Abstract
ObjectivesEnhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians’ practice about ERAS in patients undergoing CRS-HIPEC.MethodsAn online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists.ResultsThe response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated.ConclusionsMost respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.
Highlights
Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with higher morbidity compared to other gastrointestinal oncological procedures, with complications developing up to 90-days after surgery [1, 2]
Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies
The majority (95%) of respondents agreed that enhanced recovery after surgery (ERAS) could be implemented in CRS-HIPEC patient population
Summary
Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with higher morbidity compared to other gastrointestinal oncological procedures, with complications developing up to 90-days after surgery [1, 2]. Events like higher pain scores, higher nasogastric tube output, higher peritoneal drain output, and transient diarrhea are often seen after CRS-HIPEC [9, 11–13]. These patients require longer intensive care admissions and a longer hospital stay, compared to other gastrointestinal surgical procedures. An American study from 12 academic institutions showed that variation in perioperative practice patterns existed among measured ERAS pathway process/outcomes. The percentages of variation with each process/outcome measure attributable solely to institutional practices ranged from 0.6 to 66.6% [15]. We conducted this survey to study existing practices about ERAS in patients undergoing CRS-HIPEC in India
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