[Compliance with the procedures of modern perioperative care (Enhanced Recovery After Surgery) at surgery departments in the Czech Republic - results of a national survey]

Abstract

Introduction: The concept of the enhanced recovery after surgery (ERAS), also called fast-track surgery, is a complex of modern multimodal strategies intended to reduce the perioperative stress response and achieve faster postoperative rehabilitation and rapid recovery of normal physiologic functions. The effect of ERAS on reduction of length of stay and postoperative complications has been proven by randomized controlled trials. The recommendations are supported by substantial evidence, and they are guaranteed by the ERAS society and included in the European Society of Parenteral and Enteral Nutritions (ESPEN) guidelines. The aim of this study was to evaluate the compliance with ERAS protocol in surgical departments in the Czech Republic.

Materials and methods: A survey with 19 questions on ERAS measures was sent to 148 surgical departments in the Czech Republic. Answers were anonymous.

Results: The overall response rate was 57/148 (38,5%). The indications and proper administration of preoperative nutritional support are performed according to recommendations in 37% respectively 67%. In total, 55% of responders restrict oral intake for more than 6 hours prior to an elective gastrointestinal surgery. A carbohydrate drink is administered preoperatively by 7% of the respondents. A mechanical bowel preparation before surgery is routinely used in 86% of surgical departments. Overall, 52% routinely insert a permanent urinary catheter for 3-5 days and one third of departments left a nasogastric tube in place after the operation. Early postoperative oral intake is restored in 2% of questioned departments. Epidural analgesia is standardly used by 68% respondents. Half of the surgery departments indicate artificial enteral or parenteral nutrition support without any respect to the nutrition status of the patient.

Conclusion: Protocol of modern perioperative care recommended by ERAS and ESPEN societies should be respected in clinical practice in the Czech Republic. According to the national survey most of the surgical departments do not accept ERAS guidelines. The most challenging procedures include the inadequately long interval of perioperative fasting, use of mechanical bowel preparation and routine insertion of invasions. Early oral intake is, according to the answers, often replaced by artificial enteral or parenteral nutrition.