Enhanced Recovery after Surgery - best practice in perioperative care

Making changes in surgical practice is often very slow and old routines prevail way beyond the last best for use day (Lassen K; Bmj 2005; 330:1420). Treatments such as preoperative fas­ting (Ljungqvist O; Br J Surg 2003; 90:400), large enemas for preopera­tive bowel cleansing (Slim K; Br J Surg 2004; 91:1125), unrestricted perioperative fluid treatments (Lobo DN; Lancet 2002; 359:1812), delayed food intake (Lewis SJ; Bmj 2001; 323:773) are largely still in use. Even when these routines are challenged and proven wrong and outdated, it still takes a long time to make changes in daily prac­tice. A typical example are the overnight fas­ting routines that were shown over 20 years ago to be outdated but still remain in use in most of Europe (Soreide E; Acta Anaesthesiol Scand 2005; 49:1041). While many northern Euro­pean Anesthesia and other expert societies have made changes in accor­dance to current knowledge, the great majority of countries have not and in these countries nil per os from midnight still is the rule.

It is now 10 years ago that the pioneering work by Henrik Kehlet on fast track surgery was published (Kehlet H; Br J Surg 1999; 86:227). In this report he showed it possible to have more than half the patients undergoing segmental colonic resection fit to leave the hospital 2 days after the operation. For a long time, this was almost not be­lieved, but in time others have shown similar outcomes using similar protocols.