A COMPARISON OF THE SUITABILITY OF PREOPERATIVE AND POSTOPERATIVE APPLICATION IN CLINIC AREAS AFTER COLORECTAL SURGERIES FOR THE (ERAS) PROTOCOL

Yıl 2024, Cilt: 3 Sayı: 1, 8 - 19, 30.04.2024

Mehmet Sabri Kırık , Arzu Tuna , Ebru Karaaslan

Öz

Aim: This study aims to find out and evaluate the attitude and the level of information of the health personnel having information about the ERAS protocol which is implemented in the USA and Europe after colorectal surgeries.
Design: This descriptive study was conducted in three state hospitals in Diyarbakir located in 3 hospitals of the southeastern Turkey.
Method: The necessary permission was obtained from the health personnel working as surgeons, anesthetists and nurses and from the institutions, and the sampling consisted of 116 persons. The survey questions were prepared after going through the literature, and the data were collected through face to face method. The evaluation of the data was given in percentages.
Results: The average age of the participants of the survey was 29.5 +5.46, while %82.8 of them was nurse, %4.3 of them was surgeon and %12 of them was anesthetist. The rate of using stockings in the prevention of embolism was %46.5. The rate of the preoperative usage of antibiotics was %86.2. %97.5 of the patients walked within the first twenty-four hours after the surgery, while %44 of the patients walked between the first eight and twenty-four hours after the surgery. The rate of the health personnel who had never heard about the ERAS protocol was %74.1. The rate of those who could not implement this protocol because of not having an institutional support was %93.1.
Conclusions: It can be pointed out that the health personnel did not have full knowledge of the implementation of the ERAS protocol, that the ERAS practices and applications were not included in the in-service trainings and that the health personnel did not benefit from the recent literature like the ERAS protocol and kept making use of conventional and traditional practices and applications

Anahtar Kelimeler

ERAS (Enhanced Recovery After Surgery) Protocol, Fast Track Surgery, Nursing

KOLOREKTAL AMELIYATLARDA KLINIK ALANDA AMELIYAT ÖNCESI, SIRASI VE SONRASI UYGULAMALARIN ERAS PROTOKOLÜNE UYGUNLUĞUNUN KARŞILAŞTIRILMASI

Öz

Amaç: Bu çalışma, Amerika ve Avrupa'da kolorektal cerrahi sonrası uygulanan ERAS protokolü hakkında bilgi sahibi olan sağlık personelinin tutum ve bilgi düzeyinin belirlenmesi ve değerlendirilmesini amaçlamaktadır.
Tasarım: Tanımlayıcı tipte olan bu çalışma, Türkiye'nin güneydoğusundaki 3 hastanede bulunan Diyarbakır'daki üç devlet hastanesinde gerçekleştirilmiştir.
Yöntem: Cerrah, anestezist ve hemşire olarak görev yapan sağlık personeli ile kurumlardan gerekli izinler alınmış olup örneklem 116 kişiden oluşmuştur. Anket soruları literatür incelendikten sonra hazırlanmış ve veriler yüz yüze görüşme yöntemiyle toplanmıştır. Verilerin değerlendirilmesi yüzde olarak verildi.
Bulgular: Ankete katılanların yaş ortalaması 29,5 +5,46 olup, %82,8'i hemşire, %4,3'ü cerrah ve %12'si anestezisttir. Emboliyi önlemede çorap kullanma oranı %46,5 idi. Ameliyat öncesi antibiyotik kullanım oranı %86,2 idi. Hastaların %97,5'i ameliyattan sonraki ilk yirmi dört saat içinde, %44'ü ise ameliyattan sonraki ilk sekiz ile yirmi dört saat arasında yürüdü. ERAS protokolünü hiç duymayan sağlık personelinin oranı ise %74,1 oldu. Kurumsal desteği olmadığı için bu protokolü uygulayamayanların oranı ise %93,1 oldu.
Sonuç: Sağlık personelinin ERAS protokolünün uygulanması konusunda tam bilgi sahibi olmadığı, hizmet içi eğitimlerde ERAS uygulama ve uygulamalarına yer verilmediği ve sağlık personelinin son dönemde yapılan yeniliklerden faydalanmadığı söylenebilir. ERAS protokolünü beğenerek, geleneksel ve geleneksel uygulama ve uygulamalardan yararlanmaya devam ettik.

Anahtar Kelimeler

ERAS ( Ameliyat Sonrası Gelişmiş İyileşme ) Protokolü, Hızlı Geçiş Cerrahisi, Hemşirelik

