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ERAS guidelines for esophagectomy: adherence patterns among Canadian thoracic surgeons

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Abstract

Enhanced recovery after surgery (ERAS) guidelines have been incorporated across surgical specialties supported by the publication of evidence-based guidelines. The purpose of this research was to explore adherence to such guidelines among Canadian thoracic surgeons with respect to esophagectomy. A standardized questionnaire was developed comprising 43 validated ERAS recommendations. Additional questions such as the number of annual esophagectomies per institution, the clinical practice environment of the survey responder, preferred operative approach, and responder demographics were included. The survey was circulated to all Canadian Association of Thoracic Surgery (CATS) members and remained open for a four month period. Of the 136 CATS members, 74 (54.4%) completed the survey. Among responders, 29 (40.3%) did have a standard ERAS protocol at their institution. The majority of the responders practiced at an academic center (50, 88.3%). A self-reported adherence rate greater than 80% was observed in six out of 12 of the pre-operative ERAS recommendations, two out of eight of the intraoperative, and seven out of 23 of the post-operative ERAS recommendations. Among the five recommendations associated with high levels of evidence, two had been incorporated into practice by the majority of responders. Out of the 29 strong recommendations, 24 were incorporated into practice by the majority of responders. Canadian thoracic surgeons’ express practices that are largely consistent with strongly recommended ERAS guidelines in patients undergoing esophagectomy. ERAS guidelines continue to be instrumental in the improvement of perioperative care; however, high adherence is ultimately necessary for optimal patient outcomes.

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Funding

No funding was secured or utilized for this research. The authors have no financial relationships relevant to this study. Dr. Turner declares a financial relationship with Astra Zeneca and Ethicon.

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Author notes

  1. Uzair Jogiat and Daniel Sisson are co-first authors.

Authors and Affiliations

  1. Division of Thoracic Surgery, University of Alberta, 416 Community Services Centre, 10240 Kingsway Ave, Edmonton, AB, T5H 3V9, Canada

    Uzair Jogiat, Hannah Sasewich, Taufiq Islam & Simon R. Turner

  2. Division of Thoracic Surgery, Lakeridge Health, Oshawa, ON, Canada

    Daniel Sisson

  3. Division of Thoracic Surgery, Virginia Mason Medical Centre, Seattle, WA, USA

    Donald Low

  4. Division of Thoracic Surgery, Dalhousie University, Halifax, NS, Canada

    Gail Darling

Authors
  1. Uzair Jogiat
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  2. Daniel Sisson
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  4. Taufiq Islam
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  5. Donald Low
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  6. Gail Darling
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  7. Simon R. Turner
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Correspondence to Simon R. Turner.

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Ethics approval

Ethical approval for this study was obtained through the University of Alberta Research Ethics. All research was conducted in accordance with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained by each participant. The informed consent statement was provided as the first question of the survey.

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Jogiat, U., Sisson, D., Sasewich, H. et al. ERAS guidelines for esophagectomy: adherence patterns among Canadian thoracic surgeons. Updates Surg 75, 1203–1210 (2023). https://doi.org/10.1007/s13304-023-01478-8

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  • DOI: https://doi.org/10.1007/s13304-023-01478-8

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