Adjusted enhanced recovery after surgery (ERAS) protocol in colorectal surgery at dr. Cipto Mangunkusumo General Hospital, Jakarta

Abstract

Background: The Enhanced Recovery After Surgery (ERAS) strategy has been proven to be successful in lowering hospital perioperative problem rates and postoperative length of stay (LOS) in colorectal surgery. The inability of dr. Cipto Mangunkusumo General Hospital's to implement all of the components of the ERAS protocol was attributed to three major factors: patient-related (compliance), physician-related (silo mentality), and hospital-related (long waiting lists and inability to provide required facilities). This study aims to determine how well the ERAS procedure can be partially implemented to achieve the ERAS objective. Methods: This study is a cross-sectional study involving sixty-three colorectal patients who underwent surgical procedures between 2015 and 2017 were evaluated retrospectively for complete ERAS protocol implementation. The complete implementation is the ability to accomplish all 15 ERAS components. Demographic, clinical, and total LOS data were also collected from medical records. These samples were analyzed using univariate analysis and Pearson correlation tests to determine the relationship between the number of ERAS components that accomplish per subject and the LOS of the patient. Results: Eleven out of 15 ERAS components were implemented on 63 patients. The majority of the cohort were female (male-to-female ratio of 1:1.2) with an average age of 53 years, 0% mortality, 7.9% morbidity (1.6%, 1.6%, and 4.8% due to surgical site infection, pneumonia, and urinary retention, respectively), and underwent conventional rather than laparoscopic surgery (84.1% vs. 15.9%). The most common location of tumors and procedures were sigmoid (47.6%) and colostomy closure (25.4%). None of the patients was able to comply with all components of the ERAS protocol; however, the results from 6 patients who implemented ten or more components of the ERAS protocol showed a higher reduction rate of the total LOS from 8−12 days to only five days (a reduction rate of 62.5%) compared to patients who completed less than 10 components (p<0.01, r=−0.568). Conclusion: Implementing at least 10 ERAS components may have a similar impact to fully implementing the ERAS protocol regarding how patients who have colorectal surgery are managed. These ten components are subsequently called the adjusted ERAS protocol for colorectal surgery.