Clin Colon Rectal Surg 2019; 32(02): 138-144
DOI: 10.1055/s-0038-1676480
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patient Satisfaction and Quality of Life with Enhanced Recovery Protocols

Debbie Li
1   Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Christine C. Jensen
1   Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2019 (online)


While studies have demonstrated the benefits of Enhanced Recovery after Surgery (ERAS) programs in reducing length of stay and costs without increasing complications, fewer studies have evaluated patient satisfaction and quality of life (QOL) with enhanced recovery protocols. The aim of this project was to summarize the literature comparing satisfaction and quality of life after colorectal surgery following treatment within an ERAS protocol to standard postoperative care. The available evidence suggests patients suffer no detriment to satisfaction or quality of life with use of ERAS protocols, and may suffer less fatigue and return to activities sooner. Most publications reported no adverse effects on postoperative pain. However, a limited number of studies suggest patients may experience increased early postoperative pain with ERAS pathways, particularly following open colorectal procedures. Future research should focus on potential improvements in ERAS protocols to better manage postoperative pain. Overall, the evidence supports more widespread implementation of ERAS pathways in colorectal surgery.

  • References

  • 1 Thiele RH, Raghunathan K, Brudney CS. , et al; Perioperative Quality Initiative (POQI) I Workgroup. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med (Lond) 2016; 5: 24
  • 2 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 1997; 78 (05) 606-617
  • 3 Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg 2017; 152 (03) 292-298
  • 4 Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014; 101 (03) 172-188
  • 5 Stone AB, Grant MC, Pio Roda C. , et al. Implementation costs of an Enhanced Recovery After Surgery Program in the United States: a financial model and sensitivity analysis based on experiences at a quaternary academic medical center. J Am Coll Surg 2016; 222 (03) 219-225
  • 6 Khan S, Wilson T, Ahmed J, Owais A, MacFie J. Quality of life and patient satisfaction with enhanced recovery protocols. Colorectal Dis 2010; 12 (12) 1175-1182
  • 7 Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A. Patients' experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs 2017; 26 (9-10): 1172-1188
  • 8 Khan SA, Ullah S, Ahmed J. , et al. Influence of enhanced recovery after surgery pathways and laparoscopic surgery on health-related quality of life. Colorectal Dis 2013; 15 (07) 900-907
  • 9 Raymond TM, Kumar S, Dastur JK. , et al. Case controlled study of the hospital stay and return to full activity following laparoscopic and open colorectal surgery before and after the introduction of an enhanced recovery programme. Colorectal Dis 2010; 12 (10) 1001-1006
  • 10 Wu CL, Benson AR, Hobson DB. , et al. Initiating an enhanced recovery pathway program: an anesthesiology department's perspective. Jt Comm J Qual Patient Saf 2015; 41 (10) 447-456
  • 11 Pearsall EA, Meghji Z, Pitzul KB. , et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 2015; 261 (01) 92-96
  • 12 Alawadi ZM, Leal I, Phatak UR. , et al. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: a provider and patient perspective. Surgery 2016; 159 (03) 700-712
  • 13 Hughes M, Coolsen MM, Aahlin EK. , et al. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. J Surg Res 2015; 193 (01) 102-110
  • 14 Keller DS, Delaney CP, Senagore AJ, Feldman LS. Uptake of enhanced recovery practices by SAGES members: a survey. Surg Endosc 2017; 31 (09) 3519-3526
  • 15 Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003; 46 (07) 851-859
  • 16 Vlug MS, Wind J, Hollmann MW. , et al; LAFA Study Group. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 2011; 254 (06) 868-875
  • 17 Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Implementation of a fast-track perioperative care program: what are the difficulties?. Dig Surg 2007; 24 (06) 441-449
  • 18 Thiele RH, Rea KM, Turrentine FE. , et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 2015; 220 (04) 430-443
  • 19 Gatt M, Anderson ADG, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 2005; 92 (11) 1354-1362
  • 20 King PM, Blazeby JM, Ewings P. , et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis 2006; 8 (06) 506-513
  • 21 Forsmo HM, Pfeffer F, Rasdal A, Sintonen H, Körner H, Erichsen C. Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg 2016; 36 (Pt A): 121-126
  • 22 Jakobsen DH, Sonne E, Andreasen J, Kehlet H. Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 2006; 8 (08) 683-687
  • 23 Mari GM, Costanzi A, Maggioni D. , et al. Fast-track versus standard care in laparoscopic high anterior resection: a prospective randomized-controlled trial. Surg Laparosc Endosc Percutan Tech 2014; 24 (02) 118-121
  • 24 Basse L, Raskov HH, Hjort Jakobsen D. , et al. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 2002; 89 (04) 446-453
  • 25 Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I. Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition 2002; 18 (02) 147-152
  • 26 Anderson ADG, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 2003; 90 (12) 1497-1504
  • 27 Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W. ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 2004; 18: 1463-1468
  • 28 Zargar-Shoshtari K, Paddison JS, Booth RJ, Hill AG. A prospective study on the influence of a fast-track program on postoperative fatigue and functional recovery after major colonic surgery. J Surg Res 2009; 154 (02) 330-335
  • 29 Wichmann MW, Eben R, Angele MK, Brandenburg F, Goetz AE, Jauch KW. Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study. ANZ J Surg 2007; 77 (07) 502-507