Perioperative management for gastrointestinal surgery after instituting interventions initiated by the Japanese Society of Surgical Metabolism and Nutrition.

BACKGROUND

In 2012, the Japanese Society for Surgical Metabolism and Nutrition introduced the Essential Strategy for Early Normalization after Surgery with Patient's Excellent Satisfaction (ESSENSE) program to improve the perioperative management of gastrointestinal surgery. The ESSENSE program aimed to minimize ineffective perioperative management practices, and achieve adequate analgesia to expedite the return to work and activities of daily living.

METHODS

After educating relevant facilities about the ESSENSE program in 2012, we conducted questionnaire-based surveys in selected institutions in 2013 and 2016.

RESULTS

ESSENSE was implemented in 65% of the specified gastrointestinal surgical procedures in 2016. Oral fluids were discontinued >10 h before anesthesia induction by 33% and 9% of respondents in 2013 and 2016, respectively, and 2 h before anesthesia induction by 23% and 38% in 2013 and 2016, respectively. Fasting was initiated >10 h before anesthesia induction by 75% and 29% of respondents in 2013 and 2016, respectively, and 6-8 h before anesthesia induction by 20% and 60% in 2013 and 2016, respectively. Oral rehydration with a carbohydrate-containing beverage was performed 2 h preoperatively by 23% and 47% of respondents in 2013 and 2016, respectively. The median postoperative periods after which water and solids intakes were resumed were significantly shorter in 2016 than in 2013 after five surgical procedures; the exceptions were esophagectomy, laparoscopic cholecystectomy, and hepatectomy.

CONCLUSIONS

There was a high level of implementation of the ESSENSE program in participating institutions in 2016, suggesting that it is possible to achieve widespread implementation of a preoperative management protocol.