Infection prevention and enhanced recovery after surgery: A partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections

Abstract Background: Intertrochanteric fracture (ITF) is increasing with the rapid increase in the aging population, often causes a high mortality rate in old patients and increases the economic burden of the family and society. ERAS (Enhanced Recovery after Surgery) is a powerful guarantee for patients to accelerate their recovery after surgery. TCM (traditional Chinese medicine) promote repair of injured tissues and eliminate traumatic aseptic inflammation. Therefore, this prospective randomized controlled clinical trial aims to evaluate the clinical effect of the evidence-based ERAS pathway of integrating TCM with and western medicine on perioperative outcomes in ITF patients undergoing intramedullary fixation, and provide reliable evidence-based data for applying the program to clinical practice. Methods/design: We will conduct a prospective randomized, blinded, controlled trial to compare the effectiveness of ERAS care pathway with traditional care pathway, and to investigate whether the ERAS care pathway can improve the perioperative outcome in ITF patients undergoing intramedullary fixation. A total of 60 patients with ITF will be enrolled and treated with the two care pathway, respectively. Length of stay, economic indicators, Harris score, VAS score, time get out of bed, 30-day readmission rates, postoperative transfusion rates, discharge to home and mortality will be evaluated. Any signs of acute adverse reactions will be recorded at each visit during treatment. Discussion: Although an evidence-based process using the best available literature and Delphi expert-opinion method has been used to establish an ERAS pathway of integrating TCM with western medicine. But, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of ERAS pathway Trial registration: Registered on 12 Oct 2019; Trial number is ChiCTR190t0026487 Keywords: intertrochanteric fracture; enhanced recovery after surgery; perioperative period; integrating TCM with and western medicine; randomized controlled trial

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Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101294 ◽

2020 ◽

Vol 45 (8) ◽

pp. 656-659

Author(s):

Shilen Thakrar ◽

Josh Lee ◽

Caitlin E Martin ◽

John Butterworth IV

Keyword(s):

Patient Outcomes ◽

Perioperative Management ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Local Level ◽

Evidence Based ◽

National Guidelines ◽

Evidence Based Guidelines ◽

One Act ◽

Patient Centric

We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

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Perioperative Care Implementation: Evidence-Based Practice for Patients With Pancreaticoduodenectomy Using the Enhanced Recovery After Surgery Guidelines

10.1188/17.cjon.466-472 ◽

2017 ◽

Keyword(s):

Perioperative Care ◽

Evidence Based Practice ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Evidence Based

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Enhanced recovery after surgery (ERAS) in clinical practice

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i3.1287 ◽

2020 ◽

Vol 24 (3) ◽

Author(s):

Robert Leger ◽

Jon Livelsberger ◽

Ashish Sinha

Keyword(s):

Clinical Practice ◽

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Evidence Based ◽

Wide Spread ◽

Postsurgical Complications ◽

Protocol Compliance ◽

Care Practices ◽

Multidisciplinary System

‘Enhanced Recovery After Surgery’ (ERAS) protocols are an evidence-based, multidisciplinary system for patient care that— since its emergence in 2001— has shown remarkable efficacy in reducing surgical complications, shortening length of stay (LoS), and the incidence of hospital re-admission. Unfortunately, wide spread acceptance of ERAS has been slow, as it conflicts with some traditional perioperative care practices. However, with protocol compliance >70%, studies have shown significant reduction in mortality and postsurgical complications, with 30-50% reduction in LoS and approximately a 50% reduction in complications.

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An evidence-based review of enhanced recovery after surgery in total knee replacement surgery

Journal of Perioperative Practice ◽

10.1177/1750458918791121 ◽

2018 ◽

Vol 29 (9) ◽

pp. 281-290 ◽

Cited By ~ 1

Author(s):

Arijit Ghosh ◽

Urjit Chatterji

Keyword(s):

Knee Arthroplasty ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Evidence Base ◽

Evidence Based ◽

Replacement Surgery ◽

Cochrane Database ◽

Total Knee ◽

Study Methodology ◽

Insight Into

Rationale: Enhanced recovery after surgery is gaining popularity among orthopaedic surgeons across the globe and hence a strong evidence base had to be reviewed to make an evidence-based sustainable protocol. Methods The following databases, PubMed, OVID, Cochrane database and EMBASE were searched. The search was limited to 15 components of enhanced recovery after surgery programme which is divided into preoperative, intraoperative and postoperative phases. Inclusion criteria were restricted to articles published in English within the last 15 years and articles comprising of unicompartmental arthroplasty, revision knee arthroplasty, bilateral simultaneous knee arthroplasty and only hip arthroplasty excluded. The full texts were analysed and controversies and limitations of various studies were summarised. Discussion Each component of the programme was thoroughly reviewed and strength and weaknesses of the evidence base summarised. The strength of the evidence was assessed by critically appraising the study methodology and justifying the appropriateness of the inclusion in enhanced recovery after surgery protocol. Conclusion Enhanced recovery after surgery has already been used successfully in various surgical specialities. Enhanced recovery after surgery programmes in knee arthroplasty are yet to be established as a universal practice to be adopted globally. This evidence-based review provides an insight into the best evidence linked to each component and their rationale for inclusion in the proposed enhanced recovery after surgery protocol.

