Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

2021 ◽  
pp. 000313482098881
Author(s):  
Yehonatan Nevo ◽  
Tali Shaltiel ◽  
Naama Constantini ◽  
Danny Rosin ◽  
Mordechai Gutman ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Complication Rates ◽  
Activity Tracking ◽  
Primary Endpoints ◽  
Specific Complication ◽  
Secondary Endpoints ◽  
Enhanced Recovery Programs

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

scholarly journals Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Amr Nady Abdelrazik ◽  
Ahmad Sameer Sanad
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Control Groups ◽  
Analog Scale ◽  
Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

2019 ◽  
Vol 29 (4) ◽  
pp. 810-815 ◽  
Author(s):  
Basile Pache ◽  
Jonas Jurt ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Prolonged Length ◽  
Academic Center ◽  
The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

2021 ◽  
Author(s):  
Neima Briggs ◽  
Michael V Gormally ◽  
Fangyong Li ◽  
Sabrina L Browning ◽  
Miriam M Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background: Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research Question: What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study Design and Methods: We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results: Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28-0.96]; P=0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P=0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P=0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P=0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation: Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

scholarly journals A Pilot Study of Enhance Recovery after Surgery (ERAS) for Liver Resection

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Jarmin R ◽  
Mohamad IS ◽  
Ahmad AW ◽  
Othman H ◽  
Zuhdi Z ◽  
...  
Keyword(s):  
Liver Resection ◽  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Modern Approach ◽  
Full Diet ◽  
Tube Removal ◽  
Major Resection ◽  
Eras Protocol

Background: Morbidity post hepatectomy still remain persistent throughout decades compared to other surgery. Modern approach have been introduced to improve safety and reduce morbidity whilst at the same time enhance patient recovery. Thus, enhanced recovery after surgery or fast track recovery program for liver resection was initiated. Objective: The aim of this study was to achieve discharge by postoperative day 3 for minor resection and day 5 for major resection. Design and Setting: This is a prospective study conducted in Hospital Universiti Kebangsaan Malaysia (HUKM) from September 2014 till April 2015. Material and Methods: All patients undergoing open liver resection were included in the study. They were then managed post operatively according to ERAS protocol that was drawn up based on previous studies. Patient’s demographics data, intra operative parameters, postoperative complications and adherence to postoperative recovery protocol were recorded. Results: Seventeen patients (7 major and 10 minor resection) were recruited. The mean length of hospital stay for minor resection was 5.9 and major resection was 9.6 .With regards to the targets, 4 out of 10 (40%)patients in minor resection group and 4 out 7 (57.1%) in the major group were discharged on time. 9 patients had postoperative complications with no mortality recorded. In terms of the ERAS protocol targets, the PCA morphine discontinuation target was achieved in 15 patients (88.3%) ,nasogastric tube removal (13 patients -76.5%) , urinary cathether removal (6 patients - 35.3%), abdominal drains removal (9 patients-52.9%) and resumption of full diet was achieved by 82.4% (14 patients). Conclusion: From these overall achievement, most of our targets have been met and this shows that our ERAS protocol is safe to be applied to patient undergoing hepatectomy. Limitations: Some patients had achieved their target but not discharged for unknown reason.

scholarly journals Effectiveness of Enhanced Recovery After Surgery (ERAS) for patients undergoing hysterectomy: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Chengyi Ho ◽  
Hui Xian Oh ◽  
Zi An Shian Seah ◽  
Jiemin Zhu ◽  
Hong-Gu HE
Keyword(s):  
Systematic Review ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Data Extraction ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Length Of Hospital Stay ◽  
Laparoscopic Hysterectomy ◽  
Complication Rates

Background: There is a lack of systematic review exploring the effectiveness of Enhanced Recovery After Surgery (ERAS) in hysterectomy in promoting better recovery. Objectives: To synthesize the best available evidence of the effectiveness of ERAS intervention in promoting better recovery of shortened length of hospital stay (primary outcome), lower readmission, and complication rates (secondary outcomes) among patients undergoing hysterectomy due to benign conditions as compared to conventional perioperative care. Search Strategy: Seven electronic databases were searched from the date of inception to December 2020. Selection Criteria: Randomized controlled trials, cohort studies, or quasi-experimental studies published in English examining the effects of ERAS for women diagnosed with benign gynecologic diseases and underwent either abdominal or laparoscopic hysterectomy were included. Data Collection and Analysis: Two reviewers independently conducted database search, data extraction, and methodological quality assessment. Meta-analyses were performed for all outcomes. The overall quality of evidence was assessed using GRADE. Main Results: Nine studies were included in this review. Meta-analysis showed a statistically significant reduction in length of hospital stay (SMD = -0.76, 95% CI [-1.06, -0.46], Z = 4.72, p < .00001), readmission rate (RR = 0.65, 95% CI [0.44-0.96]; Z = 2.16, p = .03) and complication rate (RR = 0.61, 95% CI [0.48-0.77]; Z = 4.17, p < .0001), with high certainty of evidence. Conclusions: The effectiveness of ERAS in improving recovery indicates that hospitals could adopt the protocol to improve patients’ health and wellbeing. Future studies can focus more on standardizing the protocol’s elements.

