Are we ready for the ERAS protocol in colorectal surgery?

Michał Kisielewski; Mateusz Rubinkiewicz; Michał Pędziwiatr; Magdalena Pisarska; Marcin Migaczewski; Marcin Dembiński; Piotr Major; Kazimierz Rembiasz; Andrzej Budzyński

doi:10.5114/wiitm.2017.66672

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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General surgery

abstract:

Original paper

Are we ready for the ERAS protocol in colorectal surgery?

Michał Kisielewski

,

Mateusz Rubinkiewicz

,

Michał Pędziwiatr

,

Magdalena Pisarska

,

Marcin Migaczewski

,

Marcin Dembiński

,

Piotr Major

,

Kazimierz Rembiasz

,

Andrzej Budzyński

Videosurgery Miniinv 2017; 12 (1): 7–12

DOI: https://doi.org/10.5114/wiitm.2017.66672

Online publish date: 2017/03/22

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Introduction: Modern perioperative care principles in elective colorectal surgery have already been established by international surgical authorities. Nevertheless, barriers to the introduction of routine evidence-based clinical care and changing dogmas still exist. One of the factors is the surgeon.

Aim: To assess perioperative care trends in elective colorectal surgery among general surgery consultants in surgical departments in Malopolska Voivodeship, Poland.

Material and methods: An anonymous standardized 20-question questionnaire was developed based on ERAS principles and sent out to Malopolska Voivodeship general surgery departments. Answers of general surgery consultants showed the level of acceptance of elements of perioperative care.

Results: The overall response rate was 66%. Several elements (antibiotic and antithrombotic prophylaxis, postoperative oxygen therapy, no nasogastric tubes) had quite a high acceptance rate. On the other hand, most crucial surgical perioperative elements (lack of mechanical bowel preparation, preoperative oral carbohydrate loading, use of laparoscopy and lack of drains, early fluid and oral diet intake, early mobilization) were not followed according to evidence-based ERAS protocol recommendations. Surgeons were not willing to change their practice, but were supportive of changes in anesthesiologist-dependent elements of perioperative care, such as restrictive fluid therapy, use of transversus abdominis plane blocks, etc.

Conclusions: Many elements of perioperative care in elective colorectal surgery in Malopolska Voivodeship are still dictated by dogma and are not evidence-based. The level of acceptance of many important ERAS protocol elements is low. Surgeons are ready to accept only changes that do not interfere with their practice.

keywords:

Are we ready for the ERAS protocol in colorectal surgery?

Michał Kisielewski , Mateusz Rubinkiewicz , Michał Pędziwiatr , Magdalena Pisarska , Marcin Migaczewski , Marcin Dembiński , Piotr Major , Kazimierz Rembiasz , Andrzej Budzyński

surgeons, perioperative management, Polish survey, laparoscopic colorectal surgery

Michał Kisielewski

,

Mateusz Rubinkiewicz

,

Michał Pędziwiatr

,

Magdalena Pisarska

,

Marcin Migaczewski

,

Marcin Dembiński

,

Piotr Major

,

Kazimierz Rembiasz

,

Andrzej Budzyński