Improving perioperative cancer care: experience with the Enhanced Recovery After Surgery (ERAS) programme

Aim Surgery plays a pivotal role in the management of the majority of patients with cancer. Surgical cancer care in low-and middle-income countries is negatively impacted by high complication rates and failure to rescue the deteriorating patient. Implementation of the Enhanced Recovery After Surgery (ERAS) programme offers an opportunity to improve care. Methods Over eight years, one public and three private sector South African hospitals implemented the ERAS evidence-based colorectal guidelines tailored for context and led by multidisciplinary teams. Demographic variables, treatment and clinical outcomes were collected using an electronic audit system and analysed using statistical software for data science. Primary outcomes included length of stay and complication rates. The relationship between outcomes and compliance with ERAS guidelines year-by-year was evaluated. Results The study comprised 368 and 325 colorectal cancer patients from public and private sector hospitals, respectively, with an overall length of stay of 6 (interquartile ratio 4,9) and 4 (interquartile ratio 3,7) days, respectively. Complication rates were 39.9% (public sector) and 43.7% (private sector). Overall, ERAS compliance was greater than 70% in both sectors and ERAS compliance was greatest in the pre- and intra-operative phase. An association was seen between increasing compliance and decreased length of stay as well as decreased complication rates. Conclusions A robust colorectal cancer ERAS programme can achieve high compliance, decreased length of stay, and fewer complications in South Africa. This study provides a foundation for a large-scale national strategy for ERAS implementation for perioperative cancer care across all disciplines.