Level of ERAS understanding affects practitioners\u2019 practice and perception of early postoperative resumption of oral intake: a nationwide survey

Huizhen Huang,Yuelun Zhang,Le Shen,Yuguang Huang

doi:10.1186/s12871-021-01500-9

Abstract

BackgroundEarly postoperative resumption of oral intake is supposed to be safe and beneficial to patients recovery. However, practitioners still have great confusion and disagreement about postoperative resumption of oral intake. This is a nationwide survey to investigate the current status of clinical practice and practitioners’ attitude toward postoperative resumption of oral intake along with their level of understanding of the ERAS guidelines.MethodsAn anonymous web-based survey questionnaire via mobile social platform was carried out in mainland China from December 11–20, 2020. The Wilcoxon signed rank test or chi-square test was used to compare the propensity of the resumption of oral intake.ResultsTotally 5370 responses were received, and 89% of them were from anesthesiology departments. The nature of the responses from clinical practitioners was highly diverse, but each of the three surgery types showed unique patterns of ERAS implementation. The respondents were more conservative regarding the commencement of both fluid and solid diets after gastrointestinal (GI) and hepato-pancreato-biliary (HPB) surgery than after non-abdominal (NA) surgery. Most respondents agreed that early oral intake is beneficial to reduce postoperative complications improve bowel recovery and overall outcome. 55% respondents considered themselves to have a better understanding of ERAS and tended to initiate oral intake early for all three surgery types (P < 0.001).ConclusionsThe postoperative resumption of oral intake is highly variable among GI, HPB and NA surgeries. A better understanding of ERAS would encourage practitioners to commence oral intake resumption much earlier.

Highlights

Postoperative resumption of oral intake is supposed to be safe and beneficial to patients recovery
Traditionally, postoperative oral intake is gradually introduced following the resumption of bowel sounds and the passage of flatus or stool, which is mainly due to the fear that early oral intake can prolong paralytic ileus
Surgical and perception differences in the early postoperative resumption of oral intake This study focused on early oral intake; for clear analysis, early resumption of postoperative oral intake was defined as diet given no more than 6 h postoperatively to patients, including the timepoints of “discharge from postanesthesia care unit (PACU)” and “2-4 hours postoperation”, while late

Summary

Introduction

Postoperative resumption of oral intake is supposed to be safe and beneficial to patients recovery. The ERAS program initially became well established for colorectal surgery [6] and has been further expanded, promoting rapid functional recovery after abdominal and non-abdominal surgeries such as gastrointestinal surgery [7], pancreatoduodenectomy [8], liver surgery [9], lung surgery [10], breast surgery [11], total hip/knee replacement [12], lumbar spinal fusion [13], cardiac surgery [14] and gynecological surgeries [15, 16] Almost all these ERAS programs suggest re-establishing oral feeding as early as possible after surgery. It deserves due attention that unlike the “2–4–6–8 rule” as a universally accepted standard of preoperative fasting [18], when to commence postoperative oral intake is vague and confusing

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Discussion

Conclusion