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

Area of Science:

• Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) programs are increasingly adopted for major visceral surgery.
• Key ERAS elements include early drain removal and patient mobilization.
• Adherence to ERAS protocols requires robust assessment, which is often insufficient.

Purpose of the Study:

• To prospectively evaluate compliance with Enhanced Recovery After Surgery (ERAS) protocols in patients undergoing major visceral surgery.
• To identify discrepancies between ERAS targets and actual clinical practice.

Main Methods:

• A prospective pilot study involving 34 patients undergoing major hepatopancreatic or gastric surgery.
• Postoperative assessment until day 10, focusing on analgesia, drain management, diet, mobilization, and discharge criteria adherence.
• Utilized an established ERAS protocol scenario for data collection.

Main Results:

• Analysis of 31 cases: 54.8% pancreatic, 29.0% hepatic, 16.1% gastric resections.
• Median hospital stay was 12.5 days; 83.9% met discharge criteria.
• Significant delays in drain removal (catheters in 70-40% by POD 4) and limited mobilization (50% out of bed by POD 2, 40% comfortable with exercise).

Conclusions:

• Adherence to ERAS protocols is inadequately reported and assessed.
• A notable gap exists between ERAS goals and clinical reality for comorbid patients in major visceral surgery.
• Recommendations include redefining mobilization targets, enhancing patient counseling, and improving ERAS principle implementation.