Implementation and Review of an Enhanced Recovery After Surgery (ERAS) Program within a Tertiary Cancer Hospital
Introduction: ERAS is a pathway that ensures elective surgery patients receive evidence-based perioperative care to achieve optimal postoperative clinical outcome(1,2). Additionally, ERAS programs aim to facilitate ‘fast tracking’ of patients, promote patient-centred care, improve patient safety & quality assurance, and reduce healthcare expenditure by reducing hospital length of stay without increasing morbidity or mortality(3).
Methods: A phased implementation of our ERAS program included: a pre-ERAS audit of our perioperative practice; development of ERAS protocols and pathways; delivery of a 10-week education program for relevant clinical staff; and post-implementation and audit of ERAS protocols.
Results: Thirty patients were audited in each of the pre-ERAS and ERAS phases. Achievement of postoperative clinical care set points were significantly improved in the ERAS phase. This included time to first postoperative oral fluids (30.5 vs. 3.5 hours), time to first postoperative solid diet (56.4 vs. 11 hours) and time to first sitting out of bed, an indication of mobilisation (34.8 vs. 17 hours). There was also a significant reduction in the number of admission prior to the day of surgery (56% vs. 33%), and a reduction in the number of postoperative hospital bed days (median length of HDU/ICU and hospital stay was 2.5 and 10.0 days [pre-ERAS] vs. 2.0 and 8.1 days [ERAS], respectively).
Conclusion: Implementing an ERAS program into the surgical journey improves pain management, gut function, early mobilisation, recovery time and both length of ICU/HDU and hospital stay. Sustainability requires ongoing coordination, development, implementation and auditing of the evidence base, processes, and clinical outcomes.
References:
1. Kehlet H. Br J Surg 2005;92:3-4.
2. Zargar-Shoshtari K. ANZ J Surg 2008;78:13-23.
3. Fearon K. Clinical Nutrition 2005;466.