Adherence to Enhanced Recovery After Surgery (ERAS) With Bellwether Surgical Procedures in Ethiopia: A Retrospective Study

Abstract

Background: Enhanced recovery after surgery (ERAS) is a multimodal perioperative care approach that aims to improve patient outcomes by reducing physiological stress and promoting organ functional recovery. Implementing ERAS in low-resource settings faces challenges due to limited infrastructure and resources. This study examined the adherence to five ERAS recommendations with Bellwether surgical procedures in Ethiopian surgical facilities. Method: A retrospective database review of the Ethiopian perioperative registry was conducted. A total of 555 patients were included in this study. Data extraction included patient demographics, American Society of Anesthesiologists' Physical Status classification, surgical variables, postoperative hospital length of stay (LOS), and ERAS guidelines components. The primary outcome was adherence to five ERAS guidelines recommendations (early mobilization, feeding initiation, postoperative nausea and vomiting prophylaxis, early catheter removal, and IV fluids discontinuation). The secondary outcomes included: (i) the association between adherence to ERAS guidelines and LOS and (ii) a total unduplicated reach and frequency analysis to determine the two recommendations with the most impact on decreasing LOS for future implementation in low-resource environments. Results: A total of 555 patients were included across the three surgical categories: CS (274, 49.4%), OBF (126, 22.7%), and laparotomy (155, 27.9%). The primary outcome showed that the overall adherence was 1810 (65.2%) of the total number of the five ERAS guidelines recommendations in the cohort (2275 recommendations). The secondary outcomes showed that adherence to all five ERAS recommendations reduced LOS by 128 h compared to nonadherence to any ERAS elements. Adherence to early mobilization, early removal of urinary catheters, and early feeding each have shown consistent reductions in LOS across all Bellwether surgical procedures. Conclusion: The implementation of a limited set of ERAS recommendations in low-resource environments has the potential to decrease LOS by approximately 5 days for Bellwether surgical procedures.