EuroPOWER: European Postoperative Outcomes within / without an Enhanced Recovery After Surgery protocol in Colorectal Surgery

EuroPOWER: European Postoperative Outcomes within / without an Enhanced Recovery After Surgery protocol in Colorectal Surgery

  • Issue 78

Javier Ripollés-Melchor

Over 312 million major surgical procedures are performed globally each year (1) and despite advances in surgical and anaesthetic care, morbidity after abdominal surgery is still high. Colorectal surgery is associated with a high risk of morbidity and mortality in comparison to other general surgery sub-specialties (2).

Overall mortality rates following colorectal surgery range from 0.7(3) to 15.5%(2) with morbidity rates as high as 42%(4). The concept of fast-track surgery, also called enhanced recovery after surgery (ERAS) or multimodal surgery, involves using various perioperative strategies to facilitate better conditions for surgery and recovery in an effort to achieve faster discharge from hospital and more rapid resumption of normal activities after surgery through reducing postoperative stress and improving clinical practice by incorporating evidence-based medicine into patient management. An increase in ERAS adherence appears to be associated with a decrease in postoperative complications(4), length of stay(5) and with improved 5-year survival after colorectal cancer surgery (6).

Although individual components may vary, most of the ERAS programs include avoidance of fasting, preoperative optimisation of health, preoperative carbohydrate loading, avoidance of bowel preparation, goal-directed haemodynamic therapy, multimodal analgesia with avoidance of opiates, avoidance/early removal of tubes (nasogastric tube, Foley catheter, and drains), support of gastrointestinal function, and early convalescence (7).

The development and widespread application of ERAS, in combination with laparoscopic surgery, represent a paradigm shift in perioperative care. Furthermore, the association between laparoscopic approach and ERAS perioperative management has been recently proposed as the best option for patients undergoing segmental colectomy for colon cancer(8).

Our aim is to conduct a European 30-day cohort study of adults undergoing elective colorectal surgery in hospitals with or without an ERAS established protocol, to provide detailed data describing postoperative predefined complications (9)  and associated mortality within 30 days of surgery, and adherence to ERAS protocols items and its association with morbidity and length of stay. Our hypothesis is that the number ofpatients who develop predefined postoperative complications within 30 days of surgerydecreases as there is greater compliance with the predefined ERAS protocol items (7).

The study is funded by Grupo Español de Rehabilitación Multimodal (GERM). The one-month recruitment period in each center can be selected within a period of 6 months from October 2019 to March 2020.

You can find more information and register in our website:



Javier Ripollés-Melchor. Spanish Perioperative Audit and Research Network. REDGERM. Infanta Leonor University Hospital, Madrid

José M Ramírez-Rodríguez. Spanish Perioperative Audit and Research Network. REDGERM. Lozano Blesa University Hospital, Zaragoza



Ane Abad Motos

César Aldecoa

Maurizio Cecconi

Nader Francis

Ib Jammer

Samir Jaber

Jean Joris

Winfried Padberg

Rupert Pearse

José Manuel Ramírez-Rodríguez

Javier Ripollés Melchor

Michael Sander

Karem Slim

Antonino Spinelli



AUSTRIA: Ottokar Stundnerand Hannah N. Ladenhauf

BELGIUM: Jean Joris

CZECH REPUBLIC: Tomas Vymazaland Petr Kocián

SLOVAKIA: Roman Zahorec

FRANCE: Samir Jaberand Karem Slim

GERMANY:Michael Sander and Winfried Padberg

GREECE: Eirini ZarzavaandOrestis Ioannidis

ITALY: Maurizio CecconiandAntonino Spinelli

LITHUANIA: Jurate GudaityteandTadas Latkauskas

POLAND: Michał Pędziwiatr

PORTUGAL:Humberto Machado and Marisa Gomes Domingues dos Santos Saraiva

SPAIN: César AldecoaandJosé Manuel Ramírez-Rodríguez


UKRAINE: Sergiy Vorotyntsev

UNITED KINGDOM: Rupert Pearse andNader Francis

  1. Weiser TG, Haynes AB et al.. The Lancet. 2015 Apr;385:S11–1.
  2. ISOS.. British Journal of Anaesthesia. 2016 Oct 28;117(5):601–9.
  3. The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection. Annals of Surgery. 2015 Jun;261(6):1153–9.
  4. Ripollés-Melchor J, Ramírez-Rodríguez JM, et al. JAMA Surg. 2019 May 8;:1–11.
  5. Greco M, Capretti G, et al.. World Journal of Surgery. 2013 Dec 25;38(6):1531–41.
  6. Gustafsson UO, Oppelstrup H, et al. World Journal of Surgery. 2016 Feb 25;40(7):1741–7.
  7. Gustafsson UO, Scott MJ et al.. World Journal of Surgery. 2018 Nov 13;89(787–795):446–37.
  8. Vlug MS, Wind J, et al. Annals of Surgery. 2011 Dec;254(6):868–75.
  9. Jammer I, Wickboldt N, et al.. European Journal of Anaesthesiology. 2015 Feb;32(2):88–105.