On its face, the ERAS program is a combination of simple, low-risk interventions that, when used in an integrated approach, can reduce LOS and major complications. The benefits have been proven in multiple studies, mostly from Europe, on colorectal surgery patients, not limited to patients with cancer. Gustafsson et al contribute additional information on a large number of patients who underwent resection of colorectal cancers. The data compare an earlier phase (2002-2005) during which ERAS was poorly implemented with a more recent phase (2005-2007) during which more substantial efforts achieved significantly higher compliance with the protocol. Fewer major complications, fewer debilitating postoperative symptoms, and more frequent discharges within LOS targets were seen during the more recent phase of practice and in patients with better compliance with ERAS components. Causality can be questioned since patients who have major complications are ill and less likely to participate in various postoperative ERAS activities such as ambulation and early refeeding. However, multivariable analysis showed 2 early interventions in the process of surgery and recovery to be independent predictors of postoperative outcomes: preoperative carbohydrate loading and perioperative fluid restriction.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Surgery editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.