CR Post
Colorectal Process Measures
Post Op
Compliance Audit
Post-op
Compliance Measures to Capture
Time to First Post-op
Chemoprophylaxis Dose
ACS-ISCR (p.46)
Mechanical and Pharmacological
"All patients benefit from mechanical thromboprophylaxis achieved with compression stockings and/or intermittent pneumatic compression during hospitalization or until mobilized"
"A single daily administration of low molecular weight heparin..."
see ASRA guidelines if epidural
ERAS 2018 (p.667-8)
Early Mobilization
ERAS 2018 (p.682-3)
ASCRS-SAGES 2017 (p.770)
"Time to first ambulation-any distance"
10 feet or more
2 minutes of more
ACS-ISCR (p.47)
"Date First BID mobilization"
("optional")
ACS-ISCR (p.49)
POWERS 2019 (P < 0.001)
"Move at least to arm chair in first 12 hours post-op"
Compliance 49%
Early Feeding
ASCRS-SAGES (p.770)
"Time to first ordered clear liquids after surgery"
ACS-ISCR (p.48)
Oral liquids first 6 hours
Powers 2019 (P < 0.001)
Compliance 48%
"usually start clears w/in 4 hours"
ERAS 2018 (p.678)
"Time to first ordered solids after surgery"
ACS-ISCR (p.50)
ERAS 2018 (p.681-2)
IV Maintenance Fluid Stopped
"date and time"
ACS-ISCR (p.53)
(optional)
"preferably stopped by POD #1"
ERAS 2018 (p.678)
Stopped after PACU discharge
Fluids then given when indicated
ASCRS-SAGES (p.772)
First 24 hours Fluid balance < 1500 ml
POWERS 2019 (P < 0.001)
Compliance 81%
Urinary Catheter Removal
"Date and time of urinary catheter Removal"
> 48 hours defined as "prolonged"
ACS-ISCR (p.51-2)
Removed by 48 hours
Powers 2019 (P < 0.001)
Compliance 73%
"catheterization for 1 to 3 days"
"special considerations pelvic surgery"
ERAS 2018 (p.679-70)
ASCRS-SAGES (p.772)
Multi-modal Analgesia
2 within 48 hours post op
Acetaminophen
Gabapentinoid
(sedation concerns)
Ketamine
Intravenous Lidocaine Infusion
Regional Anesthesia
(liposomal bupivacaine in wounds?)
NSAID
(some concern with anastomotic leaks)
ACS-ISCR (p.45)
ERAS 2018 (p.674-5)
Possible
Single Pre-op Dose
Gabapentin (300mg PO)
ERAS 2018 p.667
(Thoracic) Epidural in Open
(Thoracic Epidural not placed in Laparoscopic)
> 1 analgesic drug in laparoscopic
Powers 2019 (P < 0.001)
Compliance 87%
ERAS 2018 (p.675)
ASCRS-SAGES 2017 (p.766)
Postop
Data Points to Capture
Avoid Drains
Powers 2019 (P < 0.001)
Compliance 39%
Postop
Data to Consider
Glycemic Control
< 180g/dL
Powers 2019 (P = 0.19)
Compliance 82%
ERAS 2018 (p.681)
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
