scholarly journals A Randomised Controlled Trial of Fluid Restriction Compared to Oesophageal Doppler-Guided Goal-Directed Fluid Therapy in Elective Major Colorectal Surgery within an Enhanced Recovery after Surgery Program

2014 ◽  
Vol 42 (6) ◽  
pp. 752-760 ◽  
Author(s):  
T. D. Phan ◽  
V. An ◽  
B. D'Souza ◽  
M. J. Rattray ◽  
M. J. Johnston ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Fluid Therapy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Volume Index ◽  
Goal Directed Therapy ◽  
Major Complications ◽  
Number Of Patients ◽  
Goal Directed Fluid Therapy

There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. One hundred patients, 50 in each group, were included in the analysis. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m2, P <0.001, in the latter group. Length-of-stay was similar, P=0.421. The number of patients with any complication (minor or major) was similar; 60% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.

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

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
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.

scholarly journals Implementation of an ERAS Pathway in Colorectal Surgery

2019 ◽  
Vol 32 (02) ◽  
pp. 102-108 ◽  
Author(s):  
Liliana Bordeianou ◽  
Paul Cavallaro
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Postoperative Care ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Standardized Protocol ◽  
Improve Hospital ◽  
Eras Protocol

AbstractEnhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.

Enhanced Recovery After Surgery (ERAS) Eliminates Racial Disparities in Postoperative Length of Stay After Colorectal Surgery

2018 ◽  
Vol 268 (6) ◽  
pp. 1026-1035 ◽  
Author(s):  
Tyler S. Wahl ◽  
Lauren E. Goss ◽  
Melanie S. Morris ◽  
Allison A. Gullick ◽  
Joshua S. Richman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Racial Disparities ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Length

ERAS in colorectal surgery – neglected preadmission items

2019 ◽  
Vol 98 (9) ◽  
pp. 345-349
Keyword(s):  
Stress Response ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Physical Condition ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Rapid Recovery ◽  
Physiological Functions ◽  
Postoperative Convalescence

The Enhanced Recovery After Surgery (ERAS) concept is a complex of strategies intended to reduce the perioperative stress response and achieve faster postoperative convalescence and rapid recovery of normal physiological functions. Adherence to ERAS should reduce the length of stay and postoperative complications, and it should improve the physical condition of the patient after dimission. This article is focused on those ERAS guidelines that apply to preadmission care.

scholarly journals ERAS® Program in a Portuguese Hospital: Results from Elective Colorectal Surgery after One Year of Implementation

2020 ◽  
Vol 33 (9) ◽  
pp. 568
Author(s):  
André Carrão ◽  
Daniel Ribeiro ◽  
Maria Manso ◽  
Joana Oliveira ◽  
Luís Féria ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Bowel Function ◽  
Control Group ◽  
Elective Colorectal Surgery ◽  
Improve Patient

Introduction: The Enhanced Recovery After Surgery® program comprises the implementation of various perioperative measures that reduce surgical stress and ultimately improve patient recovery and outcome. The purpose of this study is to evaluate the first-year compliance and clinical outcomes after implementation of the Enhanced Recovery After Surgery® program in elective colorectal surgery in our hospital.Material and Methods: An analysis was performed on the 210 patients who underwent elective colorectal surgery from May 2016 to December 2017. The group of patients that underwent surgery after the protocol implementation (Enhanced Recovery After Surgery® group) was compared to a conventional care control group (pre- Enhanced Recovery After Surgery® group). Differences between the two groups were adjusted using Propensity Score matching. The main outcomes were length of stay, return of bowel function, complications and mortality. The evolution of compliance with Enhanced Recovery After Surgery® principles was also analyzed.Results: After propensity score matching, 112 patients were included in the