The importance of nursing for surgical patients has been frequently underestimated. The success of enhanced recovery programs after surgery (ERAS) depends on preferably complete fulfillment of the protocol and nurses are an important part of it. Due to the additional nursing action required, such protocols are suspected to increase the nursing workload. The aim of the present study was to observe and measure objectively nursing workload before, during and after systematic implementation of a comprehensive enhanced recovery pathway in colorectal surgery. The program ERAS was introduced systematically in our tertiary academic centre 2011, since then our experience is based on more than 1500 ERAS patients. Nursing workload was prospectively assessed for all patients on a routine basis by means of a standardized and validated point system (PRN). In a retrospective cohort study, we compared nursing workload based on prospective data before, during and after ERAS implementation and correlated nursing workload to the compliance with the ERAS protocol. The study cohort included 50 patients before ERAS implementation (2010) and 69 (2011) and 148 (2012) consecutive patients after implementation; the baseline characteristics of the 3 groups were similar. Mean PRN values were 61.2 ± 19.7 per day in 2010 and decreased to 52.3 ± 13.7 (P = 0.005) and 51.6 ± 18.6 (P < 0.002) in 2011 and 2012, respectively. Increasing compliance with the ERAS protocol was significantly correlated to decreasing nursing workload (ρ = -0.42; P < 0.001). Nursing workload is--against a common belief--decreased by systematic implementation of enhance recovery protocol. The higher the compliance with the pathway, the lower the burden for the nurses!

Enhanced Recovery After Surgery (ERAS) guidelines advocate early postoperative mobilisation to counteract catabolic changes due to immobilisation and maintain muscle strength. The present study aimed to assess compliance to postoperative mobilisation according to ERAS recommendations. This is a retrospective cohort study on consecutive colorectal surgical procedures treated within an established ERAS protocol within a single center between May 2011 and May 2017. Demographics, surgical details, ERAS related items and surgical outcome were prospectively assessed in a dedicated database and compared between ambulant patients (at least 6 h out of bed at postoperative day (POD) 1) vs. patients not meeting the target (delayed mobilisation). Risk factors for decreased postoperative mobilisation were identified through multivariable logistic regression. 1170 patients were retained. 676 patients (58%) did not mobilise as recommended by ERAS protocol at POD1. Emergency operation (Odds Ratio (OR) 0.40; 95% Confidence Interval (CI) 0.18-0.91, p = 0.028), age > 70 years (OR 0.69; 95% CI 0.47-1.00, p = 0.050) and intraoperative total fluids > 2000 mL (OR 0.59; 95% CI 0.37-0.93, p = 0.025) were independent risk factors for delayed mobilisation. Patients with delayed mobilisation had significantly more overall (Clavien grade IV) (55% vs. 29%, p=<0.001), major (Clavien grade IIIb-V) (16% vs. 7%, p=<0.001) and respiratory (12% vs. 4%, p=<0.001) complications, as well as longer length of stay (12 ± 14 vs. 6±7days, p=<0.001). More than half of patients did not mobilise as recommended by ERAS guidelines. Emergency surgery, advanced age and fluid overload were independent risk factors for delayed mobilisation, which was associated with increased postoperative complications.

OBJECTIVES: Enhanced recovery after surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital. METHODS: The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the 1st patients, followed by analysis and full implementation. RESULTS: Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings and continuous feedback loops. Preliminary data from the initial cohort showed improvements in early mobilization, opioid use, respiratory complications and shorter hospital stays. CONCLUSIONS: The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.

Background: Enhanced recovery after surgery is associated with improved clinical outcomes and cost savings. Comparisons between studies and settings are challenging owing to variable data collection and definitions. The objective of this study was to explore variation in compliance with enhanced recovery after surgery and outcomes across surgery types and countries using a standardized database. Methods: This international retrospective cohort study included adult patients who underwent surgical procedures (colorectal, gynaecological, pancreatic, hepatic, breast reconstruction, head and neck, urological, pulmonary), treated with enhanced recovery after surgery recorded in a standardized database between January 2017 and September 2021. The primary outcomes, length of hospital stay and complications, and the exposure variable, compliance with enhanced recovery after surgery, were captured from the standardized database. Patient demographic characteristics and surgical complexity were abstracted and considered as co-variates. Negative binomial and logistic regression analyses were used to model outcomes as a function of enhanced recovery after surgery compliance score. Results: The cohort included 12 134 patients (from Canada, the Netherlands, and Switzerland) who had median age of 63 years and underwent colorectal (59%) or gynaecological (19%) surgery. The median compliance with enhanced recovery after surgery differed by country (Canada 78.6%, the Netherlands 67.7%, Switzerland 80.0%). Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to reduced length of hospital stay across all operations, by 0.94 (95% confidence interval (c.i.) 0.85 to 1.04) days in Canada, 1.03 (0.85 to 1.20) days in the Netherlands, and 1.55 (1.12 to 1.97) days in Switzerland. Each 1-unit increase in enhanced recovery after surgery compliance score corresponded to a 29 (95% c.i. 25 to 33)% reduction in odds of experiencing a severe complication across all operations in Canada, a 22 (14 to 31)% reduction in the Netherlands, and a 5 (2 to 8)% reduction in Switzerland. Conclusion: Using a standardized database, this study confirmed that enhanced recovery after surgery compliance is associated with reduced length of hospital stay and complications in an international multisurgical cohort.

Background: Enhanced Recovery After Surgery (ERAS®) is a coordinated, evidence-based program delivered through a multidisciplinary team, which objective is to improve outcomes and patient satisfaction, while minimizing complications. The objective of this two-cohort study is to evaluate the clinical impact of an ERAS program on elective primary hip (THA) and knee (TKA) arthroplasties with regards to hospital length of stay, during the first 12 months after implementation. Methods: We compared a retrospective pre-ERAS with a prospective ERAS cohort. Key aspects of this program included preoperative education, minimal fasting, standardised, anaesthetic and surgical techniques, multimodal analgesia, and early mobilization. The primary outcome was hospital length of stay. Other outcomes included rest, dynamic pain scores, and rates of complications. Results: From December 1st, 2021 to November 30th, 2022, data from 267 patients (138 THA, 129 TKA) were compared with data from 258 patients (128 THA, 130 TKA) collected between December 1st, 2022, and November 30th, 2023, who underwent the ERAS® program (total: 525 patients). The mean hospital length of stay for THA patients before ERAS® was 5.5 ± 2.9 days versus 4.5 ± 2.0 days after ERAS® implementation ( p = 0.002). For TKA patients, it was 6.6 ± 3.1 days before vs 5.6 ± 1.9 days after ERAS® implementation ( p = 0.001). Rest, dynamic pain scores, and rates of complications were similar between groups except for pneumonia in patients undergoing TKA. Conclusion: The implementation of an ERAS® program for hip and knee arthroplasty led to a reduced hospital length of stay, below the Swiss national average, without impacting pain outcomes and rates of complications.