Enhanced recovery after surgery in patients with colorectal cancer in Slovenia 2012

Abstract

Background : Enhanced recovery after surgery (ERAS) protocol is a model of perioperative patient management where process optimisation helps to shorten patients’ recovery time. Application of ERAS protocol in colorectal cancer surgery is a demanding process, challenging our professional and organisational measures. Methods : A questionnaire regarding ERAS was sent to all thirteen heads of departments performing surgical treatment of colorectal cancer patients in Slovenia. The questionnaire was analyzed using Microsoft Excel Program. Results : There is a strong agreement among all the respondents that ERAS is a relevant clinical concept. Only seven clinical departments have developed a clinical pathway consistent with ERAS protocol, but principles of ERAS are followed at least partly or completely in twelve clinical departments. The most obvious is lack of activity before surgery, and particularly the educational interview with a dietitian and a physiotherapist. Less than half of the patients drink the glucose drink before surgery, and the same applies to the prophylaxis of nausea and vomiting. More than two thirds of patients are still subjected to mechanical bowel preparation before surgery. More than half of them have a central line and are admitted to intensive care unit (ICU) after surgery. More than 75 % of the patients do not sit up in bed or stand up on day 1 after surgery. More than half of them still have the nasogastric tube. Laparoscopy is used more frequently for colon and less for rectal surgery. Conclusions : Comparing this analysis with the one done in 2004, we can conclude that there is an important shortening of average planned hospital stay. Nevertheless, still the majority of patients are not managed according to the ERAS protocol. The implementation of ERAS concept in Slovenia is rather poor, contrary to what we would expect considering evidence-based positive effects, but nevertheless comparable to other’s experience.