PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER. 2024

José Eduardo de Aguilar-Nascimento, and Ulysses Ribeiro Junior, and Pedro Eder Portari-Filho, and Alberto Bicudo Salomão, and Cervantes Caporossi, and Ramiro Colleoni Neto, and Dan Linetzky Waitzberg, and Antonio Carlos Ligocki Campos
Centro Universitário de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil.

BACKGROUND The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. OBJECTIVE To emphasize the most important points of a multimodal perioperative care protocol. METHODS Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

UI MeSH Term Description Entries
D001938 Brazil A country located on the eastern coast of South America, located between Colombia and Peru, that borders the Atlantic Ocean. It is bordered on the north by Venezuela, Guyana, Suriname, and French Guiana, on the south by Uruguay, and on the west by Argentina. The capital is Brasilia.
D002985 Clinical Protocols Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. Protocols, Clinical,Research Protocols, Clinical,Treatment Protocols,Clinical Protocol,Clinical Research Protocol,Clinical Research Protocols,Protocol, Clinical,Protocol, Clinical Research,Protocols, Clinical Research,Protocols, Treatment,Research Protocol, Clinical,Treatment Protocol
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000080482 Enhanced Recovery After Surgery A protocol of components related to preadmission, preoperative, intraoperative, and postoperative care. The protocol is implemented with the goal of improving patient recovery, facilitating earlier discharge from the hospital, and potentially reducing health care costs without increasing complications or hospital readmissions. The protocol components may contribute to minimizing, and/or improving the response to, physiological stress associated with surgery. Enhanced Postsurgical Recovery,Postsurgical Recoveries, Enhanced,Postsurgical Recovery, Enhanced,Recovery, Enhanced Postsurgical
D013505 Digestive System Surgical Procedures Surgery performed on the digestive system or its parts. Gastrointestinal Surgical Procedures,Digestive System Surgical Procedure,Gastrointestinal Surgical Procedure,Procedure, Digestive System Surgical,Procedure, Gastrointestinal Surgical,Procedures, Digestive System Surgical,Procedures, Gastrointestinal Surgical,Surgical Procedure, Digestive System,Surgical Procedure, Gastrointestinal,Surgical Procedures, Digestive System,Surgical Procedures, Gastrointestinal
D019990 Perioperative Care Interventions to provide care prior to, during, and immediately after surgery. Care, Perioperative

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