Ahmad Hamza, Arnaert Antonia, Shedio Waqas, Tanoli Omaid, Deckelbaum Dan, Pasha Tayyab
Center for Global Surgery, McGill University Health Center, 11405 Rue Frigon, Montreal, H3M 2R6, QC, Canada.
Department of Cardiac Surgery, Allama Iqbal Medical College, Lahore, Pakistan.
BMC Health Serv Res. 2024 Dec 21;24(1):1634. doi: 10.1186/s12913-024-11569-w.
Enhanced Recovery After Surgery (ERAS) is a cost-effective perioperative approach that has been shown to shorten patients' hospital length of stay, improve resource utilization, and reduce postoperative costs for both patients and hospitals. While ERAS has the potential to offer even greater benefits in low- and middle-income countries (LMICs) its successful long-term implementation remains incomplete in Pakistan. This study aimed to explore insights and identify opportunities for implementing ERAS within the local socio-environmental context. A qualitative descriptive approach was employed, using convenience sampling to recruit 11 surgical residents from a public tertiary care hospital in Lahore, Pakistan. Individual semi-structured interviews were conducted. The data collected was then thematically analyzed to capture the residents' experiences regarding the implementation of ERAS. Acknowledging the benefits of ERAS, participants faced several challenges when implementing ERAS in their respective wards. The participants identified several key opportunities for successful implementation, including enhanced teamwork and collaboration amongst medical teams, improved patient education and compliance towards ERAS, strengthening of peripheral healthcare services, and targeted resource allocation. Even though several challenges identified by the participants were like those highlighted in high-income countries (HICs), unique barriers specific to Pakistan's healthcare structure and culture also emerged. Further research exploring and highlighting these specific challenges is needed to overcome these core barriers and promote a shift towards a standardized healthcare system focused on improving patient outcomes.
术后加速康复（ERAS）是一种具有成本效益的围手术期方法，已被证明可以缩短患者的住院时间，提高资源利用率，并降低患者和医院的术后成本。虽然ERAS有可能在低收入和中等收入国家（LMICs）带来更大的益处，但其在巴基斯坦的长期成功实施仍未完成。本研究旨在探索见解，并确定在当地社会环境背景下实施ERAS的机会。采用了定性描述性方法，通过便利抽样从巴基斯坦拉合尔一家公立三级护理医院招募了11名外科住院医师。进行了个人半结构化访谈。然后对收集到的数据进行主题分析，以了解住院医师在实施ERAS方面的经验。尽管认识到ERAS的益处，但参与者在各自病房实施ERAS时面临了几个挑战。参与者确定了几个成功实施的关键机会，包括加强医疗团队之间的团队合作与协作、改善患者对ERAS的教育和依从性、加强基层医疗服务以及有针对性的资源分配。尽管参与者确定的几个挑战与高收入国家（HICs）突出的挑战相似，但巴基斯坦医疗结构和文化特有的独特障碍也出现了。需要进一步研究探索和突出这些具体挑战，以克服这些核心障碍，并推动向注重改善患者预后的标准化医疗系统转变。
