scholarly journals iColon, a patient-focused mobile application for perioperative care in colorectal surgery: an observational, real-world study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e045526
Author(s):  
Elisa Bertocchi ◽  
Giuliano Barugola ◽  
Irene Gentile ◽  
Teresa Zuppini ◽  
Massimo Zamperini ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Real World ◽  
Perioperative Care ◽  
Mobile Application ◽  
Enhanced Recovery ◽  
Care Pathway ◽  
Digital Health ◽  
Health Sector ◽  
Elective Colorectal Surgery ◽  
Eras Protocol

IntroductionThe enhanced recovery after surgery (ERAS) protocol provides optimised care guidelines for patients undergoing elective colorectal surgery. To ensure high compliance with active ERAS elements, patients must be educated to actively participate in the perioperative care pathway. Mobile health is a rapidly expanding area of the digital health sector that is effective in educating and engaging patients during follow-up. iColon is a mobile application designed by the Operative Unit of General Surgery of IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella, which is specifically targeted at patients undergoing elective colorectal surgery. iColon is organised into ERAS phases, and it provides real-time feedback to surgeons about a patient’s adherence to perioperative active ERAS elements.Methods and analysisWe hypothesise that by providing a patient-focused mobile application, compliance with active ERAS elements could be improved.The first coprimary objective is to build patient confidence in using the mobile application, iColon, during perioperative care. The second coprimary objective is to establish patient compliance with active ERAS elements.Secondary objectives include examining: length of stay, 30-day readmission rate, postoperative complications and patient satisfaction of received care.This study is a prospective observational real-world study of patients undergoing elective colorectal surgery who are following the ERAS protocol and using iColon during perioperative periods between September 2020 and December 2022.By educating and engaging patients in the ERAS protocol, the mobile application, iColon, should stimulate patients to be more proactive in managing their healthcare by complying more closely with active ERAS elements.Ethics and disseminationThis study has been approved by the local Ethics Committee with the protocol number 29219 of 25 May 2020. The results will be actively disseminated through peer-reviewed journals, conference presentations and various community engagement activities.

scholarly journals 129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Brennan
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Intravenous Fluid ◽  
Junior Doctors ◽  
Intravenous Fluids ◽  
Elective Colorectal Surgery ◽  
Royal Hospital ◽  
Elective Surgical Procedures ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

scholarly journals Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

2019 ◽  
Vol 29 (4) ◽  
pp. 651-668 ◽  
Author(s):  
Gregg Nelson ◽  
Jamie Bakkum-Gamez ◽  
Eleftheria Kalogera ◽  
Gretchen Glaser ◽  
Alon Altman ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Care Pathway ◽  
Gynecologic Oncology ◽  
Evidence Base ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Meta Analyses ◽  
Eras Protocol

BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

scholarly journals Effectiveness and safety of the enhanced recovery program in colorectal surgery: overview of systematic reviews

2020 ◽  
Author(s):  
Kelly Rocío Chacón Acevedo ◽  
Édgar Cortés Reyes ◽  
Óscar Alexander Guevara Cruz ◽  
Jorge Augusto Díaz Rojas ◽  
Lina María Rincón Martínez
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Systematic Reviews ◽  
Perioperative Care ◽  
Enhanced Recovery ◽  
Hospital Length ◽  
The Body ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Elective Colorectal Surgery

Introduction: Multimodal enhanced recovery programs are a new paradigm in perioperative care. Objective: To evaluate the certainty of evidence pertaining to the effectiveness and safety of the multimodal perioperative care program in elective colorectal surgery. Data source: A search was conducted in the Medline, EMBASE, and Cochrane databases, up until February 2020. Eligibility criteria: Systematic reviews that take into account the perioperative multimodal program in patients with an indication for colorectal surgery were included. The primary outcomes were morbidity and postoperative deaths. The secondary outcome was hospital length of stay. Study quality and synthesis method: The reviews were evaluated with AMSTAR-2 and the certainty of the evidence with the GRADE methodology. The findings are presented with measures of frequency, risk estimators, or differences. Results: Six systematic reviews of clinical trials with medium and high quality in AMSTAR-2 were included. Morbidity was reduced between 16 and 48%. Studies are inconclusive regarding postoperative mortality. Hospital length of stay was reduced by an average of 2.5 days (p <0.05). The certainty of the body of evidence is very low. Limitations: The effect of the program, depending on the combination of elements, is not clear. Conclusions and implications: Despite the proven evidence that the program is effective in reducing global postoperative morbidity and hospital stay, the body of evidence is of very low quality. Consequently, results may change with new evidence and further research is required.

Successful Implementation of Enhanced Recovery in Elective Colorectal Surgery is Variable and Dependent on the Local Environment

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Chelsea P. Fischer ◽  
Leandra Knapp ◽  
Mark E. Cohen ◽  
Clifford Y. Ko ◽  
Elizabeth C. Wick
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Local Environment ◽  
Successful Implementation ◽  
Elective Colorectal Surgery

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.

scholarly journals Enhanced Recovery After Colorectal Surgery (ERAS) in Elderly Patients Is Feasible and Achieves Similar Results as in Younger Patients

2017 ◽  
Vol 3 ◽  
pp. 233372141770629 ◽  
Author(s):  
Håvard Mjørud Forsmo ◽  
Christian Erichsen ◽  
Anne Rasdal ◽  
Hartwig Körner ◽  
Frank Pfeffer
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Patient Adherence ◽  
Controlled Trial ◽  
Age Groups ◽  
Postoperative Hospital Stay ◽  
Younger Patients ◽  
Eras Protocol

Aim: Enhanced recovery after surgery (ERAS) is a multimodal approach that aims to optimize perioperative treatment. Whether elderly patients receiving colorectal surgery can adhere to and benefit from an ERAS approach is uncertain. The aim of this study was to compare patients in different age groups participating in an ERAS program. Method: In this substudy of a randomized controlled trial, we analyzed the interventional ERAS arm of adult patients eligible for laparoscopic or open colorectal resection with regard to the importance of age. Patients were divided into three groups based on age: ≤65 years ( n = 79), 66-79 years ( n = 56), and ≥80 years ( n = 19). The primary end point was total postoperative hospital stay (THS). Secondary end points were postoperative hospital stay, postoperative complications, postoperative C-reactive protein levels, readmission rate, mortality, and patient adherence to the different ERAS elements. All parameters and measuring the adherence to the ERAS protocol were recorded before surgery, on the day of the operation, and daily until discharge. Results: There were no significant differences in length of THS between age groups (≤65 years, median 5 [range 2-47] days; 66-79 years, median 5.5 [range 2-36] days; ≥80 years, median 7 [range 3-50] days; p = .53). All secondary outcomes were similar between age groups. Patient adherence to the ERAS protocol was as good in the elderly as it was in the younger patients. Conclusion: Elderly patients adhered to and benefited from an ERAS program, similar to their younger counterparts.

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