The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .
Short term benefits of post-operative oral dietary supplements in surgical patients.
The present study was undertaken to investigate the short term clinical efficacy of oral dietary supplements administered post-operatively to patients undergoing predetermined moderate to severe gastrointestinal surgery . Trial end points for comparison included effects of oral dietary supplements on nutritional intake , nutritional status and incidence of serious complications .  54 patients who were scheduled to undergo predetermined moderate to major gastrointestinal surgical procedures entered the study . They were r and omly assigned to receive a normal ward diet post-operatively or the same diet supplemented ad libitum by an oral nutritional sip feed . The study period was defined as commencing from the day patients were adjudged to be capable of ingesting ' free fluids ' to the day of hospital discharge . 40 patients ( 20 in each group ) completed the study . The mean daily energy intake ( KCal/day ) assessed from 7 day food diaries was significantly higher in the treatment group ( 1833 + /- SEM 99 ) than in the control group ( 1108 + /- 56 , p < 0.0001 ) . This increase occurred not only as a consequence of energy intake from the oral dietary supplements ( 470 + /- 30 ) but also because more energy was consumed from the ward diet by the treatment than the control patients ( 1353 + /- 92 vs 1108 + /- 56 , p < 0.02 ) . The mean daily protein intake g/day in the treatment group ( 66.0 + /- 3.4 ) was also greater than in the control group ( 52.9 + /- 29 p < 0.0001 ) . This difference was due solely to the intake in protein from the oral dietary supplements ( 15.7 + /- 1.0 ) , protein intake from the ward diet being similar in the treatment ( 50.1 + /- 3.2 ) and control ( 52.9 + /- 29 ) groups . Patients in the treatment group maintained their pre-operative weight where as control patients had lostsignificant amount of their pre-operative weight by study day 3 ( 4.5 + /- 12 kg and by discharge ( 4.7 + /- 1.2 kg , p < 0.02 ) . Pre-operative muscle function as evidence d by grip strength dynamometry decreased to a greater extent in the control than treatment group patients by study day 3 ( 14.6 + /- 2.2 KPa vs 2.8 + /- 2.4 < 0.03 ) and by discharge ( 10.4 + /- 3.1 KPa vs 0.10 + /- 1.9 p < 0.03 ) . The incidence of serious infections ( pneumonia , wound infection ) was significantly higher in the control group ( 10 ) than in the treatment group ( 3 , p < 0.02 ) . It is concluded that the prescription of oral dietary supplements on an ad libitum basis to post-operative patients undergoing moderate to major gastrointestinal surgery results in clinical ly significant short term benefits
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .