Enhanced Recovery Protocol (ERP): Optimizing Post-Operative Care

Enhanced Recovery Protocol, or ERP, is an approach to post-operative care of patients that was developed in Denmark. Such techniques have been applied to patients undergoing procedures such as a radical cystectomy. ERP shows promise in these applications.

Pre-Op and Post-Op Changes

• The Enhanced Recovery Protocol was refined to apply specifically to patients undergoing surgery to the gastrointestinal tract. The Protocol eliminated mechanical bowel preparation before surgery, which allowed patients to be admitted to the hospital two days later. Post-operative care was modified to allow feeding via a tube and mobilization of the patient as soon as the actions could be tolerated.

Desired Outcomes for Patients

• The techniques -- pioneered in Denmark -- showed a number of positive results in the patients. The results included improved cardiovascular response to exercise, improved pulmonary functions and a reduction in the loss of lean body mass.

Effects of ERP

• A study in Sweden of 168 patients showed results in patients before and immediately after implementation of the Protocol that the overall hospital stay was reduced by two days. The rate of readmission of patients was comparable to slightly higher than previous protocol. Lung function and muscle strength showed less reduction as a result of the hospital stay.