Assessment of ERAS Protocol Implementation at Tikur Anbessa Specialized Hospital; An Observational Cross-Sectional Study from Jan. 1 to April 30, 2025.
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Date
2025-07
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Addis Ababa University
Abstract
Background: Enhanced Recovery After Surgery (ERAS) programs are multimodal perioperative care pathways designed to achieve early recovery for patients undergoing major surgery.
While ERAS protocols have been extensively studied and implemented in high-income countries, their application in and middle-income countries (LMICs) is low and less well-documented.
The International Surgical Outcomes Study (ISOS) and the African Surgical Outcomes Study (ASOS) highlighted the urgent need to address the quality gap in perioperative care in LMICs.
Adaptation and effective implementation of ERAS is the best solution to achieve closing gap in perioperative care of a surgical patient including resource limited countries.
Aim of this study is to assess ERAS implementation at TASH assuming that its practice is low at TASH
Methods: An observational cross-sectional study was conducted on 52 colorectal patients who underwent elective surgery. Colorectal patients who will have isolated perianal procedure were excluded and no randomization technique was utilized. The data was cleaned and entered on SPSS version for analysis. The strength of associations was assessed using adjusted odds ratios (AOR) with 95% confidence intervals (CI), and a p-value of ≤0.05 was considered statistically significant.
Result: A total of 52 patients were included in the study, with a male predominance of 61.5%. The most common diagnoses were stoma-related conditions (28.8%), rectal cancer (23.1%), and colon cancer (19.2%). Mechanical bowel preparation was administered to 63.5% of patients, and 82.7% received oral antibiotic prophylaxis. The vast majority (94.2%) underwent open surgery, with an average operative time of 150 minutes. Postoperative complications occurred in 26.9% of patients, and the mortality rate was 1.9%. The mean total length of hospital stay was 13.6 ± 6.5 days. And, the post operative hospital stay was 6.9days.
Conclusion: This study highlights a mixed level of adherence to ERAS protocols in colorectal surgery. While basic safety measures and some prophylactic interventions are well established, there is a clear gap in implementing core ERAS principles such as early feeding, DVT prophylaxis, and minimally invasive techniques. These gaps may be contributing to prolonged hospital stays and elevated complication rates.
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Keywords
Recovery, Surgery