Systematic review of enhanced recovery protocols for elective caesarean section versus conventional care

2019 ◽  
Vol 59 (6) ◽  
pp. 767-776 ◽  
Author(s):  
Sajidah Ilyas ◽  
Scott Simmons ◽  
Sohail Bampoe
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Enhanced Recovery ◽  
Elective Caesarean Section ◽  
Conventional Care ◽  
Section Versus ◽  
Recovery Protocols

Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
pp. 000313482095484
Author(s):  
Andrés Zorrilla-Vaca ◽  
Gabriel E. Mena ◽  
Juan Cata ◽  
Ryan Healy ◽  
Michael C. Grant
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Observational Studies ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Conventional Care ◽  
Recovery Programs ◽  
Enhanced Recovery Programs ◽  
Postoperative Aki

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.

scholarly journals A systematic review of enhanced recovery protocols in colorectal surgery

2011 ◽  
Vol 93 (8) ◽  
pp. 583-588 ◽  
Author(s):  
A Rawlinson ◽  
P Kang ◽  
J Evans ◽  
A Khanna
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Hospital Readmissions ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Hand Search ◽  
Recovery Protocols ◽  
Randomised Controlled

INTRODUCTION Colorectal surgery has been associated with a complication rate of 15–20% and mean postoperative inpatient stays of 6–11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise perioperative care and facilitate discharge. The purpose of this systematic review is to present an updated review of perioperative care in colorectal surgery from the available evidence and ERAS group recommendations. METHODS Systematic searches of the PubMed and Embase™ databases and the Cochrane library were conducted. A hand search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy. RESULTS A total of 59 relevant studies were identified. These included six randomised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria. These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates. CONCLUSIONS Reviewing the data reveals that ERAS protocols have a role in reducing postoperative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for perioperative care in colorectal surgery.

Active warming after caesarean section to prevent neonatal hypothermia: a systematic review

2020 ◽  
Vol 28 (12) ◽  
pp. 829-837
Author(s):  
Aliona Vilinsky-Redmond ◽  
Maria Brenner ◽  
Linda Nugent ◽  
Margaret McCann
Keyword(s):  
Systematic Review ◽  
Caesarean Section ◽  
Elective Caesarean Section ◽  
Evidence Base ◽  
Current Evidence ◽  
Skin Contact ◽  
Current Evidence Base ◽  
Randomised Controlled ◽  
Skin To Skin ◽  
Neonatal Hypothermia

There is a lack of evidence on the effects of perioperative warming on maternal and neonatal outcomes in women undergoing elective caesarean section who are performing at-birth skin-to-skin contact. This study aimed to provide a systematic review of the current evidence base on the effects of perioperative warming versus no warming. Inclusion criteria included randomised controlled trials involving pregnant women ≥18 years old undergoing an elective caesarean section at term under regional anaesthesia and who initiated at-birth neonatal skin-to-skin contact. Studies investigated active warming versus no active warming interventions. Three studies were included, with a total of 286 participants. Active warming of women resulted in significantly less occurrence of neonatal hypothermia, with no difference in maternal hypothermia. Perioperative active warming of mothers and newborns who had skin-to-skin contact may be beneficial. The quality of the included studies was low, so the review findings should be interpreted with caution. High quality studies with larger sample sizes need to be undertaken.

scholarly journals Enhanced recovery pathway for elective caesarean section

2016 ◽  
Vol 27 ◽  
pp. 94-95 ◽  
Author(s):  
E. Coates ◽  
G. Fuller ◽  
D. Hind ◽  
I.J. Wrench ◽  
M.J. Wilson ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Enhanced Recovery ◽  
Elective Caesarean Section ◽  
Enhanced Recovery Pathway
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