Enhanced Recovery After Surgery (ERAS) implementation at an acute regional hospital in Australia: A prospective trial

Abstract

Objectives: Radical cystectomy is associated with significant morbidity, ranging between 30 and 60% 1. Before 2015, we have implemented some ERAS items for cystectomy patients without a prospective database. We evaluated the results and compliance with the ERAS protocol using the ERAS Interactive Audit System (EIAS) database (Encare®) one year after implementation of a full ERAS protocol. Methods: We compared the results of 2014 (pre-ERAS) and 2015 (after implementation of full ERAS protocol) with regards to length of stay, complications and compliance to ERAS items. The results of 2014 were collected retrospectively by patient chart review as a part of the ERAS implementation programme. Data from 2015 were collected prospectively in the EIAS database. Results: The main outcomes are shown in the table. There was a trend towards a reduction in overall complications. Length of stay and highgrade complications were unchanged in the first year of our ERAS programme. Conclusion: The implementation of a full ERAS protocol including the use of a prospective database has not reduced length of stay or high-grade complications. While we achieved 100% for some of the ERAS items (e.g. PONV prophylaxis, no bowel preparation, no sedatives), some items in the postoperative period have been difficult to implement. The use of a prospective database is e helpful tool to monitor results and compliance to the ERAS protocol.