What are the risk factors of failure of enhanced recovery after right colectomy? Results of a prospective study on 140 consecutive cases

Failure of enhanced recovery after surgery: what is it?

“…The effectiveness of ERPs is now well established. Nevertheless, in recent years several authors have addressed the failure of enhanced recovery programmes in colorectal surgery [2][3][4][5][6]. In doing so they raise the question of what precisely is meant by failure of an ERP, as the criteria for failure vary markedly in the literature.…”

“…In many recent studies, the main criterion of failure was postoperative length of stay (POLOS), which varied widely from more than 5 days [3,4] to more than 7-8 days. [2,5] Other criteria of failure were postoperative nausea/vomiting (PONV) precluding early oral feeding and/or postoperative ileus (POI) [5], or unplanned readmission, complications or death [3].…”

“…Extra-corporeal anastomosis was used in some studies [2,5], and it has been clearly demonstrated in several meta-analyses that extra-corporeal anastomosis is associated with a higher rate of POI [13,14]. In neither paper [2][3][4][5] did the authors detail the actual implementation of every ERP measure. It is known with a high level of evidence that the more measures that are implemented the more beneficial an ERP is in terms of recovery and postoperative course (morbidity, quality of life and POLOS) [11,12].…”

“…The surgical technique also plays a major role in preventing POI. Extra‐corporeal anastomosis was used in some studies [2,5], and it has been clearly demonstrated in several meta‐analyses that extra‐corporeal anastomosis is associated with a higher rate of POI [13,14]. In neither paper [2–5] did the authors detail the actual implementation of every ERP measure.…”

“…Severe postoperative complications are thus not a failure of ERP per se , but rather adverse events that can occur after colorectal surgery. PONV and/or POI occurred in one study [5] despite the systematic use of prophylaxis with dexamethasone and ondansetron. We know, however, that predictive factors for POI include the perioperative fluid infusion regime (whether intra‐ or postoperative), early feeding or the use of opioids for analgesia.…”