Review
Implementation of ERAS and how to overcome the barriers

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Abstract

Background

Multimodal care or Enhanced Recovery after Surgery (ERAS) protocols are gaining popularity in order to modify surgical stress responses after colonic resection. However, these protocols are not straightforward to implement as peri-operative care is varied. We aimed to identify areas that may need attention in order to successfully change practice.

Method

The literature was reviewed for current practice, methods and issues in implementing ERAS. Based on this and our own experience we discuss several important areas that need particular attention in developing and sustaining an ERAS program.

Results

International surveys have shown that current peri-operative care in colorectal resection is not evidence based. Important aspects of the ERAS philosophy including patient counselling, teamwork and attitude change are identified and discussed.

Conclusion

Implementing evidence-based peri-operative care into practice is challenging. Barriers to multimodal recovery pathways should be addressed.

Keywords

ERAS
Fast-track
Multimodal care
Colonic surgery
Enhanced recovery

Cited by (0)

This paper is not based on previous correspondence to a society or meeting.

c

Arman Kahokehr is a lecturer at the Department of Surgery, University of Auckland.

d

Tarik Sammour is a research fellow at the Department of Surgery, University of Auckland.

e

Kamran Zargar-Shoshtari is a surgical registrar in training.

f

Lisa Thompson is charge ERAS nurse.

g

Andrew G. Hill is Associate Professor in Surgery, University of Auckland.