key: cord-0768703-fsu7fhp4
authors: Goodmaker, C J G; Kopczynska, M; Meskell, R; Slade, D
title: Paving the road to recovery: the colorectal surgery ERAS pathway during the COVID-19 pandemic
date: 2021-07-06
journal: Br J Surg
DOI: 10.1093/bjs/znab208
sha: 7ebdbeba544ef798623a08b0f573c0a3c200fb42
doc_id: 768703
cord_uid: fsu7fhp4

nan

Dear Editor, NHS England reports that 4.7 million people are awaiting an operation in England, the highest in a decade. Healthcare systems are seeking methods to limit an accumulating impact on services. Clinical pathways can be used to improve patient outcomes when recovery is relatively predictable 1 . The Enhanced Recovery After Surgery (ERAS) pathway has been shown to reduce rates of postoperative complications, reduce length of stay, and readmission and mortality rates 2 . Implementation of this pathway during and after the COVID-19 pandemic could help reduce time spent in hospital, exposure to nosocomial infections, improve patient flow and help clear waiting lists. Preliminary data from Italy, however, suggested that a colorectal surgery ERAS pathway could not be implemented effectively during a national crisis 3 . Conversely, although supporting data are limited, it has been speculated that ERAS could play a vital role in the UK's response to the pandemic 4 .

In conjunction with national guidance 5 the authors' tertiary colorectal centre implemented a brief moratorium on elective procedures during March and April 2020. Urgent and emergency cases received rapid SARS-CoV-2 PCR swab testing. Beyond April, elective cases were reintroduced with a pre-admission 14-day isolation period and 3-day preoperative SARS-CoV-2 PCR swab.

The effect of the COVID-19 pandemic on colorectal ERAS pathway adherence and patient outcomes was explored. Complete methodology and demographics can be found in Table S1 . Patients were split into two cohorts; those admitted before (January 2019-February 2020, 110 patients) and during (March 2020-December 2020, 56 patients) the pandemic ( Table 1) . Compliance with 14 ERAS pathway factors, spanning 3 days after the operation and shown to be influential on postoperative outcomes 2 , was assessed retrospectively (Table S2) .

Mann-Whitney U test analysis revealed an increase in colorectal surgery ERAS pathway compliance during the pandemic (P < 0.001) compared with before ( Table 1 and Fig. S1 ). No significant difference in length of stay ( Table 1 and Fig. S2 ) was observed. This was on the background of a reduction in admissions to 80 during year 2020 from 104 (median over past 10 years). Analysis using v 2 test did not reveal a significant difference in postoperative complications (Table S3 ) or 30-day post-discharge readmission rates ( Table 1) . The 30-day post-discharge mortality rate remained at zero in both groups and no patients tested positive for SARS-CoV-2 PCR swabs during admission.

The colorectal surgery ERAS pathway has passed the ultimate stress test; it is safe, straightforward and improves outcomes. It should form part of the post-pandemic recovery with the aim to clear waiting lists. 

Systematic review of the effectiveness of integrated care pathways

Enhanced Recovery After Surgery (ERAS) group. Consensus review of optimal perioperative care in colorectal surgery

Supplementary material is available at BJS online.