Modified ERAS protocol using preoperative oral rehydration therapy: outcomes and issues

In recent years, the use of postoperative recovery management protocols such as the “enhanced recovery after surgery (ERAS®) protocol” [1] and “fast track program” [2] is steadily spreading to clinical institutions across the country. These protocols involve evidence-based interventions to enhance patient recovery after surgery, which can be realized by a multidisciplinary team approach performed during perioperative periods. As the outcomes of the protocols, shorter hospitalization, reduced perioperative complications, and medical cost reduction are anticipated, and consistent outcomes are actually obtained [3]. At the same time, since these protocols have their origins in Europe and America, there are some aspects which are not consistent with Japanese medical culture and situation. These are (1) patients are very reluctant to accept shorter hospitalization (though length of hospital stay following operative procedures is taken as one of the endpoints in the protocol), (2) patient education and counseling are still not sufficient to adequately perform early postoperative mobilization and oral intake in patients, and more nurses and staff are required for such education and consulting services. At our hospital, we practice a “modified ERAS® protocol;” an enhanced recovery after surgery protocol modified to match medical practices and situations in this country [4]. In particular, preoperative fluid management using “preoperative oral rehydration therapy (PO-ORT)” is one of the important features, and we herein report the safety and efficacy of the “modified ERAS® protocol”, including its outcomes and issues [4, 5].