FTP4.8 A survey on enhanced recovery after surgery (ERAS) in Pakistan

Introduction

ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the stress response following surgery. Despite a significant body of evidence indicating that ERAS protocols lead to improved outcomes, implementation has been slow, and is not yet universal.

The aim of this study was to evaluate current implementation of enhanced recovery protocols among Pakistani surgeons.

Methods

A survey questionnaire consisting of 23 items was created to assess current trends in perioperative management of patients undergoing major surgery, and to ascertain the extent to which ERAS is understood and implemented.

Results

The survey was answered by 100 individuals. 32 % of participants were familiar with ERAS protocols. All participants gave pre-operative counselling. 26% performed preoperative nutritional assessment with provision of pre-operative nutritional support in 24 % cases. Anaemia was managed in 84 % cases and smoking cessation done in 70 %. Patients were kept nil per oral for > 6 hrs in about 80 % cases. Antibiotic prophylaxis given in 94 % cases. Preoperative loading with carbohydrate drinks is carried out in only 2% of cases with 90 % being unfamiliar with the term; nasogastric tube done (58 %), transurethral drainage (42%). opioid analgesia use 54 % and multi modal analgesia used in only 32 %. Prophylaxis for postoperative nausea and vomiting (34%), VTE prophylaxis 26 %. Early mobilization (84%) and early feeding in only 32 % was performed.

Conclusion

An ERAS program requires a dedicated multidisciplinary team willing to abandon out-dated paradigms and embrace new ideas.