Enhanced Recovery After Surgery® in Octogenarians Undergoing Hepatopancreatobiliary Surgery

Advances in perioperative care have increased the frequency of surgical intervention performed on the very elderly (≥80 years). This study aims to investigate the impact of Enhanced Recovery After Surgery (ERAS) on outcomes for octogenarians after major hepatopancreatobiliary (HPB) surgery. Patients ≥80 years old in a single HPB ERAS program (September 2015-July 2018) were prospectively tracked in the ERAS Interactive Audit System (EIAS). Postoperative length of stay (LOS) as well as 30-day major complications, readmissions, and mortality were compared to a pre-ERAS octogenarian control. Since ERAS implementation, octogenarians comprised 7.3% (27 of 370) of patients who underwent pancreaticoduodenectomy (n=17), distal pancreatectomy (n=7), or hepatectomy (n=3). Thirty-day readmissions decreased after ERAS implementation (50% to 15%, P=.037). Thirty-day major complications, mortality, and LOS were similar with 64% median protocol compliance. ERAS for octogenarians in HPB surgery is safe and may contribute to more sustainable recovery resulting in reduced readmissions.

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The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2017.10.151 ◽

2018 ◽

Vol 155 (4) ◽

pp. 1843-1852 ◽

Cited By ~ 38

Author(s):

Luke J. Rogers ◽

David Bleetman ◽

David E. Messenger ◽

Natasha A. Joshi ◽

Lesley Wood ◽

...

Keyword(s):

Lung Cancer ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Primary Lung Cancer ◽

Protocol Compliance ◽

Eras Protocol ◽

The Impact

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Developing implementation strategies to adopt Enhanced Recovery After Surgery (ERAS®) guidelines

BJS Open ◽

10.1093/bjsopen/zraa011 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

Jennifer Y Lam ◽

Alexandra Howlett ◽

Duncan McLuckie ◽

Lori M Stephen ◽

Scott D N Else ◽

...

Keyword(s):

Implementation Strategy ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Healthcare Providers ◽

Implementation Strategies ◽

Multidisciplinary Teams ◽

Successful Implementation ◽

Care Pathways ◽

Audit System ◽

Local Contexts

Abstract Background Strong implementation strategies are critical to the success of Enhanced Recovery after Surgery (ERAS®) guidelines, though little documentation exists on effective strategies, especially in complex clinical situations and unfamiliar contexts. This study outlines the process taken to adopt a novel neonatal ERAS® guideline. Methods The implementation strategy was approached in a multi-pronged, concurrent but asynchronous fashion. Between September 2019 and January 2020, healthcare providers from various disciplines and different specialties as well as parents participated in the strategy. Multidisciplinary teams were created to consider existing literature and local contexts including potential facilitators and/or barriers. Task forces worked collaboratively to develop new care pathways. An audit system was developed to record outcomes and elicit feedback for revision. Results 32 healthcare providers representing 9 disciplines and 5 specialties as well as 8 parents participated. Care pathways and resources were created. Elements recommended for a successful implementation strategy included identification of champions, multidisciplinary stakeholder involvement, consideration of local contexts and insights, patient/family engagement, education, and creation of an audit system. Conclusion A multidisciplinary and structured process following principles of implementation science was used to develop an effective implementation strategy for initiating ERAS® guidelines.

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Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

Anesthesiology ◽

10.1097/aln.0000000000001663 ◽

2017 ◽

Vol 127 (1) ◽

pp. 36-49 ◽

Cited By ~ 36

Author(s):

Juan C. Gómez-Izquierdo ◽

Alessandro Trainito ◽

David Mirzakandov ◽

Barry L. Stein ◽

Sender Liberman ◽

...

Keyword(s):

Colorectal Surgery ◽

Fluid Therapy ◽

Postoperative Ileus ◽

Enhanced Recovery ◽

Laparoscopic Colorectal Surgery ◽

Enhanced Recovery After Surgery ◽

Therapy Group ◽

Control Group ◽

Goal Directed Fluid Therapy ◽

The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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Evaluating the impact of specific compliance items of an enhanced recovery after surgery (ERAS®) protocol in pancreaticoduodenectomy patients

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2018.03.015 ◽

2018 ◽

Vol 25 ◽

pp. 170

Author(s):

Allyson Cochran ◽

William B. Lyman ◽

Michael Passeri ◽

Kendra Tezber ◽

Misty Eller ◽

...

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

The Impact

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PROPER—PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-003170 ◽

2021 ◽

pp. ijgc-2021-003170

Author(s):

Andre Lopes ◽

Alayne Magalhães Trindade Domingues Yamada ◽

Thais de Campos Cardenas ◽

Jaqueline Nunes de Carvalho ◽

Emília de Azevedo Oliveira ◽

...

