title: Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol - Compliance improves outcomes: A prospective cohort study.
abstract: Enhanced Recovery After Surgery protocol in colorectal surgery allows shortening length of hospital stay and reducing complication rate. Despite the clear guidelines and conclusive evidence their full implementation and putting them into daily practice meets certain difficulties, especially in the early stage. The aim of the study was to analyse the course of implementation of the ERAS protocol into daily practice on the basis of adherence to the protocol. Group included 92 patients (43F/49M) with colorectal cancer submitted to laparoscopic resection during the years 2013-2014. Perioperative care in all of them based on ERAS protocol consisting of 16 items. Its principles and discharge criteria were based on the guidelines of the ERAS Society guidelines. The entire analysed group of patients was divided into 3 subgroups (30 patients) depending on the time from ERAS protocol implementation. We analysed the compliance with the protocol and its influence on length of hospital stay, postoperative complications and readmission rate in different subgroups. The average compliance with the protocol differed significantly between groups and was 65% in group 1, 83.9% in group 2 and 89.6% in group 3. The compliance with subsequent protocol elements was different. The length of stay and complication rate was statistically different in analysed subgroups. The whole group demonstrated an inverse correlation between compliance and length of stay. This analysis leads to the conclusion that the introduction of the ERAS protocol is a gradual process, and its compliance at the level of 80% or more requires at least 30 patients and the period of about 6 months. The initial derogation from the assumed proceedings is inevitable and should not discourage further action. Particular emphasis in the initial stage should be put on continuous training of personnel of all specialties and continuous evaluation of the results.
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland. Electronic address: michal.pedziwiatr@uj.edu.pl.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kisialeuski
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Wierdak
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Stanek
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Natkaniec
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: Students' Scientific Society of 2nd Department of General Surgery, Jagiellonian University, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Małczak
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University, Krakow, Poland; Department of Endoscopic, Metabolic and Soft Tissue Tumor Surgery, Kopernika 21, 31-501 Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015331:Cohort Studies; D003106:Colon / Q000601:surgery; D013505:Digestive System Surgical Procedures; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011044:Poland; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery
keywords: Colorectal cancer; Enhanced recovery after surgery; Laparoscopy; Length of stay