scholarly journals Effect of enhanced recovery after surgery program on patient-reported outcomes and function recovery in patients undergoing liver resection for hepatocellular carcinoma

Medicine ◽  
2020 ◽  
Vol 99 (20) ◽  
pp. e20062 ◽  
Author(s):  
Qiu Ping Ren ◽  
Yan-Li Luo ◽  
Feng Ming Xiao ◽  
Tian-Fu Wen ◽  
Meng-Hang Wu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Function Recovery ◽  
Patient Reported ◽  
And Function

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 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 Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes

2018 ◽  
Vol 132 (2) ◽  
pp. 281-290 ◽  
Author(s):  
Larissa A. Meyer ◽  
Javier Lasala ◽  
Maria D. Iniesta ◽  
Alpa M. Nick ◽  
Mark F. Munsell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Opioid Use ◽  
Patient Reported

Enhanced Recovery Experience After Orthopaedic Surgery: A Systematic Review of Patient-Reported Outcomes

2019 ◽  
pp. 108-112
Author(s):  
Muath Alturkistani ◽  
Ali Alahmari ◽  
Hussam Alhumaidi ◽  
Mohammed Alharbi ◽  
Alhanouf Alqernas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Orthopaedic Surgery ◽  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Patient Reported

scholarly journals Within-subjects Effects of Standardized Prosthetic Socket Modifications on Physical Function and Patient-Reported Outcomes

2021 ◽  
Author(s):  
William Anderst ◽  
Goeran Fiedler ◽  
Kentaro Onishi ◽  
Gina McKernan ◽  
Tom Gale ◽  
...  
Keyword(s):  
Physical Function ◽  
Patient Reported Outcomes ◽  
Design Method ◽  
Pressure Sensors ◽  
Residual Limb ◽  
Prosthetic Socket ◽  
Large Patient ◽  
Increased Risk ◽  
Patient Reported ◽  
And Function

Abstract • Background: Among the challenges of living with lower limb loss is the increased risk of long-term health problems that can be either attributed directly to the amputation surgery and/or prosthetic rehabilitation or indirectly to a disability-induced sedentary lifestyle. These problems are exacerbated by poorly fit prosthetic sockets. There is a knowledge gap regarding how the socket design affects in-socket mechanics, and how in-socket mechanics affect patient-reported comfort and function. The objectives of this study are: 1) to gain a better understanding of how in-socket mechanics of the residual limb in transfemoral amputees are related to patient-reported comfort and function, 2) to identify clinical tests that can streamline the socket design process, and 3) to evaluate the efficacy and cost of a novel, quantitatively informed socket optimization process.• Methods: Users of transfemoral prostheses will be asked to walk on a treadmill wearing their current socket plus 8 different check sockets with designed changes in different structural measurements that are likely to induce changes in residual limb motion, skin strain, and pressure distribution within the socket. Dynamic biplane radiography and pressure sensors will be used to measure in-socket residual limb mechanics. Patient-reported outcomes will also be collected after wearing each socket. The effects of in-socket mechanics on both physical function and patient-reported outcomes (aim 1) will be assessed using a generalized linear model. Partial correlation analysis will be used to examine the association between research grade measurements and readily available clinical measurements (aim 2). In order to compare the new quantitative design method to the Standard of Care, patient reported outcomes and cost will be compared between the two methods, utilizing the Wilcoxon Mann-Whitney non-parametric test (aim 3).• Discussion: Knowledge on how prosthetic socket modifications affect residual bone and skin biomechanics itself can be applied to devise future socket designs, and the methodology can be used to investigate and improve such designs, past and present. Apart from saving time and costs, this may result in better prosthetic socket fit for a large patient population, thus increasing their mobility, participation, and overall health-related quality of life. • Trial registration: clinicaltrials.gov: NCT05041998

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