Ahmad Hamza, Shehdio Waqas, Tanoli Omaid, Deckelbaum Dan, Pasha Tayyab
Experimental Surgery, McGill University, Montreal, CAN.
Cardiac Surgery, Allama Iqbal Medical College, Lahore, PAK.
Cureus. 2023 Sep 26;15(9):e46030. doi: 10.7759/cureus.46030. eCollection 2023 Sep.
An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs), such as Pakistan, has driven the need for implementing Enhanced Recovery After Surgery (ERAS), a safe and cost-effective surgical service aimed at improving patient recovery and reducing post-operative complications. Despite countless benefits, there are few ERAS programs throughout Pakistan and sparse literature on healthcare professionals' views regarding ERAS. Without a deep understanding of healthcare professionals' perspectives on ERAS, underlying barriers and facilitators to a long-term ERAS implementation cannot be addressed and improved upon. Therefore, the purpose of this study is to better understand the knowledge, implementation, and perception of ERAS from the perspective of healthcare professionals across Pakistan.
Upon receiving ethical approval from the McGill University Health Center (MUHC), a previously validated questionnaire was modified and a 29-question survey was developed and disseminated to healthcare professionals practising in Pakistan. Quantitative data was analyzed using descriptive statistics and potential correlations that exist between the implementation of ERAS and the participants' gender, employment setting, and surgical specialty were investigated using the chi-squared analysis with a p-value of 0.05 as the cutoff.
A total of 49 participants responded to this survey of whom 34 (69%) worked at a tertiary care teaching hospital whereas 15 (31%) worked at a private hospital. Surprisingly, 42 (85%) participants expressed being aware of the ERAS guidelines with only 30 (61%) either strongly agreeing or agreeing to successfully implementing ERAS into practice. The largest discrepancies in implementation were seen when discussing specific elements of the ERAS guidelines such as preoperative carbohydrate loading, practicing prolonged preoperative fasting, performing mechanical bowel preparation, performing active patient warming, and early postoperative removal of Foley's catheter. Surgeons employed at a private institution were more likely to discuss postoperative pain management and control, less likely to utilize prolonged fasting, more likely to perform regular body temperature monitoring, more likely to practice providing chewing gum to patients postoperatively, and more likely to perform early removal of the Foley's catheter.
An understanding of ERAS, the implementation of various elements, and a positive attitude toward its benefits definitely seem to be prevalent among healthcare professionals in Pakistan. However, key barriers and enablers specific to the underlying healthcare environment seem to be hindering the long-term successful implementation of ERAS across Pakistan. It is crucial for future studies to explore these barriers in further detail and involve the perspective of these key stakeholders to help enhance long-term ERAS adoption.
在巴基斯坦等中低收入国家（LMICs），疾病负担日益向非传染性疾病转移，且现有的外科疾病负担较高，这促使人们需要实施术后加速康复（ERAS），这是一种旨在改善患者康复并减少术后并发症的安全且具成本效益的外科服务。尽管有诸多益处，但巴基斯坦各地的ERAS项目却很少，且关于医疗保健专业人员对ERAS看法的文献也很稀少。如果不深入了解医疗保健专业人员对ERAS的看法，就无法解决和改进长期实施ERAS的潜在障碍及促进因素。因此，本研究的目的是从巴基斯坦各地医疗保健专业人员的角度更好地了解ERAS的知识、实施情况和认知。
在获得麦吉尔大学健康中心（MUHC）的伦理批准后，对一份先前验证过的问卷进行修改，编制了一份包含29个问题的调查问卷，并分发给在巴基斯坦执业的医疗保健专业人员。使用描述性统计分析定量数据，并使用卡方分析调查ERAS实施与参与者性别、工作环境和外科专业之间存在的潜在相关性，以p值0.05作为临界值。
共有49名参与者回应了这项调查，其中34人（69%）在三级护理教学医院工作，15人（31%）在私立医院工作。令人惊讶的是，42名（85%）参与者表示知晓ERAS指南，只有30名（61%）要么强烈同意要么同意成功将ERAS应用于实践。在讨论ERAS指南的具体要素时，如术前碳水化合物负荷、长时间术前禁食、进行机械肠道准备、积极为患者保暖以及术后早期拔除 Foley 导管，实施方面存在最大差异。在私立机构工作的外科医生更有可能讨论术后疼痛管理和控制，不太可能采用长时间禁食，更有可能进行常规体温监测，更有可能在术后给患者提供口香糖，也更有可能早期拔除 Foley 导管。
在巴基斯坦的医疗保健专业人员中，对ERAS的了解、各种要素的实施以及对其益处的积极态度似乎确实很普遍。然而，特定于基础医疗环境的关键障碍和促进因素似乎正在阻碍ERAS在巴基斯坦的长期成功实施。未来的研究进一步详细探索这些障碍并纳入这些关键利益相关者的观点以帮助提高ERAS的长期采用率至关重要。