Keyword(s):

Hospital Stay ◽

Functional Capacity ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Preoperative Care ◽

Gynecologic Surgery ◽

Calorie Intake ◽

Control Group ◽

Gynecological Surgery ◽

The Impact

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

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Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽

10.3390/nu12010264 ◽

2020 ◽

Vol 12 (1) ◽

pp. 264 ◽

Cited By ~ 3

Author(s):

Ho Chiou Yi ◽

Zuriati Ibrahim ◽

Zalina Abu Zaid ◽

Zulfitri ‘Azuan Mat Daud ◽

Nor Baizura Md. Yusop ◽

...

Keyword(s):

Whey Protein ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Cancer ◽

Intervention Group ◽

Oral Feeding ◽

Control Group ◽

Early Oral Feeding ◽

Significant Difference ◽

The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

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Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03623-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Hong Xu ◽

Jingli Yang ◽

Jinwei Xie ◽

Zeyu Huang ◽

Qiang Huang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Enhanced Recovery ◽

Primary Total Knee Arthroplasty ◽

Transfusion Rate ◽

Partial Regression Coefficient ◽

Postoperative Length ◽

Total Knee ◽

The Impact

Abstract Background In an enhanced recovery after surgery program, a growing number of orthopedists are reconsidering the necessity of tourniquet use in total knee arthroplasty (TKA). However, the impact of tourniquet use on transfusion rate and postoperative length of stay (PLOS) in TKA remains controversial. Therefore, we carried out a study to investigate the effect of tourniquet application in routine primary TKA on transfusion rate and PLOS. Methods We analyzed data from 6325 patients who underwent primary unilateral TKA and divided them into two groups according to whether a tourniquet was applied during the procedure, and a tourniquet was used in 4902 and not used in 1423. The information for transfusion and PLOS was extracted from patients’ electronic health records, and the data were analyzed with logistic and linear regression analyses. Results Following TKA, the transfusion rate and PLOS were 14.52% and 7.72 ± 3.54 days, respectively, in the tourniquet group, and 6.47% and 6.44 ± 3.48 days, respectively, in the no-tourniquet group. After adjusting for the different related variables, tourniquet use was significantly correlated with a higher transfusion rate (risk ratio = 1.888, 95% confidence interval (CI) 1.449–2.461, P < 0.001) and a longer PLOS (partial regression coefficient (B) = 0.923, 95%CI 0.690–1.156, P < 0.001). Conclusions Our findings suggested that tourniquet use in routine primary TKA was related to a higher transfusion rate and a longer PLOS. The impact of tourniquet use on transfusion rate and PLOS should be taken into account in clinical practice.

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Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective caesarean delivery

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2020.05.001 ◽

2020 ◽

Vol 43 ◽

pp. 17

Author(s):

R. Irwin ◽

T. Tan

Keyword(s):

Caesarean Delivery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Maternal Outcomes ◽

Protocol Implementation ◽

The Impact ◽

Elective Caesarean Delivery

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Enhanced Recovery After Surgery Interactive Audit System: 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1673357 ◽

2019 ◽

Vol 32 (01) ◽

pp. 075-081 ◽

Cited By ~ 9

Author(s):

Andrew Currie ◽

Nicolas Demartines ◽

Kenneth Fearon ◽

Robin Kennedy ◽

Olle Ljungqvist ◽

...

Keyword(s):

Quality Improvement ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Care Program ◽

Time Frame ◽

Patient Data ◽

Cost Of Care ◽

Data Governance ◽

Elective Colorectal Surgery ◽

Audit System

AbstractThe Enhanced Recovery After Surgery (ERAS) is a managed care program that has shown the ability to reduce complications following elective colorectal surgery. In 2006, the ERAS® Society developed the ERAS® Interactive Audit System (EIAS), which has allowed centers in over 20 countries to enter perioperative patient data to benchmark against international practice within the audit system and act as a stimulus for quality improvement. The de-identified patient data are coded in SQL (a relational database), stored on secure servers, and data governance aspects have been secured in all involved countries. A collaborative approach is undertaken within involved units toward research questions with published cohort data from the audit system having demonstrated the importance of overall compliance on improving patient outcomes and less cost of care. The EIAS has shown that collaborative clinical effort can drive quality improvement in a short time frame in an international context.

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

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000268 ◽

2019 ◽

Vol 29 (4) ◽

pp. 810-815 ◽

Cited By ~ 4

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.

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