Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery

Abstract

Purpose Enhanced Recovery After Surgery (ERAS) reduces postoperative complications and shortens hospital stays. We aimed to describe the implementation and improvement of ERAS protocols in our institution through a multidisciplinary team approach. Methods A multidisciplinary team comprised of colorectal surgeons, anesthesiologists, nurses, pharmacists, nutritionists, and a performance improvement team was launched to develop the ERAS protocol. The ERAS protocol was followed in patients who underwent colonic and rectal surgery between January and November 2017. The ERAS protocol comprised 22 elements in the preoperative, intraoperative, and postoperative phases. After the initial application, ERAS compliance was monitored and audited every 4–6 months and improvements made as necessary. Results The length of hospital stay significantly decreased after the application of the ERAS protocols for colon cancer in 2017 and 2018. And there was no significant difference in the duration of hospital stay after applying the rectal cancer ERAS protocol. Moreover, after starting the colon ERAS, there was a significant decrease in the complication rate. Since December 2017, there was a continuous increase in the colorectal ERAS clinical pathway application rate, which remained high (>90%). The patient compliance rate significantly increased between 2017 and 2018, but slightly decreased again in 2019. Conclusion The application and continual improvement of an ERAS protocol are crucial. Improving compliance may result in better clinical outcomes. Additionally, the basic guidelines of ERAS must be applied and developed according to each hospital’s situation based on the team approach.

The enhanced recovery after surgery (ERAS) protocol implementation in a national tertiary-level hospital: a prospective cohort study

“…However, on the contrary, different compliance rates of patients undergoing ERAS in our study did not show significant differences in patient outcomes 20 , 24 . Seow-En et al .…”

“…Our study follows a study conducted in Korea by Choi et al . 20 , who concluded that the implementation of the ERAS protocol from 2017 to 2019 at St. Mary’s Hospital in patients undergoing colon surgery showed significant results at a shorter length of stay with an average of 5.1 days. This study evaluated more ERAS protocol components than our study.…”

The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies

“…Audits play an important role, especially in detailed and procedural analyses, because implementing new protocols is often problematic over time, 37 , 38 , 39 and these problems can encourage a return to traditional or familiar practices. For example, in this study, the ERAS items that showed good adherence were usually items that were already being practiced before starting the protocols, such as advising patients and providing antibiotic prophylaxis before scalp incision.…”

Challenging issues of implementing enhanced recovery after surgery programs in South Korea

“…Additional-ly, one study was conducted in a foreign country and another did not include details about the ERAS protocol, leading to their exclusion. Finally, the remaining 16 studies were analyzed [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Table 1 presents the authorship status of anesthesiologists in these studies, along with the inclusion of ERAS items related to the field of anesthesiology.…”