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Enhanced recovery after colorectal surgery

Rocco Ricciardi, MD, MPH
Graham MacKay, MBChB, FRCS, FFST, MD
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Enhanced recovery, otherwise known as "fast-track" programs, are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. Enhanced recovery protocols for colorectal surgery patients were developed to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery [1]. Organization and effectiveness of an enhanced recovery protocol requires participation and commitment from a multidisciplinary team, including surgeons, anesthesiologists, nursing staff, social services, and hospital administration.


Initially, enhanced recovery after surgery (ERAS) protocols converted many operations performed as inpatient to outpatient "day surgery" procedures. As experience developed with these protocols, the principles of enhanced recovery were applied to increasingly complex procedures to reduce hospital length of stay and expedite return to baseline health and functional status.

The goals of enhanced recovery protocols include attenuating the surgical stress response and reducing end organ dysfunction through integrated preoperative, intraoperative, and postoperative pathways. Discharge criteria with ERAS are similar to those of traditional care, but patients receiving ERAS care meet the discharge criteria sooner [1].


Enhanced recovery after surgery (ERAS) consists of a protocol of evidence-based techniques to reduce surgical trauma and postoperative stress by minimizing pain, reducing complications, improving outcomes, and decreasing hospital length of stay while expediting recovery following elective procedures.


Enhanced recovery after surgery (ERAS) protocols include three elements combined to form a multimodal pathway:


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Literature review current through: May 2017. | This topic last updated: Apr 19, 2017.
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