Fast-Track-Rehabilitation nach Ösophagektomie

2021 ◽  
Vol 146 (03) ◽  
pp. 306-314
Author(s):  
Wolfgang Schroeder ◽  
Christoph Mallmann ◽  
Benjamin Babic ◽  
Christiane Bruns ◽  
Hans Friedrich Fuchs
Keyword(s):  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gastric Conduit ◽  
Eine Hohe ◽  
Postoperative Morbidität ◽  
Fast Track Rehabilitation

ZusammenfassungDas multimodale und interprofessionelle Konzept der Fast-Track-Rehabilitation (Synonym: „enhanced recovery after surgery“, ERAS) ist bei der transthorakalen Ösophagektomie grundsätzlich umsetzbar, weist aber im Gegensatz zur Fast-Track-Chirurgie anderer onkologischer Prozeduren 2 wesentliche Besonderheiten auf. Aufgrund der hohen Komorbidität der Patienten mit Ösophaguskarzinom ist das Fast-Track-Konzept ein Teilaspekt des perioperativen Managements und von der präoperativen Konditionierung einzelner Organdysfunktionen (Prähabilitation) nicht zu trennen. Da die gastrale Rekonstruktion eine hohe Prävalenz eines „delayed gastric conduit emptying“ (DGCE) bedingt, ist postoperativ ein frühzeitiger und kalorisch adäquater, oraler Kostaufbau nur eingeschränkt durchführbar. Einen allgemein akzeptierten Algorithmus zum postoperativen Ernährungsmanagement und zur Prophylaxe/Therapie des DGCE gibt es gegenwärtig nicht. Die in spezialisierten Zentren bereits niedrige Mortalität wird durch das Fast-Track-Programm nicht beeinflusst. Ob die postoperative Morbidität mit diesem Konzept gesenkt wird, kann durch die gegenwärtige Studienlage nicht abschließend beantwortet werden. Nach modifizierter Fast-Track-Rehabilitation ist eine Entlassung aus der stationären Behandlung ab dem 8. postoperativen Tag bei unkompliziertem Verlauf möglich.

Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections

2017 ◽  
Vol 265 (1) ◽  
pp. 68-79 ◽  
Author(s):  
Michael C. Grant ◽  
Dongjie Yang ◽  
Christopher L. Wu ◽  
Martin A. Makary ◽  
Elizabeth C. Wick
Keyword(s):  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Associated Infections ◽  
Fast Track Surgery ◽  
Healthcare Associated

scholarly journals Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS) Protocol

2021 ◽  
Author(s):  
Gonzalo P. Rodríguez-Laiz ◽  
Paola Melgar-Requena ◽  
Cándido F. Alcázar-López ◽  
Mariano Franco-Campello ◽  
Celia Villodre-Tudela ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Restriction

Abstract Introduction Enhanced recovery after surgery (ERAS) has been shown to facilitate discharge, decrease length of stay, improve outcomes and reduce costs. We used this concept to design a comprehensive fast-track pathway (OR-to-discharge) before starting our liver transplant activity and then applied this protocol prospectively to every patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our first six years results. Patients and methods Prospective cohort study of all the liver transplants performed at our institution for the first six years. Balanced general anesthesia, fluid restriction, thromboelastometry, inferior vena cava preservation and temporary portocaval shunt were strategies common to all cases. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early. Results A total of 240 transplants were performed in 236 patients (191♂/45♀) over 74 months, mean age 56.3±9.6 years, raw MELD score 15.5±7.7. Predominant etiologies were alcohol (n = 136) and HCV (n = 82), with hepatocellular carcinoma present in 129 (54.7%). Nine patients received combined liver and kidney transplants. The mean operating time was 315±64 min with cold ischemia times of 279±88 min. Thirty-one patients (13.1%) were transfused in the OR (2.4±1.2 units of PRBC). Extubation was immediate (< 30 min) in all but four patients. Median ICU length of stay was 12.7 hours, and median post-transplant hospital stay was 4 days (2-76) with 30 patients (13.8%) going home by day 2, 87 (39.9%) by day 3, and 133 (61%) by day 4, defining our fast-track group. Thirty-day-readmission rate (34.9%) was significantly lower (28.6% vs. 44.7% p=0.015) in the fast-track group. Patient survival was 86.8% at 1 year and 78.6% at five years. Conclusion Fast-Tracking of Liver Transplant patients is feasible and can be applied as the standard of care

scholarly journals Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

2021 ◽  
Author(s):  
Wei-Ju Chang ◽  
Justine Naylor ◽  
Victor Liu ◽  
Masiath Monuja ◽  
Sam Adie
Keyword(s):  
Systematic Review ◽  
Hospital Readmission ◽  
Patient Reported Outcomes ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Risk Of Bias ◽  
Total Hip ◽  
Patient Reported ◽  
Meta Analyses

