Current pattern of perioperative practice in elective colorectal surgery; a questionnaire survey of ACPGBI members

Abstract

Introduction: Enhanced recovery programmes (ERAS) are safe and have been shown to decrease the length of the hospital stay and complications following colorectal surgery. However implementation of ERAS requires dedicated resources. In addition, the practice of ERAS still varies between different surgeons and in different centres.

Aim: The aim of this paper is to investigate the prevailing perioperative practice among members of the Association of Coloproctology of Great Britain and Ireland (APGBI).

Methods: A questionnaire was developed based on the principles of ERAS. The questionnaire was emailed to all members of the ACPGBI as extracted from the membership directory of the association of the year 2008. A postal questionnaire was subsequently sent to those who did not reply to the initial email.

Results: The response rate was 64%. Certain aspects of ERAS such as pre-operative information and assessment, intra-operative warming, avoidance of nasogastric tubes and drains and early initiation of fluid and solid food was in practice by majority of the surgeons. The routine use of bowel preparation for left sided colonic resections is in practice by nearly 60% of the surgeons. The use of carbohydrate loading prior to surgery has not been adopted by more than half of the surgeons. There was no difference between type of hospital and adherence to ERAS. Some surgeons tend to have a slightly different approach to perioperative care in open and laparoscopic surgery.

Conclusion: Adherence to ERAS among colorectal surgeons is relatively high. Certain aspects of perioperative practice have potential for improvement. Practice of ERAS should be encouraged in both laparoscopic and open surgery.