Perioperative care: a survey of New Zealand and Australian colorectal surgeons.
OBJECTIVE
Recent surveys in Europe and North America have demonstrated significant challenges in the implementation of evidence-based surgical practice.


METHODS
A survey of New Zealand and Australian colorectal surgeons was conducted to help understand current practice and perceived barriers to interventions in this region. Questions were based around elective colorectal resection care.


RESULTS
There were 152 eligible participants identified. Over a 60-day period, 82 (54%) surgeons responded but only 76 (50%) of the questionnaires were complete; they were used for data analysis. The majority of surgeons indicated a preference for laparoscopic techniques. Barriers to laparoscopy include lack of operating time, lack of adequate training and institutional pressures. Only 28 (37%) indicated that they cared for patients in a formalized enhanced recovery programme (ERAS). Barriers to implementing ERAS included lack of support from institutions and other specialities. Routine oral 'mechanical' bowel preparation for colon and rectal resection was preferred by 28% and 63%, respectively. Drainage after routine colon and rectal resection was not used by 62 (83%) and 39 (53%). Prophylactic nasogastric intubation afterwards was not used by 66 (87%) responders. The preferred mode of analgesia was patient-controlled opioid analgesia (PCA) for 52%. A 'restrictive' intravenous fluid therapy was preferred by 34 (49%) while 33 (48%) preferred no fluid restriction. A prolonged 'nil by mouth' status was preferred by 28%.


CONCLUSIONS
There appears to be a high rate of evidence in agreement with some interventions but not others. The systemic barriers to implementing evidence-based perioperative care need attention.
Department of Surgery, University of Auckland, Middlemore Hospital, Auckland, New Zealand. arman.kahokehr@gmail.com
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Kahokehr
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Robertson
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Sammour
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Soop
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Hill
D000698:Analgesia; D001315:Australia; D003106:Colon / Q000601:surgery*; D003107:Colorectal Surgery; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D004322:Drainage; D017558:Elective Surgical Procedures; D019317:Evidence-Based Medicine; D005440:Fluid Therapy; D006801:Humans; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000193:education / Q000706:statistics & numerical data; D009520:New Zealand; D019990:Perioperative Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors