Enhanced recovery after non-elective colorectal surgery: Is it time for emergency general surgeons to follow suit?

Background: Surgical dogma suggests that enhanced recovery (ERAS) pathways are not feasible in the non-elective setting. This study challenges that dogma with the implementation of ERAS in non-elective colorectal surgery. Methods: Single center review of all colorectal operations was performed following implementation of ERAS in non-elective colorectal surgery. Compliance and outcomes between elective and non-elective operations were compared. Results: 142 elective and 116 non-elective operations were performed with a compliance rate of 84 % and 46 %, respectively. Acceptable compliance was achieved with 7 metrics in the non-elective cohort. Elective operations were associated with an average LOS of 3 days and a 1 % SSI rate, compared to 8 days and 15 % in the non-elective group. On multivariate analysis, five ERAS metrics were associated with SSI. Conclusions: ERAS pathways are often neglected in non-elective surgery. Acute Care Surgeons should recognize the ERAS principles that are appropriate for their patient population and implement these strategies into practice.