The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for the management of peritoneal carcinomatosis, but is associated with significant morbidity and prolonged hospital stay. Herein, we review the impact of Enhanced recovery after surgery (ERAS) protocol on length of stay (LOS) and early complications in patients undergoing CRS and HIPEC for peritoneal carcinomatosis.Methods: PubMed and Embase were searched for studies comparing ERAS protocol with control for CRS + HIPEC. Mean difference (MD) and risk ratios (RR) were calculated for LOS and complications respectively.Results: Six retrospective studies were included. Meta-analysis indicated statistically significant reduction in LOS with ERAS (MD: −2.82 95% CI: −3.79, −1.85 I2 = 29% p < 0.00001). Our results demonstrated significantly reduced risk of Calvien Dindo grade III/IV complications with the use of ERAS protocol as compared to the control group (RR: 0.60 95% CI: 0.41, 0.87 I2 = 0% p = 0.007). Pooled analysis of limited studies demonstrated no statistically significant difference in the risk of reoperation (RR: 1.04 95% CI: 0.54, 2.03 I2 = 50% p = 0.90) readmission (RR: 0.55 95% CI: 0.21, 1.49 I2 = 0% p = 0.24), acute kidney injury (RR: 0.55 95% CI: 0.28, 1.10 I2 = 0% p = 0.09) or mortality (RR: 0.62 95% CI: 0.17, 2.26 I2 = 0% p = 0.46) between the study groups.Conclusion: For CRS + HIPEC, ERAS is associated with significantly reduced LOS along with lower incidence of complications. Limited data suggest that use of ERAS protocol is not associated with increased readmission, reoperation, and mortality rates in these patients. There is a need for randomized controlled trials to corroborate the current evidence.

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Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed

The American Surgeon ◽

10.1177/0003134820943545 ◽

2020 ◽

Vol 86 (9) ◽

pp. 1078-1082

Author(s):

Miles Landry ◽

Rachel Lewis ◽

Andrew Antill ◽

R. Eric Heidel ◽

Jessica Taylor ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Cost Of Care ◽

Longitudinal Impact ◽

Anatomic Site ◽

Elective Colorectal Surgery ◽

Before And After ◽

Eras Protocol ◽

The Impact ◽

Over Time

Background Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. Methods A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. Results A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days ( P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. Conclusion After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

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Key components of enhanced recovery after surgery protocol in lung cancer surgery

Research n Practical Medicine Journal ◽

10.17709/2410-1893-2021-8-3-7 ◽

2021 ◽

Vol 8 (3) ◽

pp. 70-83

Author(s):

A. K. Каchur ◽

V. K. Lyadov

Keyword(s):

Lung Cancer ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Lung Cancer Surgery ◽

Postoperative Mortality ◽

Early Mobilization ◽

Cancer Surgery ◽

Thoracoscopic Approach ◽

Thoracic Cancer ◽

Eras Protocol

Due to the high lung cancer morbidity and the need for surgical intervention in that patient population, introduction of the concept of standard protocol for enhanced recovery after surgery (ERAS) may lead to a significant decrease of the rate of postoperative complications and hospital stay. The aim of the review was to assess the main components of ERAS protocol in thoracic cancer surgery using video-assisted thoracoscopic interventions (VATS). Systematic implementation of specific measures in pre- (patient consulting before the intervention, compliance with fluid and nutrition regimen, exclusion of routine sedation, prophylaxis of venous thrombosis, use of intravenous antibiotics and alcohol skin-prepping solution with chlorohexidine), intra- (prevention of hypothermia, thoracoscopic approach, single-tube approach in anatomic lung resections, exclusion of pleural tube insertion, urethral catheterization for less than 2 hours and only in case of epidural anesthesia) and postoperative (early mobilization and cessation of intravenous infusion, pain control using combination of acetaminophen with NSAIDs, maintenance of normovolemy, use of balanced crystalloid solutions and non-pharmacological measures for nausea and vomiting control) periods promote improved outcomes, decrease of postoperative complication rate and postoperative mortality

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A prospective study evaluating the impact of implementing the ERAS protocol on patients undergoing surgery for advanced ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000043 ◽

2019 ◽

Vol 29 (3) ◽

pp. 605-612 ◽

Cited By ~ 5

Author(s):

Reshu Agarwal ◽

Anupama Rajanbabu ◽

Nitu P V ◽

Gaurav Goel ◽

Lipi Madhusudanan ◽

...

