Prehabilitation is a strategy to increase reserve in anticipation of an upcoming stressor. Patients with poor baseline functional capacity are at increased risk of complications and prolonged recovery (1,2). Emerging evidence suggests that a 4-week period of prehabilitation can increase walking capacity in colorectal cancer patients, and deconditioned patients in general make the biggest gains. […]
Mechanical bowel preparation has long been thought to reduce infectious complications after colorectal resection. However, mechanical bowel preparation is uncomfortable and results in fluid losses. For colon resection, meta-analyses of randomized trials conclude that mechanical bowel preparation does not decrease infectious complications or leak (1). However, these trials did not include oral antibiotics with the […]
Traditionally patients are “NPO after midnight” to reduce the risk of aspiration of gastric contents at induction of anesthesia. This results in a long period without hydration or nutrition, especially for cases booked later the following day. Oral intake of clear fluids up to 2 hours before surgery does not increase the risk of aspiration […]
Carbohydrate drink: The administration of a complex carbohydrate-rich drink before surgery (100gm the evening before surgery and 50gm 2-3 hours preop) may increase insulin sensitivity but does not reduce complications or significantly improve other outcomes when compared to placebo fluids (1). Larger trials are required to establish impact on protein catabolism and on clinical outcomes. […]
As with any quality improvement initiative, having data about both processes and outcomes is critical. Data collection should ideally begin when the ERP team is assembled, to show the team where they are starting. Length of stay is an easy way to monitor outcomes within an institution as it relates to recovery, organization, complications and […]