Implementing an Enhanced Recovery After Surgery (iERAS) Guideline to Optimize Outcomes following Colorectal Surgery ARTIC Project

There are approximately 14,000 colon resections performed in Ontario each year with an average hospital stay of seven days. There is increasing evidence that unless pre-, intra- as well as post-operative care is based on best evidence, optimal outcomes cannot be achieved.

Care of the surgical patient involves a number of health professionals and occurs over a continuum. The multidisciplinary team consisting of surgeons, anaesthetists, nurses, physiotherapists and dieticians must work collaboratively to ensure that care is coordinated as the patient transitions through the multiple points of care.  This project will develop evidence-informed coordination strategies and tools for implementation across hospitals to ensure optimal, sustainable care of patients having gastrointestinal surgery.

Current literature suggests the overall complication rate following colorectal surgery is 25-40%, the most significant being anastomotic complications which occur in 5-20% of patients.  ERAS programs have been shown to decrease postoperative complications by 50%. Additionally, whereas the average length of stay with traditional postoperative care is approximately 7-10 days, adoption of ERAS programs have resulted in a decrease in the average length of stay by 2 or more days. In addition, there is some evidence that pain and fatigue may be decreased with adoption of an ERAS protocol and that a decreased length of stay does not negatively impact on quality of life and patient satisfaction.

Currently, 15 hospitals across Ontario are participating in this program: Hamilton Health Sciences Centre, Health Sciences North, Kingston General Hospital, London Health Sciences Centre, Mount Sinai Hospital, North York General Hospital, St. Joseph’s Healthcare Hamilton, St. Michael’s Hospital, Sunnybrook Health Sciences Centre, The Ottawa Hospital, Thunder Bay Regional Health Sciences Centre and University Health Network (UHN, including Toronto General and Toronto Western), St. Joseph’s Health Care Toronto, Toronto East General Hospital.

Final Report

Objective:  The iERAS ARTIC Project used an innovative knowledge translation (KT) strategy to implement interventions to improve the outcomes of elective colorectal surgery patients and reduce hospital stay across 15 hospitals.

Key Accomplishments

  • Overall, 2,475 patients who underwent small bowel or colorectal resection were included in the program.
  • Length of stay reduced by one day, while readmissions remained unchanged and complication rates remained low.
  • Patients’ satisfaction with the iERAS program was high: over 90% of patients stated that they were satisfied with their care and the program.
  • The implementation of the iERAS program had a number of positive impacts on interprofessional team work and communication as well as spread of the iERAS program to other surgical disciplines.
  • Overall, compliance with the recommendations in the iERAS guideline increased significantly, which indicated that the KT strategies were effective.