Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Abstract

Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.

Keywords: Enhanced recovery, Surgery, Fast track, Perioperative management, Postoperative outcome

Core tip: There is a strong and evolving evidence base to support Enhanced Recovery After Surgery (ERAS) programs in abdominal surgery. Such pathways are safe and efficient in enhancing recovery and reducing morbidity. However, patient-related outcomes, cost effectiveness and long-term benefits from ERAS protocols need to be studied more carefully in the future. To support efficient and successful implementation, further educational efforts have to be performed on a national or regional level to improve the standard of care in the general population.