Preoperative Phases Research Articles

The air quality impacts of pre-operational hydraulic fracturing activities

Hydraulic fracturing (fracking) is a short phase in unconventional oil and natural gas (O&G) development. Before fracking there is a lengthy period of preparation, which can represent a significant proportion of the well lifecycle. Extensive infrastructure is delivered onto site, leading to increased volumes of heavy traffic, energy generation and construction work on site. Termed the “pre-operational” period, this is rarely investigated as air quality evaluations typically focus on the extraction phase. In this work we quantify the change in air pollution during pre-operational activities at a shale gas exploration site near Kirby Misperton, North Yorkshire, England. Baseline air quality measurements were made two years prior to any shale gas activity and were used as a training dataset for random forest (RF) machine learning models. The models allowed for a comparison between observed air quality during the pre-operational phase and a counterfactual business as usual (BAU) prediction. During the pre-operational phase a significant deviation from the BAU scenario was observed. This was characterised by significant enhancements in NOx and a concurrent reduction in O3, caused by extensive additional vehicle movements and the presence of combustion sources such as generators on the well pad. During the pre-operational period NOx increased by 274 % and O3 decreased by 29 % when compared to BAU model values. There was also an increase in primary emissions of NO2 during the pre-operational phase which may have implications for the attainment of ambient air quality standards in the local surroundings. Unconventional O&G development remains under discussion as a potential option for improving the security of supply of domestic energy, tensioned however against significant environmental impacts. Here we demonstrate that the preparative work needed to begin fracking elevates air pollution in its own right, a further potential disbenefit that should be considered.

Recomendaciones para la recuperación posquirúrgica optimizada en columna (REPOC)

Introduction/objectivesEnhanced recovery after surgery (ERAS) constitutes a multimodal approach, based on available scientific evidence, that achieves better patient's functionality, reduces pain, and even lowers financial costs. The present consensus statement proposes the standards for the implementation of ERAS programs to lumbar fusion surgery, a meant benchmark we call REPOC. MethodologyA multidisciplinary group of experts was set up ad hoc to review consensus recommendations for lumbar arthrodesis, using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. ResultsAs a result, 23 recommendations were selected throughout the preoperative, intraoperative, and postoperative phases of the surgical procedure. A 29-item checklist was also drawn up to implement REPOC protocols in spinal surgeries. ConclusionsThis list of recommendations will facilitate the implementation of this multimodal approach as a safe and effective tool for reducing adverse events in our environment.

Endophthalmitis After Cataract Surgery: A Postoperative Complication.

Endophthalmitis is a condition of the eye caused due to complications in cataract surgery. The extent of this complication can be from minor to very serious, leading to a permanent loss of light perception. It is generally an inflammation of the fluids present in the anterior and posterior chamber of the eye, consisting of vitreous and aqueous fluid. The inflammation is due to the infection of these fluids after their exposure during or after the cataract surgery. In today's situation, patient surgery is the most frequently preferredfor the correction or treatment of the cataract.There are various factors causing endophthalmitis in cataract surgery. This condition occurs mostly by the entry of infective bacteria such as staphylococcus, gram-negative organisms, and streptococcus species. As well as fungi like aspergillus and candida. Cataract surgery has many risk factors that can be divided into preoperative, intraoperative, and postoperative phases. The most common symptom of this condition is pain in the eyes and redness, which sometimes leads to purulent discharge, causing decreased vision or loss of eyesight. The increasing inflammation of the vitreous fluid is the main identification of the condition. There is a surge of inflammatory cells in the space of the vitreous fluid. The condition can be classified into two types which are exogenous and endogenous. In these types, subtypes explain the postoperative complications of the disease. It is a rare condition, and the percentage of it occurring as a postoperative complication is very low. It generally targets the old age group of people. This narrative review article explainsendophthalmitis as a postoperative complication of cataract surgery and its treatment modalities. The terms endophthalmitis, postoperative, cataract surgery, complications, and vitreous humor were used for the review article in PubMed.

The emerging role of artificial intelligence in adult spinal deformity

Artificial intelligence (AI) refers to computer-based technologies that seek to replicate human intelligence by allowing software to make decisions and provide recommendations based on the analysis of large datasets. Present applications of AI in spine deformity surgery have focused on improving safety and efficacy by automating, standardizing, and facilitating data guided approaches. In this review, the authors focus on 3 types of AI technology: 1) Surgical classification, 2) individualized outcome prediction, and 3) surgical planning. It is anticipated that AI will become an essential part of the preoperative, intraoperative, and postoperative phases of adult spinal deformity surgery.

