147 7 Improving Enhanced Recovery After Surgery (ERAS): The Effect of a Patient-Centred Mobile Application INTRODUCTION To optimize outcome for patients having to undergo colorectal surgery, the Enhanced Recovery After Surgery (ERAS) Study Group was formed.1 This group published the first evidence-based consensus protocol for colonic surgery in 2005 and rectal surgery in 2009, both outlining and stressing the importance of a multidisciplinary and multimodal approach. The ERAS protocol consists of 24 core elements in the preadmission, preoperative, intraoperative, and postoperative phases.2 ERAS elements can be categorized as requiring contribution from healthcare providers (passive elements), patients (active elements), or both (passive/active elements).3 All elements work together in an effort to reduce surgical stress, maintain postoperative physiological function, and enhance mobilization after surgery,4-8 resulting in a faster recovery, shorter hospital stay, and reduced rates of morbidity.9-11 High adherence to the ERAS protocol is significantly associated with markedly improved outcomes, such as shorter hospital stay, lower rates of postoperative complications, reduced 30-day morbidity, and lower readmission rates.12-15 However, local implementation of ERAS protocols differ across medical centres. Even when clinical pathways are based on the same ERAS guidelines, implementation of the protocol and outcomes vary.16 Protocol adherence were 69%, 72% and 53% during the preoperative, perioperative and postoperative phase respectively.17 ERAS protocol compliance may be most essential in the early postoperative phase, as it stimulate early mobilization and resumption of oral intake, avoid discharge delay and minimize the overall risk of complications.16 The provider-initiated part of the pathway include most ERAS elements which usually has high adherence.3 The elements of the ERAS protocol that require patient involvement have the poorest compliance. There are benefits to gain here, as patient empowerment plays an essential part in improving patient adherence. 18,19 In recent years, mobile healthcare applications (apps) and wearables have emerged as strategies to improve patients' adherence to treatment.20-23 Apps can provide information, stimulate desired behaviour, enhance self-efficacy and empower patients allowing patients to take an active role in their own healthcare.24-26 Several apps for postoperative recovery have been described in literature, however, the level of evidence and outcomes were varying.23 Regardless of how promising this technology is, it is unclear for many apps whether outcome is properly measured and their use in the medical domain is safe and allowed under current legislation.23 The “ERAS App” is an innovative app which combines stimulation of patient involvement in the ERAS with a personalised activity recovery program. The ERAS App offers an engaging approach to involve patients actively in their own care, providing timed information and recovery goals during the perioperative period. This randomized controlled trial (RCT) was conducted to assess whether the use of a
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