Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey

Geetu Bhandoria, Sohan Lal Solanki, Mrugank Bhavsar, Kalpana Balakrishnan, Cherukuri Bapuji, Nitin Bhorkar, Prashant Bhandarkar, Sameer Bhosale, Jigeeshu V. Divatia, Anik Ghosh, Vikas Mahajan, Abraham Peedicayil (+5 others)
2021 Pleura and Peritoneum  
Objectives Enhanced recovery after surgery (ERAS) protocols have been questioned in patients undergoing cytoreductive surgery (CRS) with/without hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancies. This survey was performed to study clinicians' practice about ERAS in patients undergoing CRS-HIPEC. Methods An online survey, comprising 76 questions on elements of prehabilitation (n=11), preoperative (n=8), intraoperative (n=16) and postoperative (n=32) management, was
more » ... management, was conducted. The respondents included surgeons, anesthesiologists, and critical care specialists. Results The response rate was 66% (136/206 clinicians contacted). Ninety-one percent of respondents reported implementing ERAS practices. There was encouraging adherence to implement the prehabilitation (76–95%), preoperative (50–94%), and intraoperative (55–90%) ERAS practices. Mechanical bowel preparation was being used by 84.5%. Intra-abdominal drains usage was 94.7%, intercostal drains by 77.9% respondents. Nasogastric drainage was used by 84% of practitioners. The average hospital stay was 10 days as reported by 50% of respondents. A working protocol and ERAS checklist have been designed, based on the results of our study, following recent ERAS-CRS-HIPEC guidelines. This protocol will be prospectively validated. Conclusions Most respondents were implementing ERAS practices for patients undergoing CRS-HIPEC, though as an extrapolation of colorectal and gynecological guidelines. The adoption of postoperative practices was relatively low compared to other perioperative practices.
doi:10.1515/pp-2021-0117 pmid:34676283 pmcid:PMC8482448 fatcat:crffgq5jyjag3pkqpsql43764i