Perioperative Pathways Leading to Better Outcomes

A n enhanced recovery program (ERP) is a set of multimodal, multidisciplinary interventions that are geared toward mitigating the undesirable effects of the surgical stress response.1 The purpose of an ERP is to accelerate postoperative surgical recovery by attenuating the factors that lead to surgical stress. Successful execution of an ERP requires coordination of the multidisciplinary teams, including surgery, anesthesiology, nursing, nutrition, physical therapy, and hospital team members.1 Together, these individuals combine best practices, namely, organization of care and effective clinical management in an evidenced-based framework. Other terminologies have been used to describe this coordination of care. These include enhanced recovery after surgery (ERAS), enhanced recovery pathways, and perioperative surgical home.1 Although there are some variations in focus, the main objectives of these practices are to improve patient care and potentially reduce health care costs.1 Colorectal surgery is among the earliest surgical models to which ERP principles were applied.1 The various elements of an ERP include preoperative patient education, modified preoperative fasting guidelines, preoperative medical optimization, fluid management, the role of bowel preparation, early oral intake, early ambulation, and standardized multimodal analgesic regimens. Specifically, 4 areas of patient care—preoperative medical optimization, pain management, use of bowel Enhanced Recovery: Perioperative Pathways Leading to Better Outcomes