scholarly journals Early but not late convalescent plasma is associated with better survival in moderate-to-severe COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254453
Author(s):  
Neima Briggs ◽  
Michael V. Gormally ◽  
Fangyong Li ◽  
Sabrina L. Browning ◽  
Miriam M. Treggiari ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Question ◽  
Severe Disease ◽  
Length Of Hospital Stay ◽  
Primary Endpoints ◽  
Before And After ◽  
Secondary Endpoints ◽  
Design And Methods ◽  
Hospital Days

Background Limited therapeutic options exist for coronavirus disease 2019 (COVID-19). COVID-19 convalescent plasma (CCP) is a potential therapeutic, but there is limited data for patients with moderate-to-severe disease. Research question What are outcomes associated with administration of CCP in patients with moderate-to-severe COVID-19 infection? Study design and methods We conducted a propensity score-matched analysis of patients with moderate-to-severe COVID-19. The primary endpoints were in-hospital mortality. Secondary endpoints were number of days alive and ventilator-free at 30 days; length of hospital stay; and change in WHO scores from CCP administration (or index date) to discharge. Of 151 patients who received CCP, 132 had complete follow-up data. Patients were transfused after a median of 6 hospital days; thus, we investigated the effect of convalescent plasma before and after this timepoint with 77 early (within 6 days) and 55 late (after 6 days) recipients. Among 3,217 inpatients who did not receive CCP, 2,551 were available for matching. Results Early CCP recipients, of whom 31 (40%) were on mechanical ventilation, had lower 14-day (15% vs 23%) and 30-day (38% vs 49%) mortality compared to a matched unexposed cohort, with nearly 50% lower likelihood of in-hospital mortality (HR 0.52, [95% CI 0.28–0.96]; P = 0.036). Early plasma recipients had more days alive and ventilator-free at 30 days (+3.3 days, [95% CI 0.2 to 6.3 days]; P = 0.04) and improved WHO scores at 7 days (-0.8, [95% CI: -1.2 to -0.4]; P = 0.0003) and hospital discharge (-0.9, [95% CI: -1.5 to -0.3]; P = 0.004) compared to the matched unexposed cohort. No clinical differences were observed in late plasma recipients. Interpretation Early administration of CCP improves outcomes in patients with moderate-to-severe COVID-19, while improvement was not observed with late CCP administration. The importance of timing of administration should be addressed in specifically designed trials.

scholarly journals Implementación de un programa ERAS®

2021 ◽  
Vol 113 (2) ◽  
pp. 189-196
Author(s):  
Ricardo E. Mentz ◽  
◽  
Juan P. Campana ◽  
Uriel Fraidenraij ◽  
Santiago M. Mata-Suarez ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Continuous Improvement ◽  
Surgical Procedures ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Inverse Correlation ◽  
Perioperative Period ◽  
Average Decrease ◽  
The Creation ◽  
Eras Protocol

Enhanced Recovery After Surgery (ERAS) is a model of care that involves the implementation of care pathways before, during and after surgery designed to improve patient’s experience throughout the perioperative period. Yet, the implementation of individual ERAS protocol elements is not sufficient. This approach requires the creation of a multidisciplinary work team, systematic recording of data and mthe use of the information recorded to implement a cycle of continuous improvement. Since 2015, 1331 patients have been recorded by Hospital Italiano de Buenos Aires. Median length of hospital stay was 4 days and median readmission rate was 7.3%. The overall adherence to the protocol elements was 56% (88% in the preoperative period, 60% in the intraoperative period and 39% in the postoperative period) There was a linear and inverse correlation between the adherence to the program and length of hospitalization for the most common surgical procedures, with an average decrease of one day of hospitalization for each 10% increase in adherence with the program for the most common surgical procedures. Despite these results, we have encountered difficulties in the data recording systems limiting the implementation of the cycle of continuous improvement. The creation of a multidisciplinary team, with fluent and efficient communication, is essential for the implementation of an ERAS® program capable of reducing length of hospital stay, morbidity and readmission rates.

