Evaluate the compliance of perioperative practices of the patients with the enhanced recovery after surgery protocols

Yeliz Cigerci; Serife Celebi

doi:10.26900/hsq.1.3.04

Authors

Yeliz Cigerci Afyonkarahisar Health Sciences University/Turkey 0000-0002-9858-0837
Serife Celebi Suleyman Demirel University/Turkey 0000-0002-9858-0837

10.26900/hsq.1.3.04

Abstract

The Enhanced Recovery after Surgery (ERAS) protocol is a multimodal and evidence-based medical practice developed to define the concept of perioperative interventions to improve postoperative outcomes. The protocol consists of a number of elements implemented in the pre-, intra - and post-operative periods. This study aimed to evaluate the compliance of perioperative practices with the ERAS protocols in patients undergoing surgical intervention. In this descriptive and prospective study, 405 patients who underwent surgery in the General Surgery Clinic of a University Hospital created a sample of the study. In the study, where no intervention was made to the patients included in the study, the compliance of routine perioperative practices in the clinic offered to patients undergoing surgery to the protocol was evaluated using the questionnaire prepared in this direction. Procedures such as, in the preoperative period, providing verbal information to all the patients and giving antibiotic prophylaxis to 98.5% of the patients, in the intraoperative period, preferring the smallest possible surgical incision, and, in the postoperative period, using the paracetamol (99.5%) as the first choice for analgesia were compatible with the ERAS protocols. Procedures such as, in the preoperative period, not providing oral carbohydrate to any of the patients and keeping the fasting period longer period (10.91 ± 4.79 hours), in the intraoperative period, preferring anesthetic agents that are effective for a long time, and not perform the necessary practices to ensure normothermia in any of the patients, and, in the postoperative period, not starting the oral nutrition early and using urinary catheterization for 87.7% of the patients were not compatible with the ERAS protocols. As a result of the research, it was determined that the routine perioperative applications in the clinic did not sufficiently comply with the ERAS protocol.

Keywords:

Enhanced recovery after surgery perioperative process

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References

ERAS Turkey Association (ETA) (2018). ERAS protokollerinin temel ogeleri. (in Turkish) http://eras.org.tr/page.php?id=10&saglikCalisani=true.

Ljungqvist O, Hubner M. Enhanced recovery after surgery ERAS principles, practice and feasibility in the elderly. Aging Clin Exp Res. 2018;30(3):249-52. doi: 10.1007/s40520-018-0905-1.

Bozkirli BO, Gundogdu RH, Ersoy PE, Akbaba S, Temel H, Sayın T. Did the ERAS protocol affect our results in colorectal surgery? Turk J Surg. 2012;28(3):149-52. doi: 10.5152/UCD.2012.05.

Ersoy E, Gundogdu H. Enhanced recovery after surgery. Turk J. Surg. 2007;23(1):35-40.

Lassen K, Hanneman P, Ljungqvist O. Pat¬terns in current perioperative practice: Survey of colorectal surgeons in five northern European countries. BMJ. 2005;330:1420-1. doi:10.1136/bmj.38478.568067.AE.

Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, Mckenzie M, Mcleod RS, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg. 2015;261(1):92-6. doi: 10.1097/SLA.0000000000000604.

Harlak A, Gundogdu H, Ersoy E, Erkek B. Attitude of surgeons in Ankara about enhanced recovery after surgery (ERAS) protocol. Turk J Surg. 2008;24(4):182-8.

Kirik MS. Kolorektal ameliyatlarda klinik alanda ameliyat öncesi, sırası ve sonrası uygulamaların ERAS protokolüne uygunluğunun karşılaştırılması [master’s thesis].(in Turkish) Gaziantep: Sanko University, Health Sciences Enstitute; 2018.

American Society of Anesthesiologists (ASA). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures: An updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376-93. doi: 10.1097/ALN.0000000000001452.

Hooper VD. SAMBA consensus guidelines for the management of postoperative nausea and vomiting: An executive summary for perianesthesia nurses. J Perianesth Nurs. 2015;30(5):377-82. doi: 10.1016/j.jopan.2015.08.009.

