Adaptation of Enhanced Recovery After Surgery Protocol for Elective Gastrointestinal and Hepatopancreaticobiliary Surgeries for Tertiary Hospitals in Ethiopia: A Modified Delphi Study.

Abstract

Patients in low- and middle-income countries (LMICs) lack access to safe and affordable surgical and anesthetic care. Standardized evidence-based perioperative care recommendations and instruments to assess guideline compliance and results are needed. Enhanced recovery after surgery (ERAS) protocols are already in use and have evidence supporting its efficacy. Although ERAS programs have been beneficial in various fields of surgery, they are not widely used in developing countries compared to developed countries. Difference in dietary patterns, living standards, healthcare innovations, and sociodemographic indexes may preclude the direct adoption of existing protocols. The aim of this study is to adapt the ERAS protocol for gastrointestinal (GI) and hepatopancreaticobiliary (HPB) elective surgeries in a way that is feasible, sustainable, and effective for Ethiopian tertiary hospitals. A modified Delphi process was used to devise an ERAS protocol for perioperative care of patients who undergo elective gastrointestinal and hepatopancreaticobiliary surgery from preexisting guidelines to fit the Ethiopian context. Thirty-two panelists were invited from target disciplines to participate in the Delphi after being sampled using purposive and snowballing sampling techniques. Two rounds were conducted until a consensus of 80% was reached on different components of the protocol. Data are presented in aggregate after deidentification. Thirty-two experts completed round one and 24/32 completed round two after which mature consensus was achieved. There are eight preoperative recommendations, seven intraoperative recommendations, and six postoperative recommendations that have been adapted from existing guidelines and six novel components. These guidelines were deemed appropriate for 7 types of surgical procedures. This adapted protocol consisting of 27 recommendations represents a critical step toward implementing standardized resource-appropriate ERAS pathways for GI and HPB surgeries in Ethiopia.