Kaynakça

• 1. Kehlet, H. (2008). Fast-track colorectal surgery. The Lancet, 371(9615), 791-793.
• 2. Kehlet, H., Wilmore, D. W. (2002). Multimodal strategies to improve surgical outcome. The American journal of surgery, 183(6), 630-641.
• 3. Alhashemi M, Fiore JF Jr, Safa N, Al Mahroos M, Mata J, Pecorelli N, Baldini G, Dendukuri N, Stein BL, Liberman AS, Charlebois P, Carli F, Feldman LS. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway. Surg Endosc. 2019 Jul;33(7):2313-2322. doi: 10.1007/s00464-018-6514-4. Epub 2018 Oct 17. PMID: 30334165.
• 4. Çetin B, Çilesiz NC, Ozkan A, Onuk Ö, Kır G, Balci MBC, Özdemir E. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Length of Hospital Stay in Radical Cystectomy: A Prospective Randomized Controlled Study. Cureus. 2024 Mar 3;16(3):e55460. doi: 10.7759/cureus.55460. PMID: 38571847; PMCID: PMC10988186.
• 5. Smith TW Jr, Wang X, Singer MA, Godellas CV, Vaince FT. Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties. Am J Surg. 2020 Mar;219(3):530-534. doi: 10.1016/j.amjsurg.2019.11.009. Epub 2019 Nov 16. PMID: 31761300.
• 6. Meillat H, Serenon V, Brun C, de Chaisemartin C, Faucher M, Lelong B. Impact of fast-track care program in laparoscopic rectal cancer surgery: a cohort-comparative study. Surg Endosc. 2022 Jul;36(7):4712-4720. doi: 10.1007/s00464-021-08811-5. Epub 2022 Apr 4. PMID: 35378628.
• 7. Gustafsson, U., Scott, M., Schwenk, W., Demartines, N., Roulin, D., Francis, N. & Soop, M. (2012). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clinical nutrition, 31(6), 783-800.
• 8. Çilingir, D., Candaş, B., ÇİLİNGİR, D. (2017). Cerrahi Sonrası Hızlandırılmış İyileşme Protokolü ve Hemşirenin Rolü.. Journal of Anatolia Nursing and Health Sciences, 2017(2).
• 9. Li J, Kong XX, Zhou JJ, Song YM, Huang XF, Li GH, Ying XJ, Dai XY, Lu M, Jiang K, Fu DL, Li XL, He JJ, Wang JW, Sun LF, Xu D, Xu JY, Chen M, Tian Y, Li JS, Yan M, Yuan Y, Ding KF. Fast-track multidisciplinary treatment versus conventional treatment for colorectal cancer: a multicenter, open-label randomized controlled study. BMC Cancer. 2019 Oct 23;19(1):988. doi: 10.1186/s12885-019-6188-x. PMID: 31647032; PMCID: PMC6806550.
• 10. Ljungqvist, O., Scott, M. & Fearon, K. C. (2017). Enhanced recovery after surgery: a review. JAMA surgery, 152(3), 292-298.
• 11. Gustafsson, U., Scott, M., Schwenk, W., Demartines, N., Roulin, D., Francis, N. & Soop, M. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World journal of surgery, 37(2), 259-284.
• 12. Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, Wellge EB, Kunzler F, Besselink MG, Asbun H, Scott MJ, Dejong CHC, Vrochides D, Aloia T, Izbicki JR, Demartines N. Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg. 2020 Jul;44(7):2056-2084. doi: 10.1007/s00268-020-05462-w. PMID: 32161987.
• 13. Becattini C, Pace U, Pirozzi F, Donini A, Avruscio G, Rondelli F, Boncompagni M, Chiari D, De Prizio M, Visonà A, De Luca R, Guerra F, Muratore A, Portale G, Milone M, Castagnoli G, Righini M, Martellucci J, Persiani R, Frasson S, Dentali F, Delrio P, Campanini M, Gussoni G, Vedovati MC, Agnelli G. Rivaroxaban vs placebo for extended antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer. Blood. 2022 Aug 25;140(8):900-908. doi: 10.1182/blood.2022015796. PMID: 35580191; PMCID: PMC9412006.
• 14. Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology. 2023 Feb 1;138(2):132-151. doi: 10.1097/ALN.0000000000004381. PMID: 36629465.
• 15. Fawcett WJ, Thomas M. Pre-operative fasting in adults and children: clinical practice and guidelines. Anaesthesia. 2019 Jan;74(1):83-88. doi: 10.1111/anae.14500. Epub 2018 Nov 30. PMID: 30500064.
• 16. Martin RF. Wound Healing. Surg Clin North Am. 2020 Aug;100(4):ix-xi. doi: 10.1016/j.suc.2020.05.012. Epub 2020 Jun 7. PMID: 32681879; PMCID: PMC7276230.
• 17. Groller KD. Systematic review of patient education practices in weight loss surgery. Surg Obes Relat Dis. 2017 Jun;13(6):1072-1085. doi: 10.1016/j.soard.2017.01.008. Epub 2017 Jan 11. PMID: 28216118.
• 18. Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, Stone R, Mena G, Elias KM, Altman AD, Bisch SP, Ramirez PT, Dowdy SC. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Gynecol Oncol. 2023 Jun;173:58-67. doi: 10.1016/j.ygyno.2023.04.009. Epub 2023 Apr 21. PMID: 37086524.
• 19. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019 Jan 1;55(1):91-115. doi: 10.1093/ejcts/ezy301. PMID: 30304509.
• 20. Willis MA, Toews I, Soltau SL, Kalff JC, Meerpohl JJ, Vilz TO. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst Rev. 2023 Feb 7;2(2):CD014909. doi: 10.1002/14651858.CD014909.pub2. PMID: 36748942; PMCID: PMC9908065.
• 21. Moffatt-Bruce SD, Hilligoss B, Gonsenhauser I. ERAS: Safety checklists, antibiotics, and VTE prophylaxis. J Surg Oncol. 2017 Oct;116(5):601-607. doi: 10.1002/jso.24790. Epub 2017 Aug 28. PMID: 28846138.
• 22. Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J. 2022 Nov;33(11):2921-2940. doi: 10.1007/s00192-022-05223-4. Epub 2022 Sep 25. PMID: 36161507.