Overview: Key Elements and the Impact of Enhanced Recovery Care

  • Kenneth C. H. Fearon
Part of the Enhanced Recovery book series (ER)


Surgeons have had a long-standing interest in the immune and metabolic response to injury. Such interest has been spurred on by the recognition that modulation of these pathways might provide a route to reduce postoperative morbidity and mortality. Claude Bernard (France) first developed the concept of the milieu intérieur and Walter Cannon (USA) described the complex homeostatic responses involving the brain, nerves, heart, lungs, kidneys and spleen that work to maintain body constancy. Subsequently, Sir David Cuthbertson (UK) divided the metabolic response to injury into ebb, flow and recovery phases and quantified the amount and likely sources of protein breakdown following long bone fracture. Thereafter, individuals such as Francis Moore (USA) and Douglas Wilmore (USA) described in detail the response to injury in humans and methods of optimal nutritional and metabolic support. However, by the time of the second millennium the average length of hospital stay after colorectal abdominal surgery was still 10–15 days.


Epidural Analgesia Postoperative Ileus Oral Nutritional Supplement Enhance Recovery Programme Open Colorectal Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Kenneth C. H. Fearon
    • 1
  1. 1.Department of Surgical OncologyUniversity of Edinburgh/Royal InfirmaryEdinburghUK

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