scholarly journals Enhanced recovery for obese patients undergoing gynecologic cancer surgery

2020 ◽  
Vol 30 (10) ◽  
pp. 1595-1602
Author(s):  
Ross Harrison ◽  
Maria D Iniesta ◽  
Brandelyn Pitcher ◽  
Pedro T Ramirez ◽  
Katherine Cain ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Enhanced Recovery ◽  
Gynecologic Cancer ◽  
Cancer Surgery ◽  
Wound Complications ◽  
Obese Patients ◽  
Opioid Use ◽  
Program Compliance ◽  
Morphine Equivalent

ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.ResultsAfter matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48–66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2–4). Obese and non-obese patients had similar rates of grade III–IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I–II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35–72.5) vs 50 mg (IQR 25–622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10–96.2) vs 29.37 mg/day (IQR 7.5–70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).ConclusionsNeither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

30 d Post-op Mortality and Length of Stay in Obese Patients After Lung Cancer Surgery

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 111A
Author(s):  
Binod Dhakal ◽  
Daniel Eastwood ◽  
Ajit Dhakal ◽  
Rafael Santana-Davila
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Lung Cancer Surgery ◽  
Cancer Surgery ◽  
Obese Patients

scholarly journals Enhanced recovery after cesarean: impact on postoperative opioid use and length of stay

2020 ◽  
Author(s):  
C. Andrew Combs ◽  
Tracy Robinson ◽  
Cindy Mekis ◽  
Marsjah Cooper ◽  
Elizabeth Adie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Opioid Use

Enhanced Recovery after Surgery in Breast Reconstruction: A Systematic Review

2019 ◽  
Vol 35 (09) ◽  
pp. 695-704 ◽  
Author(s):  
Carol E. Soteropulos ◽  
Sherry Y.Q. Tang ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Breast Reconstruction ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Fluid Management ◽  
Patient Counseling ◽  
Opioid Use ◽  
Full Spectrum ◽  
Alloplastic Breast Reconstruction

Background Enhanced Recovery after Surgery (ERAS) principles have received focused attention in breast reconstruction. Many protocols have been described in the literature for both autologous and alloplastic reconstruction. This systematic review serves to better characterize successful ERAS protocols described in the literature for potential ease of adoption at institutions desiring implementation. Methods A systematic review of ERAS protocols for autologous and alloplastic breast reconstruction was conducted using Medline, the Cochrane Database, and Web of Science. Results Eleven cohort studies evaluating ERAS protocols for autologous (n = 8) and alloplastic (n = 3) breast reconstruction were included for review. The majority compared with a retrospective cohort of traditional perioperative care. All studies described the full spectrum of implemented ERAS protocols including preoperative, intraoperative, and postoperative phases of care. Most frequently reported significant outcomes were reduced length of stay and opioid use with ERAS implementation. No significant change in major complication or readmission rate was demonstrated. Conclusion Based on this systematic review, several core elements that make up a successful perioperative enhanced recovery protocol for breast reconstruction have been identified. Elements include patient counseling and education, limited preoperative fasting, appropriate thromboprophylaxis and antibiotic prophylaxis dependent on reconstructive method, preoperative antiemetics, multimodal analgesia and use of local anesthetic, goal-directed intravenous fluid management, prompt removal of drains and catheters, early diet advancement, and encouragement of ambulation postoperatively. Implementation of ERAS protocols in both autologous and alloplastic breast reconstruction can positively enhance patient experience and improve outcomes by reducing length of stay and opioid use, without compromising successful reconstructive outcomes.

“Medically Necessary” Panniculectomy to Facilitate Gynecologic Cancer Surgery in Morbidly Obese Patients

1998 ◽  
Vol 69 (3) ◽  
pp. 237-242 ◽  
Author(s):  
John Paul Micha ◽  
Mark A. Rettenmaier ◽  
Larry Francis ◽  
Rafer Willenberg ◽  
John V. Brown
Keyword(s):  
Gynecologic Cancer ◽  
Cancer Surgery ◽  
Morbidly Obese ◽  
Obese Patients

ASO Visual Abstract: Importance of Enhanced Recovery After Surgery Protocol Compliance on Length of Stay in Ovarian Cancer Surgery

2021 ◽  
Author(s):  
Jose Luis Sánchez-Iglesias ◽  
Natalia R. Gómez-Hidalgo ◽  
Asunción Pérez-Benavente ◽  
Melchor Carbonell-Socias ◽  
Susana Manrique-Muñoz ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cancer Surgery ◽  
Protocol Compliance

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

scholarly journals Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

2015 ◽  
Vol 97 (7) ◽  
pp. 502-507 ◽  
Author(s):  
PAC Gatenby ◽  
C Shaw ◽  
C Hine ◽  
S Scholtes ◽  
M Koutra ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Length Of Stay ◽  
Total Gastrectomy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Enhanced Recovery ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery ◽  
Enhanced Recovery Programme

Introduction Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. Methods An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. Results In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. Conclusions The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity.

Enhanced Recovery after Partial and Radical Nephrectomy Reduces Length of Stay, Opioid Use and Cost

2020 ◽  
Vol 7 (1) ◽  
pp. 41-46
Author(s):  
Daniel Swerdloff ◽  
Demitri Podolski ◽  
Rachel E. Smith ◽  
Donald Lee ◽  
Michael Swerdloff ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Nephrectomy ◽  
Enhanced Recovery ◽  
Opioid Use

scholarly journals Reduction of Postoperative Opioid Use After Elective Spine and Peripheral Nerve Surgery Using an Enhanced Recovery After Surgery Program

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3283-3291
Author(s):  
Tracy M Flanders ◽  
Joseph Ifrach ◽  
Saurabh Sinha ◽  
Disha S Joshi ◽  
Ali K Ozturk ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Peripheral Nerve ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Foley Catheter ◽  
Control Group ◽  
Opioid Use ◽  
Historical Cohort ◽  
Eras Protocol ◽  
Nerve Surgery

Abstract Objective Enhanced recovery after surgery (ERAS) pathways have previously been shown to be feasible and safe in elective spinal procedures. As publications on ERAS pathways have recently emerged in elective neurosurgery, long-term outcomes are limited. We report on our 18-month experience with an ERAS pathway in elective spinal surgery. Methods A historical cohort of 149 consecutive patients was identified as the control group, and 1,141 patients were prospectively enrolled in an ERAS protocol. The primary outcome was the need for opioid use one month postoperation. Secondary outcomes were opioid and nonopioid consumption on postoperative day (POD) 1, opioid use at three and six months postoperation, inpatient pain scores, patient satisfaction scores, postoperative Foley catheter use, mobilization/ambulation on POD0–1, length of stay, complications, and intensive care unit admissions. Results There was significant reduction in use of opioids at one, three, and six months postoperation (38.6% vs 70.5%, P &lt; 0.001, 36.5% vs 70.9%, P &lt; 0.001, and 23.6% vs 51.9%, P = 0.008) respectively. Both groups had similar surgical procedures and demographics. PCA use was nearly eliminated in the ERAS group (1.4% vs 61.6%, P &lt; 0.001). ERAS patients mobilized faster on POD0 compared with control (63.5% vs 20.7%, P &lt; 0.001). Fewer patients in the ERAS group required postoperative catheterization (40.7% vs 32.7%, P &lt; 0.001). The ERAS group also had decreased length of stay (3.4 vs 3.9 days, P = 0.020). Conclusions ERAS protocols for all elective spine and peripheral nerve procedures are both possible and effective. This standardized approach to patient care decreases opioid usage, eliminates the use of PCAs, mobilizes patients faster, and reduces length of stay.

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