Evaluation of chronological changes in videofluorographic findings after transoral videolaryngoscopic surgery to reveal mechanism of dysphagia

ObjectivesTransoral surgery preserves good swallowing function in most cases, however, postoperative dysphagia sometimes leads to fatal complication such as aspiration pneumonia. We investigated the chronological changes in swallowing function have not been revealed relationship with dysphagia. The primary aim of this study was to reveal the mechanism of dysphagia following transoral surgery by analyzing chronological videofluorography (VF) findings. Moreover, the secondary aim of this study was to evaluate the relationship between mechanism of dysphagia and risk factors of patients to clarify the risk for dysphagia lead to prevention of postoperative complications. Methods22 patients who underwent transoral videolaryngoscopic surgery (TOVS) for either supraglottic or hypopharyngeal cancer were evaluated swallowing function. We performed VF during the preoperative, postoperative acute, and stable phases and investigated the chronological changes in the VF findings. The following parameters were evaluated by VF: horizontal distance of laryngeal movement, vertical distance of laryngeal elevation, laryngeal elevation delay time (LEDT), Bolus Residue Scale (BRS) scores, and Penetration Aspiration Scale (PAS) scores. Additionally, we evaluated risk factors for postoperative aspiration by investigating relationships between preoperative VF parameters, age of patients, history of radiation therapy, resection area, tumor (T) stage, postoperative Numeric Rating Scale (NRS), and PAS and BRS scores. ResultsThe median time at which oral feeding was resumed in this study was 9 (2–200) days. The patients who had postoperative acute PAS scores of 4 and above exhibited delays in resuming oral ingestion after surgery. TOVS did not impair laryngeal elevation and LEDT; however, the BRS and PAS scores temporarily worsened in the acute phase compared to the preoperative scores. These scores almost recovered to their preoperative states in the stable phase, and both the BRS and PAS scores worsened and recovered concurrently. Patients who exhibited poor vertical distance in laryngeal elevation as observed via preoperative VF or who had histories of radiation therapy had worse PAS scores in postoperative acute phase VF. Patients with broad resection areas had worse BRS scores in postoperative acute phase VF. ConclusionTOVS didn't impair the function of laryngeal elevation and elicitation of the swallowing reflex whereas pharyngeal bolus clearance, laryngeal penetration, and aspiration temporarily deteriorated concurrently but eventually almost recovered to their baseline values.Patients with histories of radiotherapy, poor laryngeal elevation, and broad resection areas are at the risk of postoperative dysphagia after TOVS. Patients with these risk factors need appropriate evaluation before resuming postoperative oral intake.

Examining the Utility of Preoperative Telemedicine Care Across Multiple Pediatric Surgery Disciplines.

Telemedicine use within pediatric surgery fields has been growing, but research on the utility of remote evaluation in the perioperative period remains scarce. The objective of this study was to examine the utility of perioperative telemedicine care for the pediatric patient by evaluating the outcomes following completion of an outpatient appointment with a surgical provider. We performed a retrospective chart review of all patients who completed a telemedicine appointment with a provider across nine pediatric surgery divisions, without a limitation based on patient-specific characteristics or telemedicine platform. We examined the result of the initial telemedicine appointment and the outcome of any surgical procedure that was performed as a result. A total of 803 patients were evaluated by telemedicine during the study period. Of the 164 encounters (20.2%) that were followed by a surgery, nearly 70% were performed using a video. There was no discordance in the preoperative and postoperative diagnoses for more than 98% of patients. Nearly 25% of operations were followed by at least a 1-night hospital stay and 6.7% of patients developed a postoperative complication. Telemedicine is a safe tool for evaluating pediatric patients in the preoperative and postoperative phases of care and offers potential value for families seeking an alternative to the traditional in-person appointment. Ongoing support will require permanent legislative changes aimed at ensuring comparable compensation and the development of strategies to adapt the outpatient healthcare model to better accommodate the evolving requirements of remotely evaluating and treating pediatric patients.

Implementation of entrustable professional activities into fellowship council accredited programs: a pilot project.

