Enhanced Recovery After Surgery in Pakistan: An Initial Assessment and Future Directions

Abstract Enhanced Recovery After Surgery, a novel and cost-effective perioperative surgical intervention, has been demonstrated to reduce patients’ hospital length of stay, provide a higher turnover of available resources and decrease the postoperative expenses for both patients and hospitals. Even though the potential benefits of implementing ERAS in LMICs could outweigh those in HICs, a successful long-term implementation of ERAS has yet to be completed across Pakistan. Thus, the purpose of this study was to gain insights and identify potential opportunities to ERAS implementation in the context of the local socio-environmental setting. A qualitative descriptive study design consisting of individual semi-structured interviews was utilized to explore the experiences of 11 surgical residents when implementing ERAS guidelines at one of the public tertiary care hospitals in Lahore, Pakistan. Acknowledging the benefits of ERAS, participants faced several challenges when implementing ERAS in their respective wards. Several key opportunities to successful implementation including enhanced team work and collaboration amongst medical teams, improved patient education and compliance towards ERAS, strengthening of peripheral healthcare services, and targeted resource allocation were identified by the participants. Even though several challenges identified by the participants were similar to those highlighted in HICs, unique barriers specific to the healthcare structure and culture of Pakistan also emerged. Further research exploring and highlighting these specific challenges is needed to overcome these core barriers and promote a shift towards a standardized healthcare system focused on improving patient outcomes.