Implementing the enhanced recovery after surgery (ERAS) protocol for oncosurgeries in a tertiary level hospital in South India: Key steps and early outcomes.

Abstract

Background: The enhanced recovery after surgery (ERAS) pathway is the standard of perioperative care for major surgeries globally. However, integrating it into practice can be challenging, especially given the variety of healthcare systems in low- and middle-income countries. At our hospital, we aimed to establish the ERAS pathway phase-wise for oncosurgeries.

Methods: We initiated the ERAS pathway in incremental steps, namely, drafting and team-building, trial run, consolidation, and expansion, with regular auditing and feedback at every stage. Six months after initiation (January to June 2024), we assessed our compliance rates and compared outcomes with historical controls (matched for age, surgical procedure, and ASA classification).

Results: In the oncosurgical patients managed under the ERAS protocol, overall compliance was 70.4%, with maximum compliance for preoperative (77.17%) and least for postoperative elements (54.16%). Compared to matched cohorts, ERAS patients had significantly lower rates of postoperative complications (median ± IQR, 1.00 ± 0.00 versus 1.50 ± 1.00, P = 0.035) and duration of ICU (median ± IQR, 0.00 ± 2.00 versus 2.00 ± 3.00, P = 0.017) and hospital stay (median ± IQR, 7.00 ± 2.00 versus 8.00 ± 4.00, P = 0.035).

Conclusions: Anesthesiologists can champion and build ERAS care pathways in hospitals by assembling a core team and systematically applying ERAS components during each surgical stage.