Enhanced recovery after surgery in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: national survey of peri-operative practice by Indian society of peritoneal surface malignancies.
Autor: | Somashekhar SP; Aster International Institute of Oncology , Aster hospital , Bengaluru, India., Deo S; Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India., Thammineedi SR; Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India., Chaturvedi H; Max Institute of Cancer care, New Delhi, India., Mandakukutur Subramanya G; Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India., Joshi R; Gynaecological Oncology, Fortis Memorial Research Institute, Gurgaon, New Delhi, India., Kothari J; HCG Cancer Centre Ahmedabad, Ahmedabad, India., Srinivasan A; Apollo Hospitals, Chennai, India., Rohit KC; Aster International Institute of Oncology , Aster hospital , Bengaluru, India., Ray M; Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India., Prajapati B; HCG Cancer Centre Ahmedabad, Ahmedabad, India., Guddahatty Nanjappa H; Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India., Ramalingam R; Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India., Fernandes A; Aster International Institute of Oncology , Aster hospital , Bengaluru, India., Ashwin KR; Aster International Institute of Oncology , Aster hospital , Bengaluru, India. |
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Jazyk: | angličtina |
Zdroj: | Pleura and peritoneum [Pleura Peritoneum] 2023 May 22; Vol. 8 (2), pp. 91-99. Date of Electronic Publication: 2023 May 22 (Print Publication: 2023). |
DOI: | 10.1515/pp-2022-0198 |
Abstrakt: | Objectives: The Enhanced recovery after surgery (ERAS) program is designed to achieve faster recovery by maintaining pre-operative organ function and reducing stress response following surgery. A two part ERAS guidelines specific for Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was recently published with intent of extending the benefit to patients with peritoneal surface malignancies. This survey was performed to examine clinicians' knowledge, practice and obstacles about ERAS implementation in patients undergoing CRS and HIPEC. Methods: Requests to participate in survey of ERAS practices were sent to 238 members of Indian Society of Peritoneal Surface malignancies (ISPSM) via email. They were requested to answer a 37-item questionnaire on elements of preoperative (n=7), intraoperative (n=10) and postoperative (n=11) practices. It also queried demographic information and individual attitudes to ERAS. Results: Data from 164 respondents were analysed. 27.4 % were aware of the formal ERAS protocol for CRS and HIPEC. 88.4 % of respondents reported implementing ERAS practices for CRS and HIPEC either, completely (20.7 %) or partially (67.7 %). The adherence to the protocol among the respondents were as follows: pre operative (55.5-97.6 %), intra operative (32.6-84.8 %) and post operative (25.6-89 %). While most respondents considered implementation of ERAS for CRS and HIPEC in the present format, 34.1 % felt certain aspects of perioperative practice have potential for improvement. The main barriers to implementation were difficulty in adhering to all elements (65.2 %), insufficient evidence to apply in clinical practice (32.4 %), safety concerns (50.6 %) and administrative issues (47.6 %). Conclusions: Majority agreed the implementation of ERAS guidelines is beneficial but are followed by HIPEC centres partially. Efforts are required to overcome barriers like improving certain aspects of perioperative practice to increase the adherence, confirming the benefit and safety of protocol with level I evidence and solving administrative issues by setting up dedicated multi-disciplinary ERAS teams. Competing Interests: Competing interests: Authors state no competing of interest. (© 2023 the author(s), published by De Gruyter, Berlin/Boston.) |
Databáze: | MEDLINE |
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