[Implementation of the ERAS pathway in emergency surgery: adherence, barriers and facilitators]

The Enhanced Recovery After Surgery (ERAS) clinical pathway has been shown to improve postoperative outcomes in elective surgery but its implementation in emergency settings remains limited and understudied. The aim of the study is to assess the degree of adherence to selected perioperative ERAS items in frequent emergency surgeries (appendectomy, cholecystectomy and non-neoplastic perforated peptic ulcer), as well as to identify barriers and facilitators for its implementation.

Descriptive, prospective and exploratory observational study including 206 consecutive patients undergoing one of the selected emergency surgeries between November 2021 and July 2022. Adherence to ERAS items was assessed in the preoperative, intraoperative and immediate postoperative phases. Barriers and facilitators were also analysed through literature review, standardised matrix development, unstructured interviews and direct observation.

Overall adherence was over 70% for most items, with greater variability, as expected, in those measures dependent on the complexity of the case, such as the use of drains or tubes. The main barrier was organisational and the previous experience of ERAS in elective surgery acted as a facilitator.

The implementation of certain perioperative ERAS items in emergency surgery is feasible, presenting high adherence in settings with previous experience in elective surgery. The main barrier detected was organisational, while the consolidated institutional culture was a key facilitator. Studies with methodologically robust designs, including evaluation of clinical outcomes, are needed to support its implementation as a standard of care.