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Protocolo ERAS® en cirugía colorrectal

Revista Argentina de Cirugía ◽

10.25132/raac.v113.n2.eras04wm.ei ◽

2021 ◽

Vol 113 (2) ◽

pp. 176-188

Author(s):

William Maclean ◽

◽

Paul Mackenzie ◽

Chris Limb ◽

Timothy Rockall

Keyword(s):

Colorectal Surgery ◽

Stress Reduction ◽

Multidisciplinary Approach ◽

Physiological Stress ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Surgical Care ◽

Evidence Based ◽

High Quality ◽

High Quality Research

Enhanced Recovery After Surgery (ERAS®) in colorectal surgery is a protocol that promotes quicker return to function. It follows the latest evidence-based research to promote stress reduction related to surgery. The recommended perioperative pathway is fine-tuned, dynamic and in line with the latest evidence-based research to enhance all aspects of the patient’s surgical care. We describe the four aspects for a patient undergoing colorectal surgery – pre-admission, pre-operative, intra-operative and post-operative. The running theme is to reduce overall physiological stress related to surgery and interventions overlap throughout the patient’s pathway. Using a multidisciplinary approach, adherence to ERAS® in colorectal surgery with ≥70 % compliance to the ERAS interventions has shown a risk reduction of 5-year cancer-related death by 42%. The optimum interventions are not only determined through the publication of high-quality research, but regular international collaboration enables experience and research to be shared and care standardised

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PREVENTING SURGICAL SITE INFECTIONS VERSUS ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL

Forum Zakażeń ◽

10.15374/fz2015029 ◽

2015 ◽

Vol 6 (3) ◽

pp. 165-170

Author(s):

Elżbieta Walewska ◽

Lucyna Ścisło ◽

Stanisław Kłęk ◽

Antoni M. Szczepanik

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Surgical Site Infections ◽

Eras Protocol

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Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

World Journal of Surgery ◽

10.1007/s00268-021-06394-9 ◽

2022 ◽

Author(s):

Erik Stenberg ◽

Luiz Fernando dos Reis Falcão ◽

Mary O’Kane ◽

Ronald Liem ◽

Dimitri J. Pournaras ◽

...

Keyword(s):

Bariatric Surgery ◽

Perioperative Care ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Evidence Based ◽

Evidence Based Practices ◽

Assessment Development ◽

Meta Analyses ◽

Large Prospective Cohort

Abstract Background This is the second updated Enhanced Recovery After Surgery (ERAS®) Society guideline, presenting a consensus for optimal perioperative care in bariatric surgery and providing recommendations for each ERAS item within the ERAS® protocol. Methods A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations. Results The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries. Conclusion A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

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Enhanced Recovery After Surgery (ERAS) Protocol for Gastrectomy: A Tailored Program Developed at a Gastric Cancer Unit

Journal of Gastric Surgery ◽

10.36159/jgs.v2i1.21 ◽

2020 ◽

Vol 2 (1) ◽

pp. 12-17

Author(s):

Jacopo Desiderio ◽

Stefano Trastulli ◽

Antonio Di Cintio ◽

Rita Commissari ◽

Andrea Colasanti ◽

...

Keyword(s):

Gastric Cancer ◽

Care Management ◽

Enhanced Recovery ◽

Patient Adherence ◽

Enhanced Recovery After Surgery ◽

Surgical Oncology ◽

Evidence Based ◽

Care Environment ◽

Comprehensive Management ◽

Eras Protocol

Background Planning for and managing patients who follow multidisciplinary paths allow institutions to provide better care administration; greater collaboration among medical staff, patients, and their relatives; better patients education; reduced possible complications related to surgery and hospital stay; and increased patient adherence to the proposed treatments due to better information. The ERAS Society’s guidelines align in this direction, and many institutions are now looking to apply the suggestions contained in its items. This effort is especially important in surgical oncology. In this work, we report the experience of our center in developing tailored guidelines for patients undergoing gastrectomy based on evidence from the literature and adapted to address the availability of personnel and equipment in our institute. Methods A permanent institutional working group was established at St. Mary’s Hospital. Evidence‐based comprehensive research was conducted to find optimal perioperative care management for patients undergoing gastrectomy. Evidence and recommendations were thoroughly evaluated and considered together with the items from the ERAS Society’s guidelines. Results A complete patient pathway has been established from the first outpatient visit to discharge. All ERAS items were considered and adapted to our hospital’s care environment. Education, nutrition, anesthesiologist care, surgical approach, and ward organization are the main points of strength highlighted in the present work. Conclusion This proposed institutional evidence‐based protocol show comprehensive management for patients with gastric cancer eligible for enhanced surgical pathways.

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