Abstract
Purpose : We are attempting to introduce Enhanced Recovery After Surgery (ERAS) into the Essential Strategy for Early Normalization after Surgery with patient's Excellent satisfaction (ESSENSE) project, which is in accordance with the circumstances of perioperative management in Japan and has been introduced in various areas of digestive surgery. In connection with the promotion of the enhanced postoperative recovery project by the Japanese Society for Surgical Metabolism and Nutrition, we conducted a questionnaire survey on perioperative management at institutions with which the councilors of the society are affiliated. Method : We conducted a written questionnaire survey of 116 medical institutions with which the councilors of the society are affiliated (159 councilors). The surveyed surgical procedures included excision of the esophagus, stomach, colon and rectum, laparoscopic cholecystectomy, hepatectomy and pancreaticoduodenectomy. Results : The response rate to the questionnaire was 40%. The results of the survey were as follows : 1. To the question, "Do you know the ERAS protocol?," 81% said 'yes' and indicated that they supported the protocol. 2. To the question, "Do you know the ESSENSE project?," 67% said 'yes'. 3. To the question, "Do you routinely perform preoperative intestinal lavage?," 44% said 'yes'. 4. To the question, "When do patients stop fluid oral intake preoperatively?," 40% responded "2 or 3 hours before induction of anesthesia." 5. To the question, "When do patients start preoperative fasting?," 62% said "More than 12 hours before induction of anesthesia." 6. To the question, "Do you perform oral rehydration at least 2 hours before the operation?" 77% said no. 7. To the question "Do you have a specific protocol for early ambulation?," 47% responded that they had no protocol in place and coped with the matter on a case-by-case basis. 8. To the question, "When do patients re-start postoperative oral intake of food and fluid (the maximum interval [days] to the start of intake of water: solid food)?" 7 : 7 days in esophagectomy, 3 : 5 days in total gastrectomy, 1 : 3 days in colectomy, 1 : 5 days in proctectomy (without colostomy), 1 : 2 days in hepatectomy, and 1 : 7 days in pancreaticoduodenectomy. 9. To the question, "What are the obstacles to promoting the enhanced postoperative recovery project?," 44% responded "Physicians' lack of awareness." Discussion : The enhanced postoperative recovery project is widely recognized among councilors, however, the implementation rate at each institution is not always high.
