Modern perioperative care is not too complicated for us

Abstract

I read with interest the critical paper by Hill.1 The opinion developed in the paper tended to demonstrate that Enhanced Recovery Programme (ERP) is difficult to implement and should be dropped in favour of lighter programmes with less intrusion of other colleagues in the perioperative care. I do not agree with the author on many aspects of his approach. First, most ERP components are evidence based.2 Not implementing those components gives a way to criticism. Evidence-based practice is recommended and cost-effective.3 If a given surgeon wants to apply evidence-based perioperative measures, he(she) applies ERP without knowing it. In my opinion, the main challenge is to deal with the reluctance to change from different caregivers. I agree that some elements (cited by the author) can be debatable, but they do not put into question the entire programme. Beyond the beneficial effects on morbidity, hospital stay duration and cost (proven in several meta-analyses), the ERP involves other important advantages: the role of patients and the team spirit.4 We all know that the team work (with anaesthetists, nurses, etc.) improves the quality of care. Through good communication, our colleagues do no longer consider their job separately from our job. Hence, instead of working ‘against’ one another, the surgeons should collaborate with different caregivers, with a good team spirit. In this setting, the surgeon is no longer the captain of the ship.5 On the other hand, the audit system is recommended at least in the early years of implementation, until the ERP becomes a standard of care; but it is not necessarily expensive; our Francophone Group has developed a free of charge system (www.grace-asso.fr). Auditing is a part of our practice. We are driving an innovation which is beneficial for the patients (evidence care with less morbidity), the teams and the society (cost-effective). Therefore, we should not miss this paradigm shift and we must make the ERP a daily practice and a standard of care.6