Barriers and Enablers Influencing Adherence to ERAS Protocols in Gastrointestinal Surgery: A Scoping Review

Vollständiger Abstract

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Background/Objective: Enhanced recovery after surgery (ERAS) is a global surgical quality improvement initiative that aims to improve perioperative care based on evidence-based interventions. Although ERAS protocols in gastrointestinal (GI) surgery result in improved patient outcomes, there are variations in protocol adherence and important gaps in understanding the barriers and enablers influencing this adherence. The objective of this scoping review was to map evidence from the relevant literature to identify the barriers and enablers influencing adherence to ERAS protocols in GI surgery. Method: Using the preferred reporting items for systematic reviews and meta-analyses flow diagram, we searched the databases and identified 45 published studies. Results: The scoping review identified staff, patient, and organizational-level barriers and enablers influencing adherence to ERAS protocols. The staff-reported barriers were (1) resistance to practice change, (2) workforce constraints and organizational barriers, (3) interdepartmental coordination barriers, (4) technical barriers, and (5) contextual barriers. The staff-reported enablers were (1) communication and coordination between teams, (2) professional education and a supportive practice environment, and (3) technology-driven patient education. The patient-reported barriers were (1) educational barriers, (2) workforce and clinical barriers, and (3) digital literacy and usability barriers. The patient-reported enablers were (1) patient-centered care and empowerment and (2) multifaceted patient education and delivery. Additionally, this review identified limited resources in smaller hospitals as an organizational-level barrier, whereas participation in national hospital collaborations and ERAS-dedicated hospital status were identified as organizational-level enablers of ERAS protocol adherence. Conclusions: Identifying the determinants of ERAS adherence as barriers and enablers allows healthcare teams to tailor interventions to individual patient needs, promoting greater compliance and improving the effectiveness of ERAS in GI surgery.