelvic surgery, hepatic resection, head and neck surgery with free-flap reconstruction, oesophageal, gastric and lung cancer surgery, radical prostatectomy, gynaecooncologic surgery, breast reconstruction and bariatic surgery.…”

Preoperative carbohydrate loading in diabetic patients undergoing gastrointestinal surgery: A pilot randomized trial

“…Return of gastrointestinal function is crucial for postoperative recovery after gastrointestinal surgery (Hedrick, et al, 2018). Time to rst atus/defecation are widely used variables indicating the return of gastrointestinal function (Short, et al, 2015).…”

Effect of stellate ganglion block on postoperative recovery of gastrointestinal function in patients undergoing surgery with general anaesthesia: a meta-analysis.

“…intestinal motility recovers in 12-24 h, and colonic motility recovers in 3-5 days [17]. The inhibition of GI function can bring about GI dysfunction and discomfort; more seriously, it could lead to systematic in ammation and even to multiple organ dysfunction syndrome [18].…”