Adherence to Enhanced Recovery after Surgery (ERAS) protocols in cardiac surgery in Pakistan: A cross-sectional survey of current practices.

Abstract

Objective: To assess the level of adherence to Enhanced Recovery After Surgery (ERAS) protocols among cardiac surgery teams in Pakistan. Study Design: Descriptive Cross-sectional Survey. Setting: Public and Private Cardiac Surgery Centers Across Pakistan. Period: June 2024 to Dec 2024. Methods: Using a 20-item questionnaire based on established ERAS guidelines. The survey was distributed electronically to healthcare professionals involved in cardiac surgery, including surgeons, anesthesiologists, critical care physicians, and residents. Responses were analyzed to evaluate compliance across the preoperative, intraoperative, and postoperative phases. Results: A total of 65 responses were received. Overall awareness of ERAS protocols was limited, with only 15.4% of participants reporting comprehensive familiarity. High adherence was observed for fasting protocols (92.3%), early extubation (92.3%), chest tube management (96.9%), and goal-directed fluid therapy (84.6%). Moderate adherence was seen in functional status evaluation (70.8%) and postoperative thromboprophylaxis (73.9%). Areas of low adherence included carbohydrate loading (40% never implemented), antifibrinolytic use (47.7% rarely or never used), and delirium assessments (26.2% never performed). Rigid sternal fixation was largely absent (90.8% not utilized). Common barriers included limited resources, lack of institutional protocols, and insufficient training. Conclusion: Adherence to ERAS protocols in cardiac surgery within Pakistan is variable, with strong uptake in certain areas and notable deficiencies in others. Improving awareness, standardizing protocols, and addressing infrastructural constraints may enhance the integration of ERAS principles in cardiac surgical care across resource-limited settings.