ObjectiveThe Fellowship Council (FC) is transitioning to a competency-based medical education (CBME) model, including the introduction of Entrustable Professional Activities (EPAs) for training and assessment of Fellows. This study describes the implementation process employed by the FC during a ten-month pilot project and presents data regarding feasibility and perceived value.MethodsThe FC coordinated the development of EPAs in collaboration with the sponsoring societies for Advanced GI/MIS, Bariatrics, Foregut, Endoscopy and Hepatopancreaticobiliary (HPB) fellowships encompassing the preoperative, intraoperative, and postoperative phases of care for key competencies. Fifteen accredited fellowship programs participated in this project. The assessments were collected through a unique platform on the FC website. Programs were asked to convene a Clinical Competency Committee (CCC) on a quarterly basis. The pilot group met monthly to support and improve the process. An exit survey evaluated the perceived value of EPAs.ResultsThe 15 participating programs included 18 fellows and 106 faculty. A total of 655 assessments were initiated with 429 (65%) completed. The average (SD) number of EPAs completed for each fellow was 24(18); range 0–72. Intraoperative EPAs were preferentially completed (71%). The average(SD) time for both the fellow and faculty to complete an EPA was 27(78) hours. Engagement increased from 39% of fellows completing at least one EPA in September to 72% in December and declining to 50% in May. Entrustment level increased from 6% of EPAs evaluated as “Practice Ready” in September to 75% in June. The exit survey was returned by 63% of faculty and 72% of fellows. Overall, 46% of fellows and 74% of program directors recommended full-scale implementation of the EPA framework.ConclusionA competency-based assessment framework was developed by the FC and piloted in several programs. Participation was variable and required ongoing strategies to address barriers. The pilot project has prepared the FC to introduce CBME across all FC training programs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00464-022-09502-5.

Enhanced Recovery After Surgery (ERAS) protocol in minimally invasive gynecological surgery: a review of the literature.

Enhanced Recovery After Surgery (ERAS) is a complex system of procedures that necessitates multidisciplinary patient care during the preoperative, intraoperative, and postoperative phases. Over the last two decades, the ERAS protocol, which was initially described in colorectal surgery, has gradually expanded to other surgical specialties. Gynecological surgery is no exception, whether for benign or malignant conditions. The ERAS program's primary objective is to overcome the pathophysiological processes associated with surgical stress and to facilitate the patient's rapid recovery, while minimizing complications, hospital stays, and costs. The objectives of minimally invasive surgical procedures largely overlap with the objectives of the ERAS program. We analyzed scientific data from studies examining the ERAS system's application in minimally invasive gynecological surgery (MIGS) and present them in this review. The central question is whether the ERAS protocol can provide additional benefits beyond those inherent in minimally invasive surgical procedures.

Virtual Surgical Planning and Three-Dimensional Printing in Rhinoplasty.

Recent developments in three-dimensional (3D) imaging technology offer a more comprehensive means of assessing facial features. 3D printing allows for the transition of planning from simply a preoperative tool to an intraoperative device with the use of tools such as 3D-printed cutting guides, marking guides, or positioning guides. With the advent of 3D printing technology, 3D surface images can now be used to generate new medical models, devices, or tools to assist with rhinoplasty during preoperative, intraoperative, and postoperative phases. In the field of rhinoplasty, 3D printing can be applied in three main areas: (1) reference models, (2) surgical guides, and (3) nasal splints. The value of 3D imaging extends far beyond the benefits of "conversion" during a preoperative consultation and has the potential to greatly enhance the overall treatment of rhinoplasty patients with enhanced communication and personalized devices that can be used during surgery and in the postoperative phase.

Pediatric penetrating keratoplasty and its unique challenges

Abstract Pediatric penetrating keratoplasty (PK) or full-thickness cornea transplant is defined as PK in a patient younger than 16 years old. This procedure is different from the adult due to anatomical differences of the globe, excessive inflammation postoperatively, the higher expectation of the parents, and less visual outcome due to amblyopia. It is often convenient to look at these issues at various stages such as preoperative, intraoperative, and postoperative phases. All these phases pose their own unique challenges that can be managed with various strategies. Proper indication of the PK, proper evaluation, timing of the surgery, surgical planning and technique, intraoperative considerations, postoperative management, follow-ups, and outcome measurement matters a lot for the success of this surgery. Everything eventually affects the outcome and prognosis of PK in the pediatric age group.

