Clinical Scorecard: Perceptions of Enhanced Recovery after Surgery (ERAS) Protocols among Colorectal Surgeons: A Nationwide Survey in Australia and New Zealand

At a Glance

Key Highlights

• ERAS programmes improve morbidity, recovery, and reduce hospital length of stay in colorectal surgery.
• Significant variation exists internationally and locally in ERAS guideline implementation and specific interventions.
• Survey of colorectal surgeons in Australia and New Zealand ranked preoperative iron infusion, minimally invasive surgery, and early catheter removal as top ERAS interventions.

Guideline-Based Recommendations

Diagnosis

• No specific diagnostic recommendations; focus is on perioperative management in colorectal surgery.

Management

• Implement ERAS protocols including preoperative iron infusion to correct anemia.
• Use minimally invasive surgical techniques when possible.
• Encourage preoperative smoking cessation and counselling.
• Avoid nasogastric tubes and drains in colon surgery; remove drains early in rectal surgery.
• Remove urinary catheters early (within 1 day for colon surgery, 1–2 days for rectal surgery).
• Use selective NSAIDs as part of multimodal pain management.

Monitoring & Follow-up

• Monitor short-term (30-day) outcomes including length of stay and readmission rates to assess ERAS effectiveness.

Risks

• Variability in evidence for some interventions such as mechanical bowel preparation and oral antibiotics.
• Potential complications if ERAS components are not properly implemented or adhered to.

Patient & Prescribing Data

Patients undergoing colorectal surgery in Australia and New Zealand

Surgeons rated preoperative iron infusion and minimally invasive surgery as highly effective ERAS components; adherence to ERAS protocols correlates with fewer complications and shorter hospital stays.

Clinical Best Practices

• Prioritize correction of preoperative anemia with iron infusion.
• Adopt minimally invasive surgical approaches where feasible.
• Promote preoperative smoking cessation and patient counselling.
• Avoid routine use of nasogastric tubes and drains in colon surgery.
• Remove urinary catheters early to reduce complications.
• Incorporate selective NSAIDs into multimodal pain management strategies.
• Recognize that early oral feeding and mobilization are standard care in ERAS.

References

• ERAS Society Guidelines
• American Society of Colorectal Surgeons Guidelines
• American College of Surgeons NSQIP
• Australian Colorectal Cancer Guidelines
• Kehlet H. Fast-track colorectal surgery