An investigation into the perioperative nutritional management of open colorectal surgery patients in major Australian hospitals: a comparison with the ERAS guidelines

Abstract

Aim The present study compared the adherence of Australian hospitals with the 'enhanced recovery after surgery' guidelines for the management of colorectal surgery patients to inform development of a colorectal surgery care-path. Methods Twelve Australian dietetic departments were approached and completed telephone interviews from June to September 2010 based on questions informed by the 'enhanced recovery after surgery' guidelines. Dietitians were questioned about their guideline awareness and the nutritional management of colorectal surgery patients within their facility. Current dietetic practices and perceived barriers and enablers to implementation of the 'enhanced recovery after surgery' guidelines were investigated. Results Dietitians at 10 of the 12 hospitals approached completed the interviews. Despite wide awareness of the 'enhanced recovery after surgery' nutrition guidelines in those surveyed and attempts to change practice, no hospital in the study had fully implemented the guidelines. Only three dietitians reported practising nutritional management of patients in accordance with more that half of the guideline elements. The most consistently implemented guideline element was the early removal of nasogastric tubes. The guideline element with the most reported difficulty were avoiding the use of bowel preparation and implementing preoperative carbohydrate supplementation. Recommendations have been presented to assist dietitians throughout Australia to close the gap between the evidence base and clinical practice. Conclusion A significant gap between the literature and clinical practice remains in the nutritional management of colorectal surgery patients. Acknowledgement of barriers and enablers to guideline implementation may assist in future guideline adoption.