Development of the Korean enhanced recovery after surgery audit program

Audit programs are essential for effective Enhanced Recovery After Surgery (ERAS) implementation to monitor compliance, ensure adherence, and optimize outcomes. To address the lack of a tailored ERAS audit program in South Korea, we developed the Korean ERAS Research and Audit System (K-ERAS) in collaboration with anesthesiologists and surgeons. This system integrates data from a concurrently conducted prospective observational study on colorectal cancer surgery and features a real-time dashboard for perioperative outcome visualization and data completeness monitoring. Using records from 556 patients registered between October 2023 and October 2024, we assessed data completeness, dashboard feasibility, and ERAS compliance rates. Data entry for all patients was successfully completed, and the K-ERAS effectively captured and visualized perioperative data. The overall ERAS compliance rate was 47.4%, with notably low adherence to perioperative fasting (0.9% for both shortened preoperative fasting and carbohydrate loading, 2.5% for postoperative early water intake, and 29.0% for postoperative early oral feeding) and pain management protocols (2.7% for preemptive analgesia, 30.9% for regional analgesia, and 30.6% for routine use of two or more non-opioid analgesics postoperatively). The K-ERAS proved to be a reliable and adaptable system for managing perioperative data within an ERAS-focused framework.