P.98 Introduction of a ‘Pain Medication Tracker’ to aid post- discharge analgesia compliance as part of an enhanced recovery after surgery for caesarean section program

2021 ◽  
Vol 46 ◽  
pp. 103096
Author(s):  
G. Gormley ◽  
S. Ilyas
Keyword(s):  
Caesarean Section ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Pain Medication ◽  
Post Discharge

scholarly journals Early Recovery after Caeserean Section What is Possible in Our Setup to Travel the Less Trodden Path: A Review

2021 ◽  
pp. 188-194
Author(s):  
Pratibha Deshmukh ◽  
Priyanka Deshmukh ◽  
Parag Sable ◽  
Vivek Chakole
Keyword(s):  
Caesarean Section ◽  
Colorectal Surgery ◽  
Surgical Procedures ◽  
Consensus Statement ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Developed Countries ◽  
Early Recovery ◽  
Obstetric Anaesthesia

Enhanced recovery after surgery is a concept put forward by Henrik Kehlet in 1997 for colorectal surgery & presented a protocol. Since then, it is adopted for various surgical procedures in many developed countries. Obstetricians & obstetric anaesthesiologists are also following the same line. In 2020 Society for obstetric anaesthesia & perinatology (SOAP) USA published a consensus statement on “early recovery after caesarean section”, presenting the pathways. Is it possible to adopt it fully in our country? Do we need to modify here & there? We are trying to find out the answers.

scholarly journals The impact of the enhanced recovery pathway and other factors on outcomes and costs following hip and knee replacement: routine data study

2020 ◽  
Vol 8 (4) ◽  
pp. 1-188
Author(s):  
Andrew Judge ◽  
Andrew Carr ◽  
Andrew Price ◽  
Cesar Garriga ◽  
Cyrus Cooper ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Knee Replacement ◽  
Natural Experiment ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Post Discharge ◽  
Replacement Surgery ◽  
Patient Reported ◽  
And Function

Background There is limited evidence concerning the effectiveness of enhanced recovery programmes in hip and knee replacement surgery, particularly when applied nationwide across a health-care system. Objectives To determine the effect of hospital organisation, surgical factors and the enhanced recovery after surgery pathway on patient outcomes and NHS costs of hip and knee replacement. Design (1) Statistical analysis of national linked data to explore geographical variations in patient outcomes of surgery. (2) A natural experimental study to determine clinical effectiveness of enhanced recovery after surgery. (3) A qualitative study to identify barriers to, and facilitators of, change. (4) Health economics analysis to establish NHS costs and cost-effectiveness. Setting Data from the National Joint Registry, linked to English Hospital Episode Statistics and patient-reported outcome measures in both the geographical variation and natural experiment studies, together with the economic evaluation. The ethnographic study took place in four hospitals in a region of England. Participants Qualitative study – 38 health professionals working in hip and knee replacement services in secondary care and 37 patients receiving hip or knee replacement. Interventions Natural experiment – implementation of enhanced recovery after surgery at each hospital between 2009 and 2011. Enhanced recovery after surgery is a complex intervention focusing on several areas of patients’ care pathways through surgery: preoperatively (patient is in best possible condition for surgery), perioperatively (patient has best possible management during and after operation) and postoperatively (patient experiences best rehabilitation). Main outcome measures Patient-reported pain and function (Oxford Hip Score/Oxford Knee Score); 6-month complications; length of stay; bed-day costs; and revision surgery within 5 years. Results Geographical study – there are potentially unwarranted variations in patient outcomes of hip and knee replacement surgery. This variation cannot be explained by differences in patients, case mix, surgical or hospital organisational factors. Qualitative – successful implementation depends on empowering patients to work towards their recovery, providing post-discharge support and promoting successful multidisciplinary team working. Care processes were negotiated between patients and health-care professionals. ‘Good care’ remains an aspiration, particularly in the post-discharge period. Natural experiment – length of stay has declined substantially, pain and function have improved, revision rates are in decline and complication rates remain stable. The introduction of a national enhanced recovery after surgery programme maintained improvement, but did not alter the rate of change already under way. Health economics – costs are high in the year of joint replacement and remain higher in the subsequent year after surgery. There is a strong economic incentive to identify ways of reducing revisions and complications following joint replacement. Published cost-effectiveness evidence supports enhanced recovery pathways as a whole. Limitations Short duration of follow-up data prior to enhanced recovery after surgery implementation and missing data, particularly for hospital organisation factors. Conclusion No evidence was found to show that enhanced recovery after surgery had a substantial impact on longer-term downwards trends in costs and length of stay. Trends of improving outcomes were seen across all age groups, in those with and without comorbidity, and had begun prior to the formal enhanced recovery after surgery roll-out. Reductions in length of stay have been achieved without adversely affecting patient outcomes, yet, substantial variation remains in outcomes between hospital trusts. Future work There is still work to be done to reduce and understand unwarranted variations in outcome between individual hospitals. Study registration This study is registered as PROSPERO CRD42017059473. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information.

scholarly journals Comparative study with or without application of enhanced recovery after surgery protocols in patients undergoing elective cesarean section

2020 ◽  
Vol 10 (1) ◽  
pp. 173
Author(s):  
Pammy Pravina ◽  
Khushbu Tewary
Keyword(s):  
Caesarean Section ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Financial Burden ◽  
Elective Caesarean Section ◽  
Elective Cesarean Section ◽  
Control Group ◽  
Operative Care ◽  
Operative Recovery ◽  
Eras Protocol

Background: Concept of enhanced recovery after surgery (ERAS) has been applied in various surgical branches. Evidence regarding the necessary components of ERAS for obstetric population is limited. Therefore, objective of this study was to test the application of ERAS in patients undergoing elective caesarean section on the post-operative recovery process.Methods: The study was conducted in the Department of Obstetrics and Gynecology, NMCH, Patna from January 2014 to December 2014. A total of 100 patients (n=100) undergoing elective caesarean section were included in the study. Cases were allocated into two groups a) Study group included 60 patients (n=60) and ERAS protocol was followed b) Control group included 40 patients (n=40) and standard post-operative care protocol was followed. Two groups were compared with respect to recovery parameters, post-operative complications and satisfaction rates.Results: More patients in the ERAS group were discharged on post-operative day 4 than the standard postoperative care group (90% vs 12.5%, p<0.0001). More patient in the ERAS group were significantly satisfied with the protocol compared to standard post-operative care (77% vs 70%, p<0.04). Approximately 77 percent of the patients in the ERAS group rated the satisfication score between 8-10 compared to 70 percent of the patients in control group (p<0.04). There was no difference between two groups with respect to recatheterization rate, readmission rate and post-discharge complaints.Conclusions: In this study with application of ERAS protocol, we reported reduced hospital stay which may reduce financial burden of patients and healthcare facilities.

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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