J Gastric Cancer.  2019 Mar;19(1):72-82. 10.5230/jgc.2019.19.e3.

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

• Jeong O
• Kim HG

• KMID: 2458819
• DOI: http://doi.org/10.5230/jgc.2019.19.e3

Abstract

PURPOSE
Despite its clinical benefits, enhanced recovery after surgery (ERAS) is less widely implemented for gastric cancer surgery. This nationwide survey investigated the current status of the implementation of ERAS in perioperative care for gastric cancer surgery in South Korea.
MATERIALS AND METHODS
This survey enrolled 89 gastric surgeons from 52 institutions in South Korea. The questionnaire consisted of 24 questions about the implementation of the ERAS protocols in the management of gastric cancer surgery. The survey was carried out using an electronic form sent via email.
RESULTS
Of the 89 gastric surgeons, 58 (65.2%) answered that they have knowledge of the concept and details of ERAS, 45 (50.6%) of whom were currently applying ERAS for their patients. Of the ERAS protocols, preoperative education (91.0%), avoidance of preoperative fasting (68.5%), maintenance of intraoperative normothermia (79.8%), thromboprophylaxis (96.5%), early active ambulation (64.4%), and early removal of urinary catheter (68.5%) were relatively well adopted in perioperative care. However, other practices, such as avoidance of preoperative bowel preparation (41.6%), provision of preoperative carbohydrate-rich drink (10.1%), avoidance of routine abdominal drainage (31.4%), epidural anesthesia (15.9%), single-dose prophylactic antibiotics (19.3%), postoperative high oxygen therapy (36.8%), early postoperative diet (14.6%), restricted intravenous fluid administration (53.9%), and application of discharge criteria (57.3%) were not very well adopted for patients.
CONCLUSIONS
Perioperative management of gastric cancer surgery is largely heterogeneous among gastric surgeons in South Korea. Standard perioperative care based on scientific evidence needs to be established to improve the quality of surgical care and patient outcomes.

Keyword

Enhanced recovery after surgery; Surveys; Gastrectomy

MeSH Terms

Anesthesia, Epidural
Anti-Bacterial Agents
Diet
Drainage
Education
Electronic Mail
Fasting
Gastrectomy
Humans
Korea*
Oxygen
Perioperative Care
Stomach Neoplasms*
Surgeons
Urinary Catheters
Walking
Anti-Bacterial Agents
Oxygen

Figure

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  Fig. 1 Level of understanding about ERAS (A) and application of ERAS (B). ERAS = enhanced recovery after surgery.

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  Fig. 2 Application of ERAS according to the type of operation. ERAS = enhanced recovery after surgery.

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