Amer MA, Smith MD, Herbison GP, Plank LD, Mccall JL. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg. 2017;104(3):87-197. doi: 10.1002/bjs.10408.

Campos SBG, Barros-Neto JA, Guedes GDS, Moura FA. Preoperative fasting: Why abbreviate? Arq Bras Cir Dig. 2018;31(2):1377. doi: /10.1590/0102-672020180001e1377.

Horosz B, Nawrocka K, Malec-Milewska M. Anaesthetic perioperative management according to the ERAS protocol. Anaesthesiol Intensive Ther. 2016;48(1):49-54. doi:10.5603/AIT.2016.0006.

Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14(6):731-7. doi: 10.1381/0960892041590944.

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195- 283. doi: 10.2146/ajhp120568.

Perez-Blanco V, Garcia-Olmo D, Maseda-Garrido E, NajeraSantos MC, Garcia-Caballero J. Evaluation of a preventive surgical site infection bundle in colorectal surgery. Cir Esp. 2015; 93(4):222-8. doi: 10.1016/j.ciresp.2014.12.003.

Bickenbach KA, Karanicolas PJ, Ammori JB, Jayaraman S, Winter JM, Fields RC, et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg. 2013; 206(3):400-9. doi:10.1016/j.amjsurg.2012.11.008.

Sajid MS, Shakir AJ, Khatri K, Baig MK. The role of perioperative warming in surgery: A systematic review. Sao Paulo Med J. 2009;127(4):231-7. doi: 10.1590/s1516-31802009000400009.

Zhang HY, Zhao CL, Xie J, Ye YW, Sun JF, Ding ZH, et al. To drain or not to drain in colorectal anastomosis: A meta-analysis. Int J Colorectal Dis. 2016;31(5):951-60. doi: 10.1007/s00384-016-2509-6.

Jottard K, Hoff C, Maessen J, Ramshorst B, Van Berlo CLH, Van Logeman F, et al. Life and death of the nasogastric tube in elective colonic surgery in the Netherlands. Clin Nutr. 2009; 28(1):26-8. doi: 10.1016/j.clnu.2008.09.002.

Li B, Liu HY, Guo SH, Sun P, Gong FM, Jia BQ. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer. Genet Mol Res. 2015;14(2):7136-41. doi: 10.4238/2015.June.29.7.

Sun DL, Li WM, Li SM, Cen YY, Xu QW, Li YJ. et al. Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: A prospective, randomized, single-blind trial. Nutr J. 2017;16(1):11. doi:10.1186/s12937-017-0228-7.

Nematihonar B, Salimi S, Noorian V, Samsami M. Early versus delayed (traditional) postoperative oral feeding in patients undergoing colorectal anastomosis. Adv Biomed Res. 2018; 16(7):30. doi: 10.4103/abr.abr_290_16.

Kim JY, Wie GA, Cho YA, Kim SY, Sohn DK, Kim SK, et al. Diet modification based on the enhanced recovery after surgery program (ERAS) in patients undergoing laparoscopic colorectal resection. Clin Nutr Res. 2018;7(4):297-302. doi:10.7762/cnr.2018.7.4.297.

Akin ML. Kolorektal Kanserlerde “Fast Track” Cerrahi. Baykan A, Zorluoglu A, Gecim E, Terzi C, Editors. Kolon ve Rektum Kanserleri. Secil Ofset Matbaacilik ve Sanayi (in Turkish); 2010. Sayfa 733-58.

Haines KJ, Skinner EH, Berney S. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: An observational cohort study. Physiotherapy. 2013;99(2):119-25. doi: 10.1016/j.physio.2012.05.013.

Grass F, Pache B, Martin D, Addor V, Hahnloser D, Demartines N, et al. Feasibility of early postoperative mobilisation after colorectal surgery: A retrospective cohort study. Int J Surg. 2018; 56:161-6. doi: 10.1016/j.ijsu.2018.06.024.