Clinical recommendations for the care of people with treatment-refractory obsessive-compulsive disorder when undergoing deep brain stimulation.

Deep brain stimulation is an emerging therapy for treatment-refractory obsessive-compulsive disorder patients. Yet, accessibility is limited, treatment protocols are heterogeneous and there is no guideline or consensus on the best practices. Here, we combine evidence from scientific investigations, expert opinions and our clinical expertise to propose several clinical recommendations from the pre-operative, surgical and post-operative phases of deep brain stimulation care for treatment-refractory obsessive-compulsive disorder patients. A person-centered and biopsychosocial approach is adopted. Briefly, we discuss clinical characteristics associated with response, the use of improved educational materials, an evaluative consent process, comprehensive programming by an expert clinician, a more global assessment of treatment efficacy, multi-disciplinary adjunct psychotherapy and the importance of peer support programs. Furthermore, where gaps are identified, future research suggestions are made, including connectome surgical targeting, scientific evaluation of hardware models and health economic data. In addition, we encourage collaborative groups of data and knowledge sharing by way of a clinical registry and a peer group of programming clinicians. We aim to commence a discussion on the determinants of deep brain stimulation efficacy for treatment-refractory obsessive-compulsive disorder patients, a rare and severe patient group, and contribute to more standardized and evidence-based practices.

A dynamic risk factor assessment for myocardial infarction and cardiac arrest in patients undergoing pancreatectomy

To identify pancreatectomy specific risk factors for myocardial infarction and cardiac arrest (MICA) and to assess whether addition of new information obtained during the hospitalization changes these risk factors. Analysis was performed on elective pancreatectomy data from the ACS-NSQIP database (2014-2019). Risk factors were grouped into pre-operative, intra-operative, and postoperative phases. Factors were selected using a bootstrap resampling procedure to determine MICA association. Independent significance was assessed by logistic regression. In the first 30 days post-op, 650 of 39779 patients (1.88%) developed MICA. Some of the surgery specific, intra- and post-operative factors that were identified are: delayed gastric emptying (OR: 2.61; 95% CI: 2.12-3.21), total pancreatectomy (OR: 2.16; 95% CI: 1.29-3.42), pancreatic fistula (OR: 1.54; 95% CI: 1.25-1.90), post-operative transfusion (OR: 1.28; 95% CI: 1.03-1.58), and open approach (OR: 1.36; 95% CI: 1.05-1.77). Adding new variables improved statistical model performance and the c-statistic improved from 0.69 to 0.76 in the final analysis. Surgery specific, intra-, and post-operative factors were associated with MICA. Addition of new information during the hospital course changed risk factors and the statistical prediction of MICA risk improved.

An integrated approach of building information modelling and life cycle assessment (BIM-LCA) for gas and solar water heating systems

Buildings are responsible for the energetic consumption and potential greenhouse gas emissions during their life cycle. Water heating system contribute to a building’s energetic consumption, mainly in residential units, throughout the building’s operational phase. Variability in energy sources, reservation and distribution systems of hot water along with the types of construction materials used in these building systems are key decisions to make in the initial design phases of a building project. Often, the definition of the most appropriate water heating system for a building is made via a technical-economic decision. However, the decision is rarely based on natural resource consumption and environmental impact generation throughout the life-cycle of the heating systems and of buildings as a whole. This study presents an application of a specific environmental management tool, based on an integrated Building Information Modelling (BIM) and Life-Cycle Analysis (LCA) method for selection of hot water systems, during the early design building phase. The proposed approach is implemented in the pre-operational phase, in order to enable decision makers to appreciate the resulting environmental performance of water heating systems in buildings. The applicability of the framework is tested via a comparative study of solar heating water systems and natural gas heating water systems for a residential multifamily building to be constructed in Rio de Janeiro, Brazil. For the indicators damage to human health and damage to ecosystem, results indicate that the greatest impact on global warming comes from the natural gas heating system, while for solar heating, free particulate matter was the highest negative contribution. The operation phase for the natural gas system was highest for climate change while for solar heating system, it was the fresh water that was impacted the most during the pre-operational phase of the system’s use.

Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols.