scholarly journals Challenging boundaries: an enhanced recovery programme for radical cystectomy

2013 ◽  
Vol 95 (3) ◽  
pp. 200-206 ◽  
Author(s):  
S Mukhtar ◽  
BE Ayres ◽  
R Issa ◽  
MJ Swinn ◽  
MJA Perry
Keyword(s):  
Hospital Stay ◽  
Radical Cystectomy ◽  
Outcome Measures ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Icu Stay ◽  
Open Radical Cystectomy

Introduction The implementation of enhanced recovery programmes (ERPs) in colorectal surgery has seen improvements in the length of inpatient stay with no increase in complications. We investigated the role of ERP in radical cystectomy at our institution. Methods Prospective data were collected from 26 consecutive patients prior to the introduction of the ERP and 51 patients who underwent open radical cystectomy within an ERP. Individuals in the ERP cohort did not receive bowel preparation or nasogastric drainage but received preoperative carbohydrate drinks, perioperative epidural analgesia and immediate mobilisation on day 1. Primary outcome measures included duration of intensive care unit (ICU) stay and length of hospital stay. Secondary outcome measures included the time to the passage of flatus and faeces, and time to mobilisation. Other measures that were analysed included operation time and complications. Results Baseline characteristics for both groups were similar. The median length of hospital stay fell from 11.5 days to 10.4 days and the mean ICU stay dropped from 2.4 days to 1.0 days (p=0.01). Time to removal of nasogastric tube, and time to passage of flatus and faeces were significantly shorter in the ERP group, as was the time to full oral diet. Clavien complication rates and 30-day mortality rates were similar in both groups. There were no readmissions. Conclusions ERP in radical cystectomy is safe and not associated with any increase in complications or readmissions. It is associated with reductions in ICU stay, and could also reduce length of hospital stay and duration of postoperative ileus.

Decreasing length of hospital stay following radical cystectomy using multimodal enhanced recovery protocol.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 313-313
Author(s):  
Hooman Djaladat ◽  
Hamed Ahmadi ◽  
Anne Schuckman ◽  
Siamak Daneshmand
Keyword(s):  
Bladder Cancer ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Opioid Antagonist ◽  
Complication Rates ◽  
Historical Cohort ◽  
Prolonged Intubation ◽  
Regular Diet ◽  
Continent Diversion ◽  
Eras Protocol

313 Background: To evaluate a peri-operative protocol to expedite recovery and decrease length of stay (LOS) without increasing readmission and complication rates after cystectomy for bladder cancer. Methods: From 5/2012 to 8/2013, a peri-operative protocol used in 126 unselected consecutive patients who underwent open cystectomy for bladder cancer with prospective follow-up. The enhanced recovery after surgery (ERAS) protocol focused on avoiding bowel prep and NGT, early feeding, minimizing narcotics and use of a μ-opioid antagonist. Exclusion was any adjunct surgery (10), previous diversion (2) and prolonged intubation (4). Time to bowel movement (BM) and regular diet, LOS, 30-day readmission and complication rates were captured. The outcomes of interest were compared to a historical cohort. Results: A total of 110 (84 male) patients were included. Median age was 69 y/o (range, 31-90). 40 (36%) patients were ≥ 75 y/o and 75 (68%) patients underwent continent diversion. 90 (82%) patients had BM and 87 (79%) were advanced to regular diet by postop day (POD) 2. Median LOS was 4 days and 63/110 (57%) discharged at or before POD 4. Five patients needed NGT due to ileus. Most common 30-day complications were anemia requiring transfusion (19%), UTI (13%) and dehydration (9%), with the latter two also being the most common etiologies for readmission. Major complications (≥ Clavian grade III) were seen in 15 (13%) patients and were significantly higher in patients ≥75 y/o than younger (22% vs. 8%; P=0.05). There was no difference in other measured outcomes with respect to age (≥75 vs. <75 y/o) and type of diversion (continent vs. incontinent). Conclusions: Our current ERAS protocol resulted in significant reduction in time to BM and LOS without increasing early readmission and complication rates. [Table: see text]

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