Project 461206

Surgery is essential for the health and quality of life for over 1.5 million Canadians a year. However, surgery can burden patients and the healthcare system - complications are common and costly to patients and healthcare systems. Taken together, optimizing surgical care is critical. Enhanced Recovery After Surgery (ERAS) guidelines have greatly reduced surgical complications, length of stay and cost. As with many guidelines, implementing ERAS is challenging. Improving implementation of ERAS is a priority for the international ERAS Society. Our objective is to understand ERAS guideline compliance to inform implementation strategies to improve evidence-based surgical care via ERAS guidelines. We will use existing clinical and administrative data sources to examine trends and variability in ERAS compliance within and between 41 hospitals in 3 countries. All adult patients undergoing ERAS-guided surgeries from 2017-2021 will be included and identified using the Enhanced Recovery After Surgery Interactive Audit System (EIAS) which captures 150 variables, including demographics and baseline health status, surgical data, and key compliance metrics. Using these data and statistical analyses we will determine the rate of ERAS compliance and variations by components of ERAS, type of surgery, patient and surgical factors, and between hospitals and countries, and the association between ERAS compliance and outcomes. We will also explore barriers to using ERAS among two groups of end-users (patients and healthcare providers) using qualitative methods. Our team of experts will identify gaps in ERAS compliance and opportunities to improve the use of ERAS. These gaps will lead to implementation studies of intervention to improve ERAS compliance. By strategically integrated knowledge users and representatives from the international ERAS Society into our research team the information gleaned from this study will shape the implementation program for ERAS globally.