The impact of an enhanced recovery after surgery (ERAS) program on opioid use reduction in patients undergoing minimally invasive hysterectomy (MIH) in gynecology oncology

2019 ◽  
Vol 154 ◽  
pp. 159
Author(s):  
E. Weston ◽  
M. Noel ◽  
K. Douglas ◽  
K. Terrones ◽  
F. Grumbine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Use ◽  
Gynecology Oncology ◽  
The Impact ◽  
Minimally Invasive Hysterectomy

scholarly journals Enhanced recovery after surgery (ERAS) pathway optimizes outcomes and costs for minimally invasive radical prostatectomy

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092007
Author(s):  
Ying Xu ◽  
Ao Liu ◽  
Lu Chen ◽  
Hai Huang ◽  
Yi Gao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multivariable Analysis ◽  
Conventional Care ◽  
Conventional Group ◽  
Hospitalization Costs ◽  
The Impact

Objective To evaluate the impact of an enhanced recovery after surgery (ERAS) pathway on patients undergoing minimally invasive radical prostatectomy at a single institute. Methods In this retrospective study, 301 patients who underwent laparoscopic or robot-assisted laparoscopic radical prostatectomy from May 2014 to September 2018 were consecutively recruited. Before April 2017, the patients were treated with conventional care; all patients were treated with the ERAS pathway thereafter. The primary outcome was the postoperative length of hospital stay (LOS). The secondary outcomes were hospitalization costs and postoperative complications. Results In total, 138 patients were treated with the ERAS pathway, and the remaining patients underwent conventional care. The postoperative LOS was significantly shorter in the ERAS group than in the conventional group (median, 6 vs. 8 days). The hospitalization costs were also significantly lower in the ERAS group ($4086 vs. $5530). Ten (6.1%) patients in the ERAS group and 17 (12.3%) patients in the conventional group developed postoperative complications. The multivariable analysis showed that ERAS care was a significant independent predictive factor for a shortened LOS and reduced hospitalization costs. Conclusions The ERAS pathway was associated with a shortened LOS and reduced hospitalization costs for patients undergoing minimally invasive radical prostatectomy.

Implementation of an Enhanced Recovery after Surgery Pathway to Reduce Inpatient Opioid Consumption after Cesarean Delivery

2021 ◽  
Author(s):  
Jared L. Tepper ◽  
Olivia M. Harris ◽  
Jourdan E. Triebwasser ◽  
Stephanie H. Ewing ◽  
Aasta D. Mehta ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cesarean Delivery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Consumption ◽  
Quality Improvement Initiative ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Opioid Prescription ◽  
The Impact

Objective Opioid prescription after cesarean delivery is excessive and can lead to chronic opioid use disorder. We assessed the impact of an enhanced recovery after surgery (ERAS) pathway on inpatient opioid consumption after cesarean delivery. Study Design An ERAS pathway was implemented as a quality improvement initiative in December 2019. Preintervention (PRE) data were collected from March to May 2019 to assess baseline opioid consumption. Postintervention (POST) data were collected from January to March 2020. The primary outcome was inpatient postoperative opioid consumption in morphine milligram equivalents (MME). Secondary outcomes included the consumption of any opioids, postpartum length of stay, and opioid prescription at discharge. Results A total of 92 women were in the PRE group and 91 were in the POST group. Inpatient opioid consumption decreased by 87.3% from PRE to POST, from 124.7 (interquartile range [IQR]: 10–181.6) MME to 15.8 (IQR: 0–75) MME (p < 0.001). There was no difference in median postpartum length of stay (3.4 days PRE vs. 3.3 days POST; p = 0.12). The proportion of women who did not consume any opioids increased by 75.4% from PRE to POST (p = 0.02). The proportion of women discharged with an opioid prescription decreased by 25.6% from PRE to POST (p = 0.007), despite no formal change to prescribing practices. After adjustment for differences in race/ethnicity and gravidity, there was still a reduction in total inpatient opioid consumption (p < 0.001) and an increase in the proportion of women not consuming any opioids (adjusted relative risk (RR): 2.14, 95% confidence interval [CI]: 1.18–3.87), but the difference in rate of prescription of opioids at discharge was no longer statistically significant (adjusted RR: 0.70, 95% CI: 0.48–1.02). Conclusion Adoption of an ERAS pathway for cesarean delivery resulted in a marked reduction in inpatient opioid consumption. Such a pathway can be implemented across institutions and may be a powerful tool in combating the opioid epidemic. Key Points

The Enhanced Recovery After Surgery (ERAS) Elements that Most Greatly Impact Length of Stay and Readmission

2020 ◽  
pp. 000313482095144
Author(s):  
Kristofor A. Olson ◽  
R. Y. Declan Fleming ◽  
April W. Fox ◽  
Andrew E. Grimes ◽  
S. Sameer Mohiuddin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Pain Control ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Early Mobilization ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Opioid Use ◽  
Multimodal Pain Control

Background Enhanced recovery after surgery (ERAS) protocols have been shown to decrease length of stay (LOS) and improve patient outcomes in a wide variety of surgical fields; however, barriers exist preventing the implementation of all elements. We hypothesize that a subset of ERAS elements are most influential on LOS and readmission following colorectal surgery. Study Design A retrospective review of 840 patients was performed and their compliance with 24 ERAS components evaluated. Two independent machine-learning statistical algorithms were employed to determine which subset of ERAS elements was most impactful on LOS <3 days and hospital readmission. Results Increasing compliance with ERAS elements had an inverse linear relationship with LOS. Open (vs minimally invasive) surgery was associated with increased LOS. Early mobilization and multimodal pain management are the elements most protective against increased LOS. Readmissions increase with the number of morphine milligram equivalents (MME)/day. The subset of patients who underwent minimally invasive procedures, had multimodal pain control, and less than 16 MME per day were least likely (23%) to have >3-day LOS. Those patients who underwent an open procedure with less than 15 ERAS elements completed were most likely (84%) to have >3-day LOS. Conclusion While increasing compliance with ERAS protocols and minimally invasive procedures decrease LOS and readmission overall, a subset of components—multimodal pain control, limited opioid use, and early mobilization—was most associated with decreased LOS and readmission. This study provides guidance on which ERAS elements should be emphasized.

Opioid use in gynecology oncology patients after minimally invasive hysterectomy

2018 ◽  
Vol 149 ◽  
pp. 5
Author(s):  
E. Weston ◽  
C. Raker ◽  
D. Huang ◽  
A.B. Parker ◽  
K.M. Robison ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Opioid Use ◽  
Oncology Patients ◽  
Gynecology Oncology ◽  
Minimally Invasive Hysterectomy

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

2018 ◽  
Vol 155 (4) ◽  
pp. 1843-1852 ◽  
Author(s):  
Luke J. Rogers ◽  
David Bleetman ◽  
David E. Messenger ◽  
Natasha A. Joshi ◽  
Lesley Wood ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Primary Lung Cancer ◽  
Protocol Compliance ◽  
Eras Protocol ◽  
The Impact

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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