Keyword(s):

Ovarian Cancer ◽

Hospital Stay ◽

Readmission Rate ◽

Enhanced Recovery ◽

Advanced Ovarian Cancer ◽

University Teaching ◽

Protocol Compliance ◽

Operative Recovery ◽

Eras Protocol ◽

The Impact

ObjectiveInformation on the benefits of enhanced recovery after surgery (ERAS) when applied to advanced ovarian cancer() is minimal. The study objectives were to prospectively evaluate whether the implementation of ERAS in AOC patients improves post-operative recovery, and reduces the length of hospital stay (LOHS), without increasing the readmission rate or surgery-related complications; and to investigate ERAS protocol compliance.MethodsThis was a prospective interventional study carried out at a single university teaching hospital. Patients undergoing laparotomy for advanced ovarian cancer (stages IIb–IV) from March 2017 to February 2018 were managed using an ERAS protocol. The conventional management (CM) period extended from January 2016 to December 2016. The primary outcome was reduction in LOHS. Secondary outcomes were ERAS protocol compliance, incidence of post-operative complications, and readmission rate.ResultsThe CM and ERAS groups each comprised 45 patients. Both the groups were comparable in terms of clinicopathological and operative characteristic. Median LOHS of the full cohort, primary debulking cohort, interval debulking cohort, staging surgery cohort (all 6 vs 4 days; p<0.001), and complex cytoreductive surgery cohort (5 vs 4 days; p=0.019) were significantly reduced in the ERAS group. The overall compliance for the ERAS protocol was 90.6%. Occurrence of moderate or severe (17.8% vs 0%; p=0.003) and ≥grade 2 extended Clavein-Dindo complications (22.2% vs 0%; p=0.001); and hospital stay due to occurrence of complications (31.1% vs 2.2%; p<0.001) were also significantly reduced in the ERAS group. There was no difference in the 30-day readmission rates.ConclusionThe results from our investigation suggest that the ERAS program can be successfully implemented in advanced ovarian cancer patients even in low-resource settings provided the program is modified to meet local needs so as not to increase healthcare costs.

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Safe and effective protocol for discharge 3 days after cardiac surgery

Scientific Reports ◽

10.1038/s41598-021-88582-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Omar Asdrúbal Vilca Mejia ◽

Gabrielle Barbosa Borgomoni ◽

Nilza Lasta ◽

Mariana Yumi Okada ◽

Mariana Silva Biason Gomes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Latin American ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Postoperative Stay ◽

Eras Protocol ◽

The Impact

AbstractThe Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the “TotalCor protocol”. After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.

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The impact of Enhanced Recovery after Surgery (ERAS) pathways with regard to perioperative outcome in patients with ovarian cancer

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06339-6 ◽

2021 ◽

Author(s):

Susanne Reuter ◽

Linn Woelber ◽

Constantin C. Trepte ◽

Daniel Perez ◽

Antonia Zapf ◽

...

