Debunking Enhanced Recovery Protocols in Colorectal Surgery: Minimal Requirements for Maximum Benefit

  • Deborah S. Keller
  • Lawrence Lee


Enhanced recovery protocols (ERPs) are established “order sets” covering the entire patient surgical experience. ERPs eliminate outdated perioperative care principles, reduce physiological stress and postoperative organ dysfunction, and implement evidence-based innovations to expedite recovery. Since their introduction in the 1990s, ERPs have been proven to reduce the time to recovery, postoperative complications, hospital length of stay, use of postdischarge nursing care, and healthcare utilization with no increase in readmission or reoperation rates. While there is solid support for ERP, awareness and use are still not unanimous. Full implementation and compliance with protocols are a distinct process that requires planning and participation of the entire surgical team, institution, and patient. Using a stepwise approach, the steps and minimal requirements for successful incorporation of ERP into practice can be applied by surgeons performing colorectal surgery for maximum benefit.


Enhanced recovery after surgery (ERAS) Enhanced recovery protocols (ERPs) Healthcare outcomes Cost savings Healthcare value Prehabilitation 


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Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Deborah S. Keller
    • 1
  • Lawrence Lee
    • 2
  1. 1.Division of Colorectal Surgery, Department of SurgeryNew York Presbyterian Hospital-Columbia University Medical CenterNew YorkUSA
  2. 2.Department of SurgeryMcGill University Health CentreMontrealCanada

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