scholarly journals Enhanced recovery after surgery in paediatrics: a review of the literature

BJA Education ◽  
2020 ◽  
Vol 20 (7) ◽  
pp. 235-241
Author(s):  
K. Roberts ◽  
M. Brindle ◽  
D. McLuckie
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Review Of The Literature

scholarly journals Enhanced recovery after surgery in pediatric spine surgery: systematic review

2021 ◽  
Vol 18 (4) ◽  
pp. 6-27
Author(s):  
Aleksandr Petrovich Saifullin ◽  
Andrei Evgenievich Bokov ◽  
Alexander Yakovlevich Aleynik ◽  
Yulia Alexandrovna Israelyan ◽  
Sergey Gennadevich Mlyavykh
Keyword(s):  
Systematic Review ◽  
Children And Adolescents ◽  
Spinal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Early Mobilization ◽  
Cochrane Library ◽  
Control Group ◽  
Review Of The Literature

Objective. To conduct a systematic review of the literature on the use of enhanced recovery after surgery (ERAS) protocols in spinalsurgery of children and adolescents to determine the existing evidence of the effectiveness of ERAS implementation in clinical practice.Material and Methods. The authors conducted a systematic review of the literature on ERAS in spinal and spinal cord surgery in children and adolescents selected in the databases of medical literature and search resources of PUBMED/MEDLINE, Google Scholar, Cochrane Library and eLibrary according to the PRISMA guidelines and the PICOS inclusion and exclusion criteria.Results. A total of 12 publications containing information on the treatment of 2,145 children, whose average age was 14.0 years (from 7.2 to 16.1), were analyzed. In the reviewed publications, the average number of key elements of the ERAS program was 9 (from 2 to 20), and a total of 23 elements used in spinal surgery in children and adolescents were identified. The most commonly used elements were preoperative education and counseling, prevention of infectious complications and intestinal obstruction, multimodal analgesia, refusal of routine use of drains, nasogastric probes and urinary catheters, standardized anesthesia protocol, early mobilization and enteral loading. The introduction of the ERAS protocol into clinical practice allowed to reduce the complication rate in comparison with the control group by 8.2 %(from 2 to 19 %), the volume of blood loss by 230 ml (from 75 to 427 ml), the operation time by 83 minutes (from 23 to 144 minutes), theduration of hospitalization by 1.5 days (from 0.5 to 3 days) and the total cost of treatment by 2258.5 dollars (from 860 to 5280 dollars).The ERAS program was implemented in pediatric clinics in the USA (75 %), France (8 %) and Canada (17 %).Conclusion. The conducted systematic review of the literature allows us to conclude that the technology of enhanced recovery after surgery is a promising technology that improves surgical outcomes and is applicable in pediatric practice. There is a significant shortage of published studies evaluating the implementation of ERAS in pediatric surgical practice in general, and in spinal surgery in particular, which requires further prospective randomized studies to evaluate ERAS in spinal surgery in children and adolescents.

Clinical utility of enhanced recovery after surgery pathways in pediatric spinal deformity surgery: systematic review of the literature

2020 ◽  
pp. 1-14
Author(s):  
Zach Pennington ◽  
Ethan Cottrill ◽  
Daniel Lubelski ◽  
Jeff Ehresman ◽  
Kurt Lehner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Deformity ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Reoperation Rate ◽  
Review Of The Literature ◽  
Patient Controlled Analgesia ◽  
Pain Scores ◽  
Spinal Deformity Surgery ◽  
Quantitative Analyses

OBJECTIVESMore than 7500 children undergo surgery for scoliosis each year, at an estimated annual cost to the health system of $1.1 billion. There is significant interest among patients, parents, providers, and payors in identifying methods for delivering quality outcomes at lower costs. Enhanced recovery after surgery (ERAS) protocols have been suggested as one possible solution. Here the authors conducted a systematic review of the literature describing the clinical and economic benefits of ERAS protocols in pediatric spinal deformity surgery.METHODSThe authors identified all English-language articles on ERAS protocol use in pediatric spinal deformity surgery by using the following databases: PubMed/MEDLINE, Web of Science, Cochrane Reviews, EMBASE, CINAHL, and OVID MEDLINE. Quantitative analyses of comparative articles using random effects were performed for the following clinical outcomes: 1) length of stay (LOS); 2) complication rate; 3) wound infection rate; 4) 30-day readmission rate; 5) reoperation rate; and 6) postoperative pain scores.RESULTSOf 950 articles reviewed, 7 were included in the qualitative analysis and 6 were included in the quantitative analysis. The most frequently cited benefits of ERAS protocols were shorter LOS, earlier urinary catheter removal, and earlier discontinuation of patient-controlled analgesia pumps. Quantitative analyses showed ERAS protocols to be associated with shorter LOS (mean difference −1.12 days; 95% CI −1.51, −0.74; p < 0.001), fewer postoperative complications (OR 0.37; 95% CI 0.20, 0.68; p = 0.001), and lower pain scores on postoperative day (POD) 0 (mean −0.92; 95% CI −1.29, −0.56; p < 0.001) and POD 2 (−0.61; 95% CI −0.75, −0.47; p < 0.001). There were no differences in reoperation rate or POD 1 pain scores. ERAS-treated patients had a trend toward higher 30-day readmission rates and earlier discontinuation of patient-controlled analgesia (both p = 0.06). Insufficient data existed to reach a conclusion about cost differences.CONCLUSIONSThe results of this systematic review suggest that ERAS protocols may shorten hospitalizations, reduce postoperative complication rates, and reduce postoperative pain scores in children undergoing scoliosis surgery. Publication biases exist, and therefore larger, prospective, multicenter data are needed to validate these results.

scholarly journals Enhanced recovery after spine surgery: review of the literature

2019 ◽  
Vol 46 (4) ◽  
pp. E2 ◽  
Author(s):  
Marco V. Corniola ◽  
Bertrand Debono ◽  
Holger Joswig ◽  
Jean-Michel Lemée ◽  
Enrico Tessitore
Keyword(s):  
Functional Outcome ◽  
Spine Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Standards Of Care ◽  
Review Of The Literature ◽  
Risks And Benefits ◽  
Care Approach ◽  
High Standards

The concept of Enhanced Recovery After Surgery (ERAS) entails recovery facilitation of patients who undergo surgery through the implementation of a multidisciplinary and multimodal perioperative care approach. By its application, ERAS improves the overall functional outcome after surgery while maintaining high standards of care. A review of the essential aspects of ERAS in spine surgery was undertaken. Special consideration was given to the risks and benefits for patients and caregivers, as well as the medical and economical aspects of this concept.

Psychological influences on wound healing

2019 ◽  
Vol 98 (8) ◽  
pp. 312-314
Keyword(s):  
Wound Healing ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
State Of Mind ◽  
Life Threatening ◽  
Psychological Influences ◽  
Fear And Anxiety ◽  
Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

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