Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration

Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration

Can J Surg 2020;63(1):E19-E20 | Full Text | PDF

Leah M. Gramlich, MD, Brae Surgeoner, MSc, Gabriele Baldini, MD, MSc, Erin Ballah, MBA, MSc(PT), Melinda Baum, MSW, Franco Carli, MD, MPhil, Ahmer A. Karimuddin, MD, MAEd, Gregg Nelson, MD, PhD, Philippe Richebé, MD, PhD, Deborah Watson, RN, MN, Carla Williams, RN, MHSM, Claude LaFlamme, MD, MHSc; Enhanced Recovery Canada


Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute’s Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.

Accepted June 4, 2019

Acknowledgements: The authors (ERC working group leads and members of the governance committee) acknowledge that this work would not have been possible without the dedicated support and expertise of all of the working group members. A list of all contributors can be found on the pathway.

Affiliations: From the Department of Medicine, University of Alberta, Edmonton, Alta. (Gramlich); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Surgeoner); the Department of Anesthesia, McGill University, Montreal, Que. (Baldini); Eastern Health, St. John’s, Nfld. (Ballah); the Ministry of Corrections and Policing, Swift Current, Sask. (Baum); the Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, BC (Karimuddin); the Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Nelson); the Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital/CEMTL, Université de Montréal, Montreal, Que. (Richebé); the Department of Nursing, McGill University, Montreal, Que. (Watson); and the Canadian Patient Safety Institute, Edmonton, Alta. (Williams).

Members of the ERC Pathway Working Group (excluding the authors): Mary-Anne Aarts, MD; Biniam Kidane, MD, MSc; Liane Feldman, MDCM; Magda Recsky, MD, MSc; Tony MacLean, MD; Evan Minty, MC, MSc; Stuart McCluskey, MD, PhD; Kelly Mayson, MD; Selena Fitzgerald, BScN, RN; Lucie Filteau, MD; Hance Clark, MD, PhD; Naveen Eipe, MBBS, MD; Gabrielle Page, PhD; Krista Brecht, RN, BScN; Veronique Brulotte, MD, MSc; Husein Moloo, MD, MSc; Heather Keller, RD, PhD; Manon Laporte, RD; Marlis Atkins, RD; Chelsia Gillis, RD, MSc; Louis-Francois Cote, RD; Celena Scheede Bergdahl, MSc, PhD; Julio Fiore, PT, MSc, PhD; Jackie Farquhar, MD; Chiara Singh, BScPT; Sender Liberman, MD; Amal Bessissow, MD, MSc; Bevin Ledrew; Nancy Posel, PhD; Kathy Kovacs Burns, MSc, MHSA, PhD; Valerie Phillips; Jennifer Rees, BSc.

Funding: This work was funded by the Canadian Patient Safety Institute (CPSI) and a number of industry sponsors listed on the CPSI website. Industry sponsors were not involved in pathway development discussions.

Competing interests: None declared. Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.006819

Correspondence to: L. Gramlich, 214 Community Services Centre, Royal Alexandra Hospital, 10240 Kingsway Ave, Edmonton AB T5H 3V9,