A survey on the practice of enhanced recovery after elective colorectal surgery in Western Australia

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a 24-item multidisciplinary questionnaire program designed to optimize the patient's perioperative care to reduce postoperative morbidity. However, its adoption remains largely influenced by region and the institution and surgeons' personal judgement. Objectives: This study aims to evaluate the practice of ERAS in elective colorectal surgery in Western Australia through a survey. Design: Prospective survey. Setting: The survey was sent to all surgeons identified to be performing routine elective colorectal surgery in Western Australia. Patients and Methods: A questionnaire was designed based on the latest ERAS guidelines, consisting of questions on the demographics of the surgeons, annual number of major colorectal resections, and on various aspects of pre-, intra- and postoperative practices. The questionnaire was sent through email or handed to the surgeons in August 2020 for a period of 2 months. Sample Size: Twenty-four eligible surgeons participated in the survey. Main Outcome Measures: The main outcome was to investigate the areas of agreement and difference in ERAS practice in elective colorectal surgery in Western Australia. Results: Twenty of the 24 eligible surgeons (83.3%) completed the questionnaire. Among these, 65% surgeons perform >50 major colorectal resections annually. There is a high agreement of the practice in certain areas: 70% surgeons perform >50% of their cases laparoscopically; they do not routinely use nasogastric tubes, majority of the surgeons do not routinely place drains after right (95%) and left (70%) colonic surgeries, 75% surgeons are guided by the Acute Pain Service for postoperative analgesia, and 95% surgeons encourage early mobilization. A few areas of practice remain widely variable: preoperative mechanical bowel preparation, postoperative fluids and electrolytes, and assessment of gut function. Conclusion: This survey provides a snapshot of the practice of ERAS in elective colorectal surgery in Western Australia. While certain aspects are considered as universal practice, there are some gaps and barriers to implementation that need to explored further. Limitations: The survey did not classify questions into open or laparoscopic surgery, and some surgeons worked both in public and private institutions, where practices may differ.