scholarly journals Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

2021 ◽  
Author(s):  
Carol J. Peden ◽  
Geeta Aggarwal ◽  
Robert J. Aitken ◽  
Iain D. Anderson ◽  
Nicolai Bang Foss ◽  
...  
Keyword(s):  
High Risk ◽  
English Language ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care ◽  
Surgical Patient ◽  
Emergency Laparotomy ◽  
Emergency General Surgery ◽  
Optimal Care ◽  
Level Of Evidence

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. Methods Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1. Results Twelve components of preoperative care were considered. Consensus was reached after three rounds. Conclusions These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

PROPER—PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial

2021 ◽  
pp. ijgc-2021-003170
Author(s):  
Andre Lopes ◽  
Alayne Magalhães Trindade Domingues Yamada ◽  
Thais de Campos Cardenas ◽  
Jaqueline Nunes de Carvalho ◽  
Emília de Azevedo Oliveira ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Functional Capacity ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care ◽  
Gynecologic Surgery ◽  
Calorie Intake ◽  
Control Group ◽  
Gynecological Surgery ◽  
The Impact

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

scholarly journals Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Abhijit S. Nair ◽  
Sandeep Diwan
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Early Discharge ◽  
Major Surgery ◽  
Emergency Laparotomy ◽  
Early Recovery ◽  
Recovery Pathways ◽  
Perioperative Care Pathway ◽  
The Cost

Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

scholarly journals Enhanced Recovery After Surgery Protocol in Emergency Laparotomy: A Randomized Control Study

2021 ◽  
Vol 07 (02) ◽  
pp. e92-e99
Author(s):  
Jyoti Sharma ◽  
Navin Kumar ◽  
Farhanul Huda ◽  
Yashwant Singh Payal
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Intestinal Perforation ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Randomized Study ◽  
Conventional Care ◽  
Care Group ◽  
Emergency Laparotomy

Abstract Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) protocols in elective surgeries but its effectiveness in emergency surgeries has been nominally studied. We aimed at studying the feasibility and effectiveness of ERAS protocols in patients undergoing emergency abdominal surgery for intestinal perforation and small bowel obstruction and compare their surgical outcomes with conventional care. Materials and methods This prospective randomized study was performed for a period of 16 months. A total of 100 patients presenting either with intestinal perforation or acute small bowel obstruction were recruited; 50 each in the ERAS and the conventional care groups. The primary outcomes studied were the postoperative length of stay and 30-day morbidity and mortality. Results It was seen that the median (interquartile range) of the duration of hospital stay in the ERAS group was 4 (1) days while it was 7 (3) days in the conventional care group, which was statistically significant (W = 323.000, p ≤ 0.001). Similarly, postoperative morbidities like a chest infection and surgical site infections) were significant in the conventional care group. Conclusion The ERAS protocols are safe and effective in emergency surgeries and result in a better postoperative outcome.

scholarly journals Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

2019 ◽  
Vol 29 (4) ◽  
pp. 651-668 ◽  
Author(s):  
Gregg Nelson ◽  
Jamie Bakkum-Gamez ◽  
Eleftheria Kalogera ◽  
Gretchen Glaser ◽  
Alon Altman ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Gynecologic Oncology ◽  
Evidence Base ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Meta Analyses ◽  
Eras Protocol

BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

scholarly journals Enhanced recovery after bariatric surgery – a modern approach

2014 ◽  
Vol 11 (4) ◽  
pp. 19-24
Author(s):  
Bekkhan Bayalovich Khatsiev ◽  
Aleksandr Nikolaevich Kuzminov ◽  
Yuriy Ivanovich Yashkov ◽  
Nauruz Akhmatovich Uzdenov
Keyword(s):  
Bariatric Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Electrolyte Balance ◽  
Preoperative Preparation ◽  
Level Of Evidence ◽  
Modern Approach ◽  
Number Of Publications ◽  
High Level

Guidelines for enhanced recovery after surgery (ERAS) are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

scholarly journals Pre-habilitation in Enhanced Recovery After Surgery Programs: A New Potential for Balneology and Physical Medicine to Benefit Patients

2019 ◽  
Vol 61 (2) ◽  
pp. 78-80
Author(s):  
David Ferson
Keyword(s):  
Quality Of Care ◽  
21St Century ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Patient ◽  
Physical Medicine ◽  
Long Term Outcomes ◽  
Multidisciplinary Teamwork

Medicine in the 21st century is becoming more integrated and less episodic. The ERAS programs have demonstrated that developing an organized, multidisciplinary teamwork approach to surgical patient care can significantly improve the quality of care and reduce complications. The next step in further improving the ERAS programs and potentially positively influencing the long-term outcomes for the patients is optimal conditioning and preparation before the surgery.

Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)

2018 ◽  
Vol 219 (6) ◽  
pp. 523.e1-523.e15 ◽  
Author(s):  
R. Douglas Wilson ◽  
Aaron B. Caughey ◽  
Stephen L. Wood ◽  
George A. Macones ◽  
Ian J. Wrench ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care
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