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Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery

Focus on Anesthesiology for Colorectal Surgery

Ban, Kristen A., MD*,†; Gibbons, Melinda M., MD, MSHS; Ko, Clifford Y., MD, MS, MSHS*,‡; Wick, Elizabeth C., MD§; Cannesson, Maxime, MD, PhD; Scott, Michael J., MB, ChB, FRCP, FRCA, FFICM; Grant, Michael C., MD#; Wu, Christopher L., MD§,**

doi: 10.1213/ANE.0000000000003366
Perioperative Medicine: Special Article
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The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture. The objectives of this review are to evaluate the evidence supporting anesthesiology components of colorectal (CR) pathways and to develop an evidence-based CR protocol for implementation. Anesthesiology protocol components were identified through review of existing CR enhanced recovery pathways from several professional associations/societies and expert feedback. These guidelines/recommendations were supplemented by evidence made further literature searches. Anesthesiology protocol components were identified spanning the immediate preoperative, intraoperative, and postoperative phases of care. Components included carbohydrate loading, reduced fasting, multimodal preanesthesia medication, antibiotic prophylaxis, blood transfusion, intraoperative fluid management/goal-directed fluid therapy, normothermia, a standardized intraoperative anesthesia pathway, and standard postoperative multimodal analgesic regimens.

From the *American College of Surgeons, Chicago, Illinois

Department of Surgery, Loyola University Medical Center, Maywood, Illinois

Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles California

§Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland

Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California

Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia

#Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore Maryland

**Department of Anesthesiology, The Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.

Published ahead of print 7 February 2018.

Accepted for publication February 7, 2018.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Christopher L. Wu, MD, Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Hospital, Zayed 8-120J, 1800 Orleans St, Baltimore, MD 21287. Address e-mail to chwu@jhmi.edu.

© 2019 International Anesthesia Research Society
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