Patient experience of health and care when undergoing colorectal surgery within the ERAS program

Abstract

Background: Several studies show that the enhanced recovery after surgery (ERAS) program reduces complications postoperatively and leads to faster recovery and shorter hospital stays. However, little is known about patients' selfreported health in an enhanced recovery context. The aim of this study was firstly to describe patient experiences of health within the concept of ERAS after colorectal (CR) surgery during a hospital stay and within 2 weeks of discharge. Secondly, to explore whether the ASA classification/co-morbidity, sex, and surgical method affect the patient's experience of health. Methods: Data were collected through the ERAS-HEALTH questionnaire, including two open-ended questions, and through telephone interviews postoperatively. Qualitative and quantitative analysis was used. Patients undergoing CR surgery (n = 80) were included from October 2016 to June 2018. Results: The patients had mainly positive experiences of their hospital stay as well as most of them felt comfortable coming home. However, experienced state of health is affected by factors like surgical method and comorbidity. Improvements were desired concerning information, food/food intake, pain management, and environment. At home, the patients experienced a lack of information about food/food intake and ostomy care. Decreased appetite and difficulties with micturition were also described. The most troublesome symptom was postoperative fatigue (POF). Analysis of the ERAS-HEALTH questionnaire showed that patients with higher comorbidity and those who underwent open surgery have a significantly worse experience of their health compared with patients who underwent laparoscopy. However, it seems that the surgical method affects postoperative health to a greater extent than co-morbidity. Conclusions: The patients reported many positive aspects and challenges when being cared for within the ERAS program. However, several improvements are needed to satisfy patient wishes regarding their care both in hospital and at home. Laparoscopic surgery affects patient state of health positively in several respects compared with open surgery.

The patient perspective of same day discharge colectomy: one hundred patients surveyed on their experience following colon surgery

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Cuidados de enfermagem relacionados à prevenção de prolapso em ostomias intestinais: uma revisão integrativa da literatura

“…A Outro estudo, que também utilizou a abordagem do protocolo ERAS, evidenciou que todos os pacientes são encorajados a manter um diário para registrar quanto comem e com que frequência estão ativos no pós-operatório. Todavia, a pesquisa revelou que os pacientes perdem o interesse em registrar suas atividades de reabilitação (por exemplo: comer e beber) ou em seguir as instruções relacionadas a essas atividades quando os profissionais de saúde não mostram interesse em ouvi-los, o que aponta a necessidade de acompanhamento do estomaterapeuta, inclusive, para orientar o paciente quanto à necessidade de reversão do estoma nos casos de colostomias temporárias (Wennström et al, 2020).…”

Controversies in enhanced recovery after cardiac surgery

“…Enhanced Recovery After Surgery (ERAS) programs have become ubiquitous in the field of perioperative medicine and have played a key role in defining the essence of this relatively young discipline. These protocols have typically been applied to non-cardiac surgical populations (Wennström et al 2020 ; Smith et al 2019 ; Gupta and Senagore 2017 ), but more recently they have also been applied to cardiac surgery patients (Engelman et al 2019 ). While consensus has emerged in some areas of perioperative management for patients undergoing heart surgery, considerable differences of opinion remain for others.…”