Adherence to ERAS elements in major visceral surgery-an observational pilot study.

Abstract

Enhanced recovery after surgery (ERAS) programs have been introduced increasingly into major visceral surgery. Key elements target on early drain removal and mobilization of the patients; however, reporting of adherence to ERAS protocols has often been insufficiently assessed. The present study aims to prospectively evaluate ERAS compliance after major visceral surgery. A prospective pilot study was designed, and 34 patients scheduled for major hepatopancreatic or gastric surgery were followed postoperatively until postoperative day (POD) 10. Analgesia and drain management, diet, mobilization, willingness to exercise, and the use of discharge criteria were accurately assessed within an established ERAS protocol scenario. Thirty-one cases were analyzed that consisted of 54.8% major pancreatic, 29.0% hepatic, and 16.1% gastric resections. The median hospital stay was 12.5days, and 83.9% of the patients met the objective criteria before discharge. By POD 4, wound, epidural, and urinary catheters were still in place in 70, 60, and 40% of the patients, respectively. Fifty percent of the patients ambulated out of bed until POD 2. The cumulative duration of postoperative mobilization per day ranged from 15 to 155min, and only 40% of the patients felt comfortable with additional mobilization or physical exercise. Adherence to ERAS protocols is poorly reported. The results indicate a discrepancy between ERAS targets and actual practice in comorbid patients undergoing major visceral surgery, need for a prompt redefinition of ERAS mobilization targets, need for the improvement of counseling, and need for the implementation of ERAS principles.