Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital.

Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital.

Norman A et al. Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital. Can J Surg. 2020 May 21;63(3):E292-E298. doi: 10.1503/cjs.016018.

What is already known:

ERAS programmes especially for colorectal surgery have been around for a long time and can be hugely successful, especially in a trial setting. But what happens after the trial ends?

What this paper adds:

The community hospital in this study employed an ERAS coordinator to run things on the ward and ensured the guideline was adhered during the trial period (six months). This was successful. Adherence improved from 52% to 81%, and length of stay reduced from 7.25 days to 5.44. However once the trial finished and the ERAS coordinator left, adherence dropped and length of stay rose back to 7 days. This really highlights the importance of not relying on just one person (especially when they are not permanent members of staff). A successful ERAS programme requires buy-in from all members of the team and often needs a culture shift. So that all the elements of the pathway just become routine care rather than just elements of a trial. Whilst the sustainability aspect of this trail failed, there were some longer lasting improvements. Adherence did fall, but there was an overall rise from the original starting point (52% to 75%), and ileus rates also fell from 13.8% to 4.6%.

Sustainability is so important, if things don’t work outside of a closely controlled trial setting then it will never work. Implementing a comprehensive ERAS pathway which works in the long term takes a lot of work from a lot of people, but many successful ERAS centres have shown that it is possible.

Chris Jones, Guildford. @chrisnjones