Results of a colorectal enhanced recovery after surgery (ERAS) programme and a qualitative analysis of healthcare workers’ perspectives

Seow‐En, Isaac; Wu, Jianchun; Yang, Lily Wei Yun; Tan, Joel Shi Quan; Seah, Alvin Wan Hin; Foo, Fung Joon; Chang, Meihuan; Tang, Choong Leong; Tan, Emile

doi:10.1016/j.asjsur.2020.07.020

Cited by 23 publications

(22 citation statements)

References 26 publications

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“…Previous studies have shown that increased compliance with ERAS programmes would lead to better treatment outcomes and may have long-term benefits for survival. 23 Therefore, the compliance of patients and families to all ERAS programmes is an important indicator to ensure the implementation effect of ERAS. Our study demonstrated that high costs were one of the main reasons for the poor compliance of patients and families.…”

Section: Discussionmentioning

confidence: 99%

“…On the outcome dimension, participants agreed that poor compliance of patients and families would cause the quality of ERAS implementation to decline. Previous studies have shown that increased compliance with ERAS programmes would lead to better treatment outcomes and may have long-term benefits for survival 23. Therefore, the compliance of patients and families to all ERAS programmes is an important indicator to ensure the implementation effect of ERAS.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have found many barriers to interprofessional cooperation among ERAS-MDTs, such as a lack of personnel, resistance to changes in traditional surgical concepts, poor patient compliance and collaboration, and a lack of unified management and operative plans for MDTs. [22][23][24][25] However, the current qualitative research mainly focused on surgeons, nurses and anaesthesiologists. 25 There are only limited data on the barriers encountered by dietitians in the implementation of ERAS, 26 warranting further study.…”

Section: Open Accessmentioning

confidence: 99%

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Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

et al. 2022

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ObjectiveTo explore the attitudes and barriers encountered in the implementation of enhanced recovery after surgery (ERAS) in China from the perspective of multidisciplinary team members.DesignBased on Donabedian’s structure–process–outcome (SPO) model, a multicentre qualitative study using semistructured interviews was conducted.SettingFrom September 2020 to December 2020, the participants of this study were interviewed from six tertiary hospitals in Sichuan province (n=3), Jiangsu province (n=2) and Guangxi province (n=1) in China.ParticipantsA total of 42 members, including surgeons (n=11), anaesthesiologists (n=10), surgical nurses (n=14) and dietitians(n=7) were interviewed.ResultsMultidisciplinary team (MDT) members still face many barriers during the process of implementing ERAS. Eight main themes are described around the barriers in the implementation of ERAS. Themes in the structure dimension are: (1) shortage of medical resources, (2) lack of policy support and (3) outdated concepts. Themes in the process dimension are: (1) poor doctor–patient collaboration, (2) poor communication and collaboration among MDT members and (3) lack of individualised management. Themes in the outcome dimension are: (1) low compliance and (2) high medical costs. The current implementation of ERAS is still based on ideas more than reality.ConclusionsIn general, barriers to ERAS implementation are broad. Identifying key elements of problems in the application and promotion of ERAS from the perspective of the MDT would provide a starting point for future quality improvement of ERAS, enhance the clinical effect of ERAS and increase formalised ERAS utilisation in China.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

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Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

et al. 2022

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“…Despite the efforts by various affiliated societies like the European Society for Clinical Nutrition and Metabolism and the International Association for Surgical Metabolism and Nutrition, the ERAS protocol is still yet to be fully adopted[ 28 - 30 ]. Recent evidence has shown that compliance to the protocol ranges only about 60%-65% at best, with a study from Singapore indicating that only 26.7% of surgeries adhered to > 70% compliance to ERAS principles[ 31 ]. When split into the pre-, intra- and post-operative components, one study revealed that postoperative protocol compliance was only 30%[ 30 ].…”

Section: Enhanced Recovery After Surgery – Why Do We Need Something Better?mentioning

confidence: 99%

“…Thirdly, a majority of rehabilitative programs begin after surgery and in order for patients to reap the most benefits, a multitude of studies have advocated at least 1-2 mo of rehabilitation[ 34 - 36 ]. However, upon discharge, patients’ compliance to the exercise and nutrition regime is often at best 70%[ 28 - 31 ]. Having the mentality that surgery is the definitive step in the removal of their pathology is a misconception that needs to be weeded out.…”

Section: Enhanced Recovery After Surgery – Why Do We Need Something Better?mentioning

confidence: 99%

Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data

Koh

Chua

Tan

et al. 2021

WJGS

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A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

et al. 2021

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ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.OBSERVATIONS Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low-and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCETo date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

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Results of a colorectal enhanced recovery after surgery (ERAS) programme and a qualitative analysis of healthcare workers’ perspectives

Cited by 23 publications

References 26 publications

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Barriers to implementation of enhanced recovery after surgery (ERAS) by a multidisciplinary team in China: a multicentre qualitative study

Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data

Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

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