title: Adherence to ERAS elements in major visceral surgery-an observational pilot study.
abstract: BACKGROUND
  Enhanced recovery after surgery (ERAS) programs have been introduced increasingly into major visceral surgery. Key elements target on early drain removal and mobilization of the patients; however, reporting of adherence to ERAS protocols has often been insufficiently assessed. The present study aims to prospectively evaluate ERAS compliance after major visceral surgery.
  
  
  METHODS
  A prospective pilot study was designed, and 34 patients scheduled for major hepatopancreatic or gastric surgery were followed postoperatively until postoperative day (POD) 10. Analgesia and drain management, diet, mobilization, willingness to exercise, and the use of discharge criteria were accurately assessed within an established ERAS protocol scenario.
  
  
  RESULTS
  Thirty-one cases were analyzed that consisted of 54.8 % major pancreatic, 29.0 % hepatic, and 16.1 % gastric resections. The median hospital stay was 12.5 days, and 83.9 % of the patients met the objective criteria before discharge. By POD 4, wound, epidural, and urinary catheters were still in place in 70, 60, and 40 % of the patients, respectively. Fifty percent of the patients ambulated out of bed until POD 2. The cumulative duration of postoperative mobilization per day ranged from 15 to 155 min, and only 40 % of the patients felt comfortable with additional mobilization or physical exercise.
  
  
  CONCLUSIONS
  Adherence to ERAS protocols is poorly reported. The results indicate a discrepancy between ERAS targets and actual practice in comorbid patients undergoing major visceral surgery, need for a prompt redefinition of ERAS mobilization targets, need for the improvement of counseling, and need for the implementation of ERAS principles.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Wolk
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Müssle
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Söthje
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. thilo.welsch@uniklinikum-dresden.de.
authors.forename: Thilo
authors.initials: T
authors.lastname: Welsch
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004434:Early Ambulation; D005260:Female; D005743:Gastrectomy; D019983:Guideline Adherence; D006498:Hepatectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010865:Pilot Projects; D011182:Postoperative Care; D011446:Prospective Studies; D020127:Recovery of Function
keywords: ERAS; Fast track; Mobilization; Pancreatic surgery; Visceral surgery