CR Intra
Colorectal Process Measures
Intraop
Compliance Audit
Intra-op
Compliance Measures to Capture
Regional Anesthesia
Thoracic epidural for open
ASCRS-SAGES 2017 (p.766)
Consideration for ESP catheters?
and for laparoscopic
No Epidural
Place
TAP block
(Transversus Abdominis Plane)
ERAS 2018 (p.677)
or
Intrathecal Narcotics
ACS-ISCR (p.43)
ERAS 2018 (p.676)
In postop tracking
"multi-modal"
Epidural for Open
>1 analgesic for laparoscopic
Powers 2019 (P < 0.001)
87% compliance
For Laparoscopic
Consider Liposomal Bupivacaine
in Wounds
ERAS 2018 (p.675-6)
ASCRS-SAGES 2017 (p.766)
PONV Prophylaxis
(Pre and/or Intraop)
1 agent
ACS-ISCR (p.44)
POWERS 2019 (P = 0.60)
Compliance 72%
1 to 3 agents
ERAS 2018 (p.665)
ASCRS-SAGES 2017 (p.767)
Consider:
"at least 2 classes of agents given including preop"
Multi-Modal Analgesia
Tracked in Post Op
ACS-ISCR (p.45)
Powers 2019 (P < 0.001)
87% compliance
ERAS 2018 (p.674-5)
ASCRS-SAGES 2017 (p.766)
Intraop
Data Points to Capture
Laparoscopic
Powers 2019 (P < 0.001)
Compliance 66%
ERAS 2018 p 672-3
ASCRS-SAGES 2017 (p.769)
Nasogastric tube
removed before Emergence
Powers 2019 (p = 0.08)
Compliance 61%
ERAS 2018 (p.673-4)
ASCRS-SAGES 2017 (p.769)
Postop Abdominal Drain
No Routine - No Prophylactic
Powers 2019 (P < 0.001)
Compliance 39%
ERAS 2018 (p.673)
ASCRS-SAGES 2017 (p.769-70)
Intraop
Data to Consider
Goal-Directed Fluid Therapy
POWERS 2019 (P = 0.75)
Compliance 40%
"it may not be necessary to offer all patients GDFT, and this should be reserved, after risk stratification, for high risk patients or for patients undergoing high-risk procedures"
"Inotropes should be considered in patients with reduced contractility (cardiac index < 2.5 L/min)"
ERAS 2018 p.671
"In high-risk patients and in patients undergoing major colorectal surgery associated with significant intravascular losses, the use of goal-directed fluid therapy is recommended".
"In patients treated with ERPs, advancements in perioperative and surgical care seem to have offset the previously demonstrated benefits of GDFT".
"An optimal GDFT algorithm cannot be recommended".
ASCR-SAGES (p.768)
Normothermia
98% compliance
ERAS 2018 p.671-2
IV Antibiotics
99% Compliance
ERAS 2018 (p.667)
Skin Prep
prior to draping
Chlorhexidine-Alcohol-Based
ERAS 2018 (p.668)
References
POWER Study Group 2019: real data
Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery. The Postoperative Outcomes within Enhanced Recovery After Surgery Protocol (POWER) Study
Javier Ripolles-Melchor et at, JAMA Surg 2019;154(8):725-736
