Implementing Enhanced Recovery After Surgery (ERAS) Protocols in Resource-Limited Environments: A Critical Review for Nigerian Surgical Patients

Fagbohun  Omolola; Oshunpidan  Adekunbi; Eke  Ngozi

doi:10.22270/ijmspr.v12i3.198

Authors

Fagbohun Omolola Department of Anaesthesia, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria https://orcid.org/0000-0001-5083-4394
Oshunpidan Adekunbi Department of Anaesthesia, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria https://orcid.org/0009-0002-7650-8284
Eke Ngozi Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria https://orcid.org/0000-0002-0809-0886

DOI:

https://doi.org/10.22270/ijmspr.v12i3.198

Keywords:

Enhanced Recovery After Surgery (ERAS), perioperative care, resource-limited settings, Nigeria, surgical outcomes, healthcare optimization

Abstract

Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to improve perioperative outcomes and reduce healthcare costs in various settings. However, their implementation in resource-limited environments, such as Nigeria, remains constrained due to infrastructural, economic, and sociocultural barriers.

Methods: This critical review synthesizes current literature on the application of ERAS protocols in resource-constrained environments, with a focus on Nigeria. A comprehensive search of PubMed, Scopus, and African Journals Online was conducted to identify relevant studies. Data were extracted regarding the clinical benefits, cost-effectiveness, challenges, and context-specific strategies for ERAS implementation.

Results: Evidence indicates that ERAS protocols can significantly reduce postoperative complications, length of hospital stay, and overall healthcare expenditure in resource-limited settings. Successful implementation requires adaptation of ERAS components to local realities, prioritization of low-cost and high-impact interventions, and active engagement of multidisciplinary stakeholders.

Conclusion: The adoption of ERAS protocols in Nigeria requires careful adaptation to address local challenges and cultural factors. By focusing on readily available, reproducible, cost-effective strategies and fostering collaboration among healthcare providers, ERAS protocols can enhance surgical outcomes and optimize resource utilization in low- and middle-income countries.

Keywords: Enhanced Recovery After Surgery (ERAS), perioperative care, resource-limited settings, Nigeria, surgical outcomes, healthcare optimization

Author Biographies

Fagbohun Omolola , Department of Anaesthesia, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria

Department of Anaesthesia, Lagos State University College of Medicine and Teaching Hospital, Ikeja, Lagos, Nigeria

Oshunpidan Adekunbi , Department of Anaesthesia, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Department of Anaesthesia, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Eke Ngozi , Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

References

Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008; 248(2):189-98. https://doi.org/10.1097/SLA.0b013e31817f2c1a PMid:18650627

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care for elective gastrointestinal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2013; 37(2):259-84. https://doi.org/10.1007/s00268-012-1772-0 PMid:23052794

Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3):466-77. https://doi.org/10.1016/j.clnu.2005.02.002 PMid:15896435

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. Enhanced recovery after surgery (ERAS) pathway in elective abdominal surgery: A systematic review and meta-analysis. Br J Surg. 2015; 102(3):188-98.

Greer NL, Gunnar WP, Dahm P, Lee AE, MacDonald R, Shaukat A, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery: A systematic review and meta-analysis. Ann Surg. 2018; 267(5):860-70.

Pędziwiatr M, Pisarska M, Kisielewski M, Małczak P, Major P, Wierdak M, et al. ERAS protocol in laparoscopic surgery for colonic versus rectal cancer: Are there differences in short-term outcomes? Med Oncol. 2016; 33(6):57. https://doi.org/10.1007/s12032-016-0772-6 PMid:27154634 PMCid:PMC4859853

Ologunde R, Leff R, Sharma S, Harrison S, Davies J, Shinde S, et al. Anaesthesia and surgical care in Nigeria: A review of the current situation. Afr J Anaesth Intensive Care. 2015; 15(1):34-40.

Ibeanusi SE, Nwankwo UA, Onyemaechi NO. Surgical care in a Nigerian teaching hospital: Challenges and prospects. Niger J Surg. 2017; 23(2):63-7.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-213.10. Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015; 386(9993):569-624. https://doi.org/10.1016/S0140-6736(15)60160-X PMid:25924834

Kwok AC, Leff R, Seshadri R, Magee WP, Fitzgerald TN, Hodges AM, et al. Implementation of an enhanced recovery after surgery (ERAS) program in a resource-limited setting: A pilot study. World J Surg. 2018; 42(12):3801-8.

Bentrem DJ, Kushner DM, Stein S, McGree ME, Dowdy SC, Cliby WA, et al. Enhanced recovery after surgery in Ghana: A feasibility study. J Surg Res. 2018; 221:103-11