Breaking surgical barriers: ERAS in action in Romania

Implementing Enhanced Recovery After Surgery (ERAS) protocols presents challenges for healthcare systems, particularly for patients undergoing complex surgeries. Though ERAS effectively reduces postoperative complications and hospital stays, its implementation varies. Our hospital adopted the ERAS protocol in 2020. This study details specific ERAS components implemented in our clinic, emphasizing surgical and anesthetic strategies. We describe preoperative, intraoperative, and postoperative phases and analyze the evidence for each component's integration. Additionally, we highlight the specific challenges faced in Romania, such as funding limitations, resource constraints, and reluctance among healthcare professionals. We conducted a prospective study of 147 patients with colorectal cancer treated from 2020 to 2023, detailing the perioperative care phases and supporting evidence for protocol components. The methodology was refined to account for potential confounding factors by ensuring consistency in patient selection criteria and perioperative management. Despite ERAS's advantages, patients and staff resisted its implementation. In Romanian hospitals, colorectal surgery uses ERAS only in limited cases due to inadequate funding, insufficient medical personnel, logistical challenges, and a lack of awareness or skepticism among healthcare professionals and patients. The study presents specific clinical outcomes, including length of hospital stay (LOS), postoperative complications, and readmission rates among ERAS patients. We recommend expanding medical networks and utilizing advanced technologies like telemedicine services and home-based care to improve ERAS protocol adherence. Furthermore, educational programs are essential to increase awareness and compliance with ERAS principles among patients and healthcare providers.