Are we ready for the ERAS protocol in colorectal surgery?

Area of Science:

• Colorectal Surgery
• Perioperative Care
• Evidence-Based Medicine

Background:

• Established perioperative care principles exist for elective colorectal surgery.
• Barriers to implementing evidence-based clinical care and changing surgical dogmas persist.
• Surgeons are identified as a key factor influencing practice adoption.

Purpose of the Study:

• To assess current perioperative care trends in elective colorectal surgery.
• To evaluate adoption of evidence-based practices among general surgery consultants.
• Focus on Malopolska Voivodeship, Poland.

Main Methods:

• Anonymous, standardized 20-question questionnaire developed from ERAS principles.
• Survey distributed to general surgery departments in Malopolska Voivodeship.
• Assessed the level of acceptance of perioperative care elements by general surgery consultants.

Main Results:

• A 66% response rate was achieved.
• High acceptance rates for antibiotic prophylaxis, antithrombotic prophylaxis, postoperative oxygen therapy, and no nasogastric tubes.
• Low adherence to crucial surgical elements: no mechanical bowel preparation, preoperative carbohydrate loading, laparoscopy, no drains, early oral intake, and early mobilization.
• Surgeons showed willingness to adopt anesthesiologist-dependent changes (e.g., fluid therapy, TAP blocks) but resisted practice-altering surgical elements.

Conclusions:

• Perioperative care in elective colorectal surgery in the region is often dogma-driven, not evidence-based.
• Significant low acceptance of key Enhanced Recovery After Surgery (ERAS) protocol elements.
• Surgeons are more receptive to changes that do not directly alter their established surgical practices.