First ERAS experience with good results in a university hospital

Initial goals: Our first goal was to introduce ERAS protocol for colorectal surgery for the first time in our hospital. Then, we tried to satisfy the majority of proposed items and we evaluated patients for a mean follow-up of 36 months, 30 day mortality and patients compliance to the protocol. Plan: We use an Excel database open to all the surgical equipment, in order to allow anyone to modify an to correct it. We used to discuss partial results once a month, so we were able to modify surgical and preoperative strategies with work in progress. We used a standardized surgical approach: patients were operated by two senior surgeons with the same equipment every time, tracers were placed in same position and the surgical device (staplers, energy devices) were not changed during this period. We've recently introduced the ICG view. In order to gain best results, we elaborate our protocol within multidisciplinary team (surgeons, anesthesiologists, nurses). Success measures: We evaluated the application of all considered items, the statistical analyst of results, an in particular about anastomotic leak, length of hospitalization, first flatus and first stool day, post-operative day patient was ready to be discharged. How did you overcome any problems? Surgical complications were treated depending on clinical manifestation and patients conditions; complications were classified within Clavien-Dindo score. The database was checked both during the data collection and at the end by two different members of the team. Team misunderstanding (for example between different specialists) and old surgeons (and patients) cultural heritage were discussed time by time and we tried to be as close as possible to ERAS protocol, although we've never forced patients to do anything they we're not confident. What is next for your team? We hope to compete all items described by ERAS society protocol within laparoscopic colorectal surgery, starting even with IBD surgery. If possible, we hope there will soon be a new European audit of ERAS Society as it's already been for European Society of ColoProctology (ESCP).