Evaluation of compliance of the perioperative practices of the i̇npatients i̇n the surgery clinic with Eras protocol and effects on patient outcomes

ERAS Protocol is an effective/important approach for perioperative clinical practices for minimizing the function losses caused by the surgery, preventing postoperative complications, and accelerating the recovery time, in patients who underwent a surgical intervention. In this research, it was aimed to prospectively observe the patients who underwent surgery in a general surgery clinic and to evaluate the compliance of the perioperative practices with ERAS Protocol. In this descriptive study, 405 patients who were operated in the General Surgery Clinic of Afyon Kocatepe University Hospital between November 2016 - January2017 were evaluated. Routine clinical practices were recorded using a questionnaire prepared according to ERAS protocol without any intervention in the patients enrolled in the research. When the research results are examined, the practices that are compliant with ERAS protocol are as follows: in the preoperative period, providing information to all patients verbally, applying an antibiotic prophylaxis to 98.5% of them, and not providing premedication treatment for none of the patients; in the intraoperative period, preferring the smallest possible surgical incision; and in the postoperative period, using paracetamol as the first option for providing analgesia. The practices that are not compliant with ERAS protocol are as follows: in the preoperative period, providing mechanical bowel cleansing (37%), giving no oral carbohydrate to the patients, prolonging the fasting time (10.91 ± 4.79 hours), and continuing smoking (20%); in the intraoperative period, choosing long acting anesthetic agents, not performing the necessary practice for none of the patients to provide normothermia, and inserting a drain in 44.4% of the patients; in the postoperative period, not starting an early oral feeding, and applying a urinary catheterization to 87.7% of the patients. As a result of the study, it was found that the routine clinical practices were not sufficient for compliance with ERAS protocol. In order to raise the awareness of the health professionals, it is thought that the extent of compliance with ERAS protocol may be increased by providing trainings on ERAS protocol and supporting participation in these trainings, and by providing an individualized care to the patient according to ERAS items from his/her first admission in a hospital to discharge by a multidisciplinary approach.