Two scientific articles have just been published which describe the positive adoption of the ERAS protocol in the clinical practice of hospitals in the Piedmont Region which perform surgery for colorectal tumors and hysterectomies.

ERAS (Enhanced Recovery After Surgery) is a peri-operative protocol developed at an international level which provides for careful and shared management by a multi-professional team (which includes nurses, surgeons, anesthetists, dieticians) of the entire path of the patient dealing with surgery, with the aim of reducing stress and speeding up the post-surgery recovery phase.

The protocol contains approximately 25 detailed recommendations to optimize all stages of the patient's journey starting from the pre-hospitalization phase (with particular attention to the communication and information aspects, to any problems related to nutrition or incorrect habits, to the abolition of traditional long fasting pre-surgery), to which is added a more appropriate use of drugs and supports during and after the surgery and help in resuming nutrition and mobility as soon as possible.

ERAS, despite being based on extensive international experience and on literature capable of documenting a reduction in hospitalization and complications and greater patient satisfaction, was poorly applied in our National Health Service (NHS), including Piedmont, as it resulted from previous investigations (Piovano et al., Int J Gyn Oncol 2019; Pellegrino et al., Healthcare 2022).

In 2019, thanks both to the initiative of some regional centers that had already successfully adopted ERAS, and to the interest of the Regional Health Department, the Piedmont Valle d'Aosta Oncology Network and the fortunate coincidence of the launch of the network program EASY-NET, co-financed by the Piedmont Region and the Ministry of Health, aimed at evaluating the effectiveness of Audit & Feedback (A&F) to improve clinical practice (https://easy-net.info/progetti/wp3-piemonte/ ), two parallel experimental studies were planned.

The common objective was to evaluate to what extent an organized and widespread intervention in the regional territory where the ERAS protocol was adopted in general surgery and gynecology could obtain good adherence, contributing to reducing the length of hospitalization, containing complications and increasing patient satisfaction. patients.

The Clinical Epidemiology Structure of the AOU Città della Salute e della Scienza of Turin, responsible for EASY-NET for Piedmont, organized and coordinated the entire project, adopting an experimental model for both studies and involving, between September 2019 and May 2021, 29 general surgery centers (with 2397 patients) and 23 gynecology centers (with 2086 patients).

The results of both studies have demonstrated, also thanks to the continuous monitoring of the activity carried out through the use of A&F, a clear increase in the application of the recommendations contained in the ERAS protocols (+13% overall adherence), in particular improving pre-hospitalization management (+18% in surgeries; +21% in gynecologies) and post-surgery management (+17% in surgeries, +11% in gynecologies). The length of hospitalization was reduced on average by 0.6 days for colorectal operations, while it was already low in hysterectomy operations.

A result of particular interest is that the reduction in length of stay and complications was more evident with increasing experience of using ERAS, in hospitals that applied it more completely and in those that started from levels of lower initial adhesion. In both studies, questionnaires filled in directly by the patients were also collected, partly during the post-operative hospital stay, and partly after about a month from discharge, which confirmed an improvement in the recovery of autonomy and a high satisfaction with the treatment received .

These two studies represent the most extensive trials published so far on ERAS and demonstrate how it is possible to contribute to the development of scientific knowledge and the improvement of clinical practice with studies conducted on a regional hospital network, with the generous involvement of patients and NHS staff, even in hospitals generally excluded from research activities and in an extraordinarily complex period such as that which occurred during the COVID pandemic.


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