Compliance with the procedures of modern perioperative care (Enhanced Recovery After Surgery) at surgery departments in the Czech Republic – results of a national survey
Authors:
O. Ryska 1; Z. Šerclová 1; F. Antoš 2
Authors‘ workplace:
Chirurgická klinika 2. LF UK a ÚVN, Praha, přednosta: Prof. MUDr. M. Ryska, CSc
1; Chirurgická klinika, Nemocnice Na Bulovce, Praha, přednosta: Doc. MUDr. J. Fanta, DrSc.
2
Published in:
Rozhl. Chir., 2013, roč. 92, č. 8, s. 435-442.
Category:
Original articles
Overview
Introduction:
The concept of the enhanced recovery after surgery (ERAS), also called fast-track surgery, is a complex of modern multimodal strategies intended to reduce the perioperative stress response and achieve faster postoperative rehabilitation and rapid recovery of normal physiologic functions. The effect of ERAS on reduction of length of stay and postoperative complications has been proven by randomized controlled trials. The recommendations are supported by substantial evidence, and they are guaranteed by the ERAS society and included in the European Society of Parenteral and Enteral Nutrition’s (ESPEN) guidelines.
The aim of this study was to evaluate the compliance with ERAS protocol in surgical departments in the Czech Republic.
Materials and methods:
A survey with 19 questions on ERAS measures was sent to 148 surgical departments in the Czech Republic. Answers were anonymous.
Results:
The overall response rate was 57/148 (38,5%). The indications and proper administration of preoperative nutritional support are performed according to recommendations in 37% respectively 67%. In total, 55% of responders restrict oral intake for more than 6 hours prior to an elective gastrointestinal surgery. A carbohydrate drink is administered preoperatively by 7% of the respondents. A mechanical bowel preparation before surgery is routinely used in 86% of surgical departments. Overall, 52% routinely insert a permanent urinary catheter for 3–5 days and one third of departments left a nasogastric tube in place after the operation. Early postoperative oral intake is restored in 2% of questioned departments. Epidural analgesia is standardly used by 68% respondents. Half of the surgery departments indicate artificial enteral or parenteral nutrition support without any respect to the nutrition status of the patient.
Conclusion:
Protocol of modern perioperative care recommended by ERAS and ESPEN societies should be respected in clinical practice in the Czech Republic. According to the national survey most of the surgical departments do not accept ERAS guidelines. The most challenging procedures include the inadequately long interval of perioperative fasting, use of mechanical bowel preparation and routine insertion of invasions. Early oral intake is, according to the answers, often replaced by artificial enteral or parenteral nutrition.
Key words:
survey - enhanced recovery after surgery - surgery Czech Republic
Sources
1. Kehlet H. Organizing postoperative accelerated recovery programs. Reg Anesth 1996;21(6 Suppl):149–151.
2. Weimann A, Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 2006;25:224–44.
3. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr 2012;31:783–800.
4. Fearon KC, Ljungqvist O, von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24: 466–477.
5. Varadhan KK, Neal KR, Dejong CH, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010;29:434–40.
6. Wind J, Polle SW, Fung Kon Jin PH, et al.Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 2006;93:800–9.
7. Lassen K, Soop M, Nygren J, et al. Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 2009;144:961–9.
8. Walter CJ, Collin J, Dumville JC, et al. Enhanced recovery in colorectal resections:a systematic review and meta-analysis. Colorectal Dis 2009;11:344–53.
9. Khan S, Wilson T, Ahmed J, et al. Quality of life and patient satisfaction with enhanced recovery protocols. Colorectal Dis 2010;12:1175–82.
10. Kehlet H, Buchler MW, Beart Jr RW, et al. Care after colonic operatione is it evidence-based? Results froma multinational survey in Europe and the United States. J Am Coll Surg 2006;202:45–54.
11. Lassen K, Hannemann P, Ljungqvist O, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 2005;330:1420–1.
12. Nygren J, Soop M, Thorell A, et al. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998;17:65–71.
13. Brady M, Kinn S, Stuart P, et al. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev 2003:CD004423.
14. Holte K, Nielsen KG, Madsen JL, et al. Physiologic effects of bowel preparation. Dis Colon Rectum 2004;47:1397–402.
15. Guenaga KF, Matos D, Castro AA, et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2003;CD001544.
16. Kheterpal S, Tremper KK, Englesbe MJ, et al. Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function. Anesthesiology 2007;107:892–902.
17. Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med 2009;34:542–8.
18. Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERASŽ) Society recommendations. Clin Nutr 2012;31:801–16.
19. Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 1999;229:174–80.
20. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev. 2007:CD004929.
21. Zingg U, Miskovic D, Hamel CT, et al. Influence of thoracic epidural analgesia on postoperative pain relief and ileus after laparoscopic colorectal resection: Benefit with epidural analgesia. Surg Endosc 2009;23:276–82.
22. JŅrgensen H, Wetterslev J, MŅiniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev 2000:CD001893.
23. Ng WQ, Neill J. Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review. J Clin Nurs 2006;15:696–709.
24. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006:CD004080.
25. Hasenberg T, Keese M, Längle F, et al. Fast-track colonic surgery in Austria and Germany—results from the survey on patterns in current perioperative practice. Colorectal Dis 2009;11:162–7.
26. Roig JV, García-Fadrique A, Redondo C, et al. Perioperative care in colorectal surgery: current practice patterns and opinions. Colorectal Dis 2009;11:976–83.
27. Kahokehr A, Robertson P, Sammour T, et al. Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Colorectal Dis 2011;13:1308–13.
28. Arsalani-Zadeh R, Ullah S, Khan S, et al. Current pattern of perioperative practice in elective colorectal surgery; a questionnaire survey of ACPGBI members. Int J Surg. 2010;8:294–8.
29. Kahokehr A, Sammour T, Zargar-Shoshtari K, et al. Implementation of ERAS and how to overcome the barriers. Int JSurg 2009;7:16–9.
30. Plodr M, Ferko A. Fast track in surgery. Rozhl Chir 2005;84: 557–60.
31. Serclová Z. Fast track in intestinal surgery; current review. Rozhl Chir 2009;88:527–35.
32. Kuthan D, Ludvik P, Podebradsky J, et al. Our initial experience with the fast-track method in the colorectal carcinoma management. Rozhl Chir 2008;87:125–7.
33. Holak J. Fast track concept in colorectal surgery in a regional hospital setting. Rozhl Chir 2009;88:524–6.
34. Kaska M, Grosmanová T, Havel E, et al. Preparation of patients for operation with per-oral intake on the day of the planned surgery. Rozhl Chir 2006;85:554–9.
35. Serclova Z, Dytrych P, Marvan J, et al. Tolerance of accelerated postoperative rehabilitation following intestinal resections. Rozhl Chir 2009;88:178–84.
36. Serclova Z, Dytrych P, Marvan J, et al. Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clin Nutr 2009;28:618–24.
37. Kaska M, Grosmanova T, Havel E, et al. The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery - a randomized controlled trial. Wien Klin Wochenschr 2010;122:23–30.
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Perspectives in Surgery
2013 Issue 8
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