Keyword(s):

Ovarian Cancer ◽

Postoperative Complications ◽

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Oncology ◽

Long Term Outcome ◽

Surgical Data ◽

Eras Protocol ◽

The Impact

Abstract Purpose Major surgery for ovarian cancer is associated with significant morbidity. Recently, guidelines for perioperative care in gynecologic oncology with a structured “Enhanced Recovery after Surgery (ERAS)” program were presented. Our aim was to evaluate if implementation of ERAS reduces postoperative complications in patients undergoing extensive cytoreductive surgery for ovarian cancer. Methods 134 patients with ovarian cancer (FIGO I-IV) were included. 47 patients were prospectively studied after implementation of a mandatory ERAS protocol (ERAS group) and compared to 87 patients that were treated before implementation (pre-ERAS group). Primary endpoints of this study were the effects of the ERAS protocol on postoperative complications and length of stay in hospital. Results Preoperative and surgical data were comparable in both groups. Only the POSSUM score was higher in the ERAS group (11.8% vs. 9.3%, p < 0.001), indicating a higher surgical risk in the ERAS group. Total number of postoperative complications (ERAS: 29.8% vs. pre-ERAS: 52.8%, p = 0.011), and length of hospital stay (ERAS: 11 (6–23) vs pre-ERAS: 13 (6–50) days; p < 0.001) differed significantly. A lower fraction of patients of the ERAS group (87.2%) needed postoperative admission to the ICU compared to the pre-ERAS group (97.7%), p = 0.022). Mortality within the ERAS group was 0% vs. 3.4% (p = 0.552) in the pre-ERAS group. Conclusion The implementation of a mandatory ERAS protocol was associated with a lower rate of postoperative complications and a reduced length of stay in hospital. If ERAS has influence on long-term outcome needs to be further evaluated.

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The impact of compliance with Enhanced Recovery After Surgery (ERAS) protocol on short and long-term outcomes in patients after laparoscopic colorectal cancer surgery

Postępy Polskiej Medycyny i Farmacji ◽

10.5604/01.3001.0014.9195 ◽

2021 ◽

Vol 8 ◽

pp. 31-35

Author(s):

Magdalena Pisarska-Adamczyk

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Long Term Results ◽

Surgical Trauma ◽

Short Term ◽

Eras Protocol ◽

The Impact

Patients undergoing surgery for colorectal cancer are a special group of patients. Not only performed resections are extensive, but also the underlying disease significantly depletes regenerative capacities of the body. It is well known that every surgical procedure is associated with an injury, the size of which is proportional to the type and extent of the intervention. The size of surgical trauma in postoperative period is proportional to the increase in insulin resistance which delays convalescence and increases the risk of postoperative complications. Hence, for several years, a specific program had been developed and introduced to reduce trauma associated with the surgery and its adverse consequences. The use of a modern multimodal care protocol for Enhanced Recovery After Surgery(ERAS) served this purpose. The aim of the study was to determine the impact of compliance to ERAS protocol on short-term results in a group of patients operated for colorectal cancer. In the next stage, it was checked whether it is possible to maintain high compliance of the protocol for a long time. Finally, I tried to determine the relationship between the compliance and distant oncological results. Consecutive patients with colon or rectal cancer undergoing laparoscopic resection were included in the study. In all patients the 16-item ERAS protocol was applied. The use of ERAS protocol improves short-term results: accelerates convalescence, reduces morbidity and reduces the length of hospital stay. However, its impact on short-term results correlates with the level of protocol implementation. The higher compliance with the protocol, the better the short-term results. Maintaining a high level of implementation of the protocol is possible despite the slight decrease over time. However, this has no adverse effect on short-term results. The compliance with ERAS protocol seems to also affect long-term results. Low compliance with ERAS protocol, along with the higher stage of cancer and postoperative complications, is an independent factor worsening long-term survival.

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46 The impact of an enhanced recovery after surgery (ERAS) protocol in patients undergoing abdominal hysterectomies in a teaching hospital

10.1136/ijgc-2019-igcs.46 ◽

2019 ◽

Author(s):

V Alvarenga Bezerra ◽

G Marçal Rios ◽

AC Seixas Mengai ◽

C Amaral Tavares Daltro ◽

S Podgaec ◽

...

Keyword(s):

Teaching Hospital ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Eras Protocol ◽

The Impact

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