Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol – Compliance improves outcomes: A prospective cohort study

Abstract

Enhanced Recovery After Surgery protocol in colorectal surgery allows shortening length of hospital stay and reducing complication rate. Despite the clear guidelines and conclusive evidence their full implementation and putting them into daily practice meets certain difficulties, especially in the early stage. The aim of the study was to analyse the course of implementation of the ERAS protocol into daily practice on the basis of adherence to the protocol. Group included 92 patients (43F/49M) with colorectal cancer submitted to laparoscopic resection during the years 2013-2014. Perioperative care in all of them based on ERAS protocol consisting of 16 items. Its principles and discharge criteria were based on the guidelines of the ERAS Society guidelines. The entire analysed group of patients was divided into 3 subgroups (30 patients) depending on the time from ERAS protocol implementation. We analysed the compliance with the protocol and its influence on length of hospital stay, postoperative complications and readmission rate in different subgroups. The average compliance with the protocol differed significantly between groups and was 65% in group 1, 83.9% in group 2 and 89.6% in group 3. The compliance with subsequent protocol elements was different. The length of stay and complication rate was statistically different in analysed subgroups. The whole group demonstrated an inverse correlation between compliance and length of stay. This analysis leads to the conclusion that the introduction of the ERAS protocol is a gradual process, and its compliance at the level of 80% or more requires at least 30 patients and the period of about 6 months. The initial derogation from the assumed proceedings is inevitable and should not discourage further action. Particular emphasis in the initial stage should be put on continuous training of personnel of all specialties and continuous evaluation of the results.

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

“…Furthermore, the reduction of LOS while having similar complication rates allows the assumption that ERAS protocol improves functional recovery. It is believed that modern perioperative care leads to the reduction of postoperative stress response, thus allowing faster convalescence [27]. According to the ERAS Congress held in Cannes in 2013, full functional recovery after surgery is the main goal of perioperative care [28].…”

Enhanced recovery after surgery protocol in oesophageal cancer surgery: Systematic review and meta-analysis

“…Shorter LOS with non-surgical morbidity reduction and no influence on surgical complications allows us to imply that ERAS protocol improves general functional recovery. It is generally believed that modern perioperative care diminishes postoperative stress response, thus allowing faster convalescence [29]. Currently it is emphasized that a full functional recovery, rather than the postoperative hospital stay, is considered as the main goal of perioperative care [30].…”

Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

“…In our study, we attempted to study the effect of ongoing adherence to the ERAS protocol in a group of patients undergoing routine pancreatic and hepatic resections at the same hospital. Division between each group was based on a previously reported number of patients necessary to achieve satisfactory adherence to the ERAS program at the institutional level . The main findings were that, despite the similar or improving compliance levels, ongoing use of the ERAS protocol did not result in the improvement of recorded perioperative outcomes and length of stay.…”