In the 90s, two different groups of surgical professionals developed new strategies aimed at improving the postoperative outcome of colon or rectal surgery patients. On the one hand, a group led by Dr. Kehlet from Scotland proposed different measures pre and post operatory while in Cleveland, another group led by Dr. Delaney focused his studies on postoperative models of introduction of an oral diet and early mobilization. Note that these new guidelines were not based on innovative technologies, but what they wanted was to simply lessen the suffering of the sick taking care to accomplish a combination of essential elements: better informed patients on the overall process, stress reduction, decreased pain, exercise as soon as possible, etc (Kehlet 1997).
In 2001, the same Dr. Kehlet led the group ERAS (Enhanced Recovery After Surgery), which coordinated several units of colo-rectal surgery in the Nordic European countries. ERAS developed 17 strategies, all evidence based with the intent to promote activities ranging from the politics of patient’ preparation to the process’ evaluation and outcomes (Fearon 2005).
Subsequently several systematic reviews and a meta-analysis have demonstrated the success of the ERAS program, also known as fast-track multimodal rehabilitation or (multimodal rehabilitation), which managed to obtain a significant reduction in the average hospital stay without increasing readmissions (Varadhan 2010).