ABSTRACTIntroductionEmerging evidence suggests that fast-track and enhanced recovery after surgery (ERAS) targeting modifiable risk factors reduce complications after total hip (THR) and knee replacement (TKR). However, what constitutes an effective preoperative optimisation protocol for THR and TKR remains unclear. The aims are to: (1) describe pre-operative optimisation protocols for THR and TKR; (2) evaluate the effects of pre-operative optimisation protocols for THR and TKR on morbidity, and patient-reported outcomes.Methods and analysisSystematic review and meta-analysis. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the study eligibility and risks of bias. Two independent reviewers will select the eligible studies and any disagreement will be resolved through a third reviewer. We will include studies investigated pre-operative optimisation protocols administered prior to participants receiving primary THR or TKR to improve post-operative outcomes. Primary outcomes are hospital readmission, complications and patient-reported pain and function. Risk of bias will be assessed using the Cochrane RoB 1 tool and strength of evidence will be examined using the GRADE approach. Pre-operative optimisation protocols will be summarised qualitatively. Meta-analyses on the effects of included protocols will be conducted if appropriate.Ethics and disseminationThis systematic review does not require ethics approval. The findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.RegistrationThis protocol has been submitted to the International Prospective Register of Systematic Reviews on 30 August 2021.ARTICLE SUMMARYStrength and LimitationsThis systematic review aims to describe pre-operative optimisation protocols for total hip and knee replacement and to synthesise evidence for the effects of pre-operative optimisation protocols on hospital readmission, complications and patient-reported outcomes.Two independent reviewers will conduct study selection, data extraction and risk of bias assessment.Meta-analyses, sub-group and sensitivity analyses will be performed where appropriate.

scholarly journals Fast-track surgery and enhanced recovery after surgery concepts after their application in hernia repair

2021 ◽  
Vol 68 (1) ◽  
pp. 10-16
Author(s):  
V.V. Boiko ◽  
◽  
K.Y. Parkhomenko ◽  
O.E. Feskov ◽  
A.Y. Gavrikov ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Postoperative Period ◽  
Efficient Solution ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Preparation ◽  
Fast Track Surgery ◽  
Postoperative Rehabilitation ◽  
Surgical Interventions

The growing number of surgical interventions that occur worldwide, along with the increasing prevalence of general somatic pathology, keeps current the problem of preventing complications during surgery and in the postoperative period. An efficient solution to this problem is to determine the risk of surgery, directed preoperative preparation, taking into account the comorbidity, optimization of surgery and postoperative rehabilitation. Fast-track surgery and enhanced recovery after surgery programs have significant potential for improving outcomes of surgery. These programs are widely used in various fields of surgery, but their effectiveness in herniology, especially in the performing simultaneous surgeries, there are very few reports, and the results of individual studies are contradictory. The review provides an analysis of holistic strategies of fast-track surgery and enhanced recovery and individual measures to assess the effectiveness of their impact on the immediate results of surgical interventions.

scholarly journals IMPLEMENTATION OF FAST-TRACK PROGRAM FOR STOMA REVERSAL PROCEDURES

2020 ◽  
Vol 19 (1) ◽  
pp. 67-72
Author(s):  
V. V. Darvin ◽  
A. Y. Ilkanich ◽  
Yu. S. Voronin
Keyword(s):  
Clinical Practice ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Single Center ◽  
Stoma Reversal ◽  
Enhanced Recovery Protocol ◽  
Eras Protocol

AIM: evaluation of the effectiveness of the enhanced recovery protocol for stoma reversal procedures.PATIENTS AND METHODS: a single-center retrospective analysis of stoma reversal surgery in 130 ostomy patients in 2012-18 was performed. From 2012 to 2015, 56 (43.1%) patients were treated before the implementation of the Enhanced Recovery After Surgery (ERAS) protocol in clinical practice, 74(56.9%) patients were treated in accordance with the principles of fast-track.RESULTS: the introduction into clinical practice of the ERAS protocol reduced postoperative complications from 8.5% to 5.4% (p=0.002) and the hospital stay from 16,3±9,4 to 11,4±4,2 days (p=0.003).CONCLUSION: the fast-track strategy is an effective way to improve the results of stoma reversal procedures.

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