Evidence map›Paper›PMID 42305649›Full record

ArticleInnovative surgical sciences2026

Adherence to an enhanced recovery protocol in colorectal surgery before and during a structured implementation - a prospective cohort study from nine German hospitals.

Wolfgang Schwenk, Christoph Strey, Sven Flemming, Monsserat Girona-Johannkämper, Wolfgang Wendt, Ibrahim Darwich, Hannes Neeff, Mark Banysch, Sandra Henn, Michael Scheruhn

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Innovative surgical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Wolfgang SchwenkGesellschaft für Optimiertes PeriOperatives Management, GOPOM GmbH, Düsseldorf, Germany.
Christoph StreyDepartment of General and Visceral Surgery, DRK Krankenhaus Clementinenhaus, Hannover, Germany, (Chairman: PD Dr. med. C. Strey).
Sven FlemmingDepartment of General, Visceral, Transplant, Vascular and Pediatric Surgery, University of Würzburg, Würzburg, Germany, (Chairman: Professor Dr. med. C. T. Germer).
Monsserat Girona-JohannkämperDepartment of Coloproctology, PROSELIS Stiftungsklinikum Prosper Hospital, Recklinghausen, Germany, (Chairman: Dr. med. E. Berg).
Wolfgang WendtVisceral Surgery/Proctology, Diakonissenkrankenhaus Dresden, Dresden, Germany, (Chairman: Dr. med. Th. Jacobi).
Ibrahim DarwichDepartment of General and Visceral Surgery, St. Marien Krankenhaus Siegen, Siegen, Germany, (Chairman: Professor Dr. med. F. Willeke).
Hannes NeeffDepartment of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany, (Chairman: Professor Dr. med. S. Fichtner-Feigl).
Mark BanyschSurgical Clinic 1, St. Bernhard Hospital, Kamp-Lintfort, Germany, (Chairman: Professor Dr. med. G. Kaiser).
Sandra HennDepartment of General- and Visceral Surgery, Rheinlandklinikum Lukaskrankenhaus, Neuss, Germany, (Chairman: Professor Dr. med. A. Ulrich).
Michael ScheruhnGeneral- and Visceral Surgery, Krankenhaus Buchholz/Nordheide, Buchholz in der Nordheide, Germany, (Chairman: Dr. med. M. Scheruhn).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objectives: Enhanced recovery protocols (ERP) are considered as state of the art in perioperative management of elective colorectal resections. However, adoption of ERP in the clinical routine is not easy and a structured implementation process is recommended. The aim of the present data analysis was to evaluate the learning curve of the structured implementation of an enhanced recovery protocol in elective colorectal resections based on adherence to recommended ERP elements and clinical outcomes. Methods: During a 12-month structured implementation of an ERP in nine hospitals, perioperative management data were prospectively documented. Patients during the 3-month preparation phase were differentiated as a comparison group with traditional management from patients during the clinical ERP implementation. In addition, the 9-month ERP application phase was divided into three equal sections. Adherence to 23 recommended ER elements and to the pre-, intra- and postoperative elements was calculated. Results: One thousand one hundred fifty-three patients (48.3 % female) were included. Traditional perioperative treatments were applied in 313 patients (preERP), while 840 patients (249, 297 and 294 during months during the first [ERP3], second [ERP6] and last 3 months [ERP9] interval) were treated according to the enhanced recovery protocol. Overall preERP ERP-adherence was 52 (IQR: 48-57)% in 9 hospitals but increased to 87 (78-91)% at the end of ERP-implementation. Functional recovery after surgery increased from preERP to ERP9, and postoperative length of stay was reduced from 7 (6 - 8) to 5 (5 - 7) days. Major improvements in overall and preoperative ERP adherence were achieved during the first 3 months, while postoperative ERP adherence took 6-9 months to reach best results. Conclusions: Structured implementation of an enhanced recovery protocol resulted in high adherence to 23 ERP-elements within 12 months. Although major achievements occurred during the first 3 months of clinical ERP utilization, a total of 9 months are needed especially to improve postoperative ERP-adherence.

Indexed as

enhanced recovery after surgery (ERAS)learning curveoptimized perioperative managementperioperative medicine

Identifiers

PMID42305649
PMCPMC13268677

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.