Background:Infection following implant-based breast reconstruction (IBBR) results in increased rates of hospital readmission, reoperation, patient and hospital expenses, and reconstructive failure. IBBR is a complex, multistep procedure, and there is a relative lack of high-quality plastic surgery evidence regarding “best practices” in the prevention of implant infections. In the absence of strong data, standardizing procedures based on available evidence can reduce error and improve efficacy and outcomes.Methods:We performed a focused literature review of the available evidence supporting specific interventions for infection prevention in the preoperative, intraoperative, and postoperative phases of care that are applicable to IBBR. In addition, we examined previously published standardized perioperative protocols for implant reconstruction.Results:Preoperative, intraoperative, and postoperative planning and organization is crucial in IBBR. Preoperative planning involves skin decolonization in advance of surgery with either chlorhexidine gluconate or mupirocin. Intraoperative methods that have shown potential benefit include double-gloving, breast pocket irrigation, separate closing instruments, and the utilization of “no-touch” techniques. In the postoperative period, the duration of drain removal and postoperative antibiotic administration play an important role in the prevention of surgical site infection.Conclusions:There is a crucial need to establish an evidence-based set of “best practices” for IBBR, and there exists a paucity of evidence in the breast literature. These data can be utilized to develop a standardized protocol as part of a rigorous quality improvement methodology.

Perioperative nursing – exclusive or inclusive?

Perioperative nursing is very much a multidimensional area of practice that has evolved as models of perioperative patient care, surgery, anaesthetics and their complexity, techniques and equipment have evolved. Within the broad perioperative area there are numerous nursing roles. However, they do not all necessarily identify as being under a singular ‘perioperative’ umbrella and this is largely due to how the roles evolved. Thus the question: is perioperative nursing exclusive, in that it identifies with only one facet of the pre-operative, intra-operative and post-operative phases of the patient’s surgical experience? Or is it inclusive, in that nurses who work in any of these phases consider themselves perioperative nurses with a common aim to advance safe, quality perioperative nursing care for Australians?

Emerging role of telemedicine in perioperative anaesthesia and pain management

The novel coronavirus disease (COVID-19) pandemic has caused significant alterations in our traditional healthcare system. The use of technologies such as telemedicine has seen a rapid upsurge. Though the benefits of telemedicine are well-documented; its use in anaesthesia is still in the nascent stage. Various authors have successfully demonstrated its application in perioperative anaesthesia and chronic pain. The ongoing pandemic has highlighted the importance of its more widespread use in anaesthesia. The establishment of clear guidelines addressing telemedicine and its legal and ethical concerns by many countries should provide a further impetus to its more frequent adoption. This article aims to review the existing literature about the use of telemedicine in the preoperative, intraoperative and postoperative phases of anaesthesia as well as in chronic pain and academics. As the pandemic abates, it presents a unique opportunity to expand the application of telemedicine in the various spheres of anaesthesia and pain.

A survey of surgical site infection prevention practice in UK vascular surgery

Background: Surgical site infections (SSI) have a significant impact on morbidity and mortality within vascular surgery. Despite the publication of several guidelines, there is a lack of consensus regarding the most effective perioperative practice to minimise the incidence of SSI. This study aimed to assess the current practice of SSI prevention among UK vascular surgeons. Methods: An online survey developed using the current National Institute for Health Care and Excellence (NICE), Centers for Disease Control and Prevention (CDC) and World Health Organisation (WHO) SSI prevention guidelines was piloted in a tertiary vascular centre before being distributed by email to the members of the Vascular Society of Great Britain and Ireland. The survey contained 15 question domains across preoperative, perioperative and postoperative phases to establish current SSI prevention practice. The survey was open for 1 month with reminder emails at 2 and 3 weeks. Results: A total of 109 respondents from 47 UK hospitals completed the survey, 90 of which were consultants (82.6%). The median reported SSI rate was 7.5% (IQR 5–10%). Lower limb arterial and major limb amputations were highlighted as the highest risk procedures of SSI. Empirical criteria are used by 67.2% of respondents to diagnose SSI, and over half (52.2%) of surgeons used this alone. Most respondents use alcoholic chlorhexidine gluconate (69.6%) skin preparation and basic wound dressings (67.6%). Around half (52.5%) of respondents reported that they would use negative pressure wound therapy for closed wounds. Formal wound surveillance was not undertaken by 73.7% of respondents. Conclusions: There is little agreement in current guidelines on the best practice to prevent SSI. Unsurprisingly then, clinical practice follows suit and continues to show little consensus on prevention measures used. There also appears to be a disparity in registry level, clinical perception and literature data for SSI rates. Well-designed high-quality trials are needed to provide evidence-based recommendations in this field.

The challenges of deep learning in artificial intelligence and autonomous actions in surgery: a literature review

Aim: Artificial intelligence (AI) is rapidly evolving in healthcare worldwide, especially in surgery. This article reviews important terms used in machine learning and the challenges of deep learning in surgery. Methods: A review of the English literature was carried out focused on the terms “challenges of deep learning” and “surgery” using Medline and PubMed between 2018 and 2022. Results: In total, 54 articles discussed the challenges of deep learning in general. We include 25 articles from various surgical specialties discussing challenges corresponding to their respective specialties. Conclusion: The increased utilization of AI in surgery is faced with a wide variety of technical, ethical, clinical, and business-related challenges. The best way to expedite its expansion in surgery in the safest and most cost-efficient manner is by ensuring that as many surgeons as possible have a clear understanding of basic AI concepts and how they can be applied to the preoperative, intraoperative, postoperative, and long-term follow-up phases of the surgical patient care.

Acute peri-operative neurocognitive disorders: a narrative review.

Peri-operative neurocognitive disorders are the most common complication experienced by older individuals undergoing anaesthesia and surgery. Peri-operative neurocognitive disorders, particularly postoperative delirium, result in long-term poor outcomes including: death; dementia; loss of independence; and poor cognitive and functional outcomes. Recent changes to the nomenclature of these disorders aims to align peri-operative neurocognitive disorders with cognitive disorders in the community, with consistent definitions and clinical diagnosis. Possible mechanisms include: undiagnosed neurodegenerative disease; inflammation and resulting neuroinflammation; neuronal damage; and comorbid systemic disease. Pre-operative frailty represents a significant risk for poor postoperative outcomes; it is associated with an increase in the incidence of cognitive decline at 3 and 12 months postoperatively. In addition to cognitive decline, frailty is associated with poor functional outcomes following elective non-cardiac surgery. It was recently shown that 29% of frail patients died or experienced institutionalisation or new disability within 90 days of major elective surgery. Identification of vulnerable patients before undergoing surgery and anaesthesia is the key to preventing peri-operative neurocognitive disorders. Current approaches include: pre-operative delirium and cognitive screening; blood biomarker analysis; intra-operative management that may reduce the incidence of postoperative delirium such as lighter anaesthesia using processed electroencephalography devices; and introduction of guidelines which may reduce or prevent delirium and postoperative neurocognitive disorders. This review will address these issues and advocate for an approach to care for older peri-operative patients which starts in the community and continues throughout the pre-operative, intra-operative, postoperative and post-discharge phases of care management, involving multidisciplinary medical teams, as well as family and caregivers wherever possible.

Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery.

PurposeEnhanced Recovery After Surgery (ERAS) reduces postoperative complications and shortens hospital stays. We aimed to describe the implementation and improvement of ERAS protocols in our institution through a multidisciplinary team approach.MethodsA multidisciplinary team comprised of colorectal surgeons, anesthesiologists, nurses, pharmacists, nutritionists, and a performance improvement team was launched to develop the ERAS protocol. The ERAS protocol was followed in patients who underwent colonic and rectal surgery between January and November 2017. The ERAS protocol comprised 22 elements in the preoperative, intraoperative, and postoperative phases. After the initial application, ERAS compliance was monitored and audited every 4–6 months and improvements made as necessary.ResultsThe length of hospital stay significantly decreased after the application of the ERAS protocols for colon cancer in 2017 and 2018. And there was no significant difference in the duration of hospital stay after applying the rectal cancer ERAS protocol. Moreover, after starting the colon ERAS, there was a significant decrease in the complication rate. Since December 2017, there was a continuous increase in the colorectal ERAS clinical pathway application rate, which remained high (>90%). The patient compliance rate significantly increased between 2017 and 2018, but slightly decreased again in 2019.ConclusionThe application and continual improvement of an ERAS protocol are crucial. Improving compliance may result in better clinical outcomes. Additionally, the basic guidelines of ERAS must be applied and developed according to each hospital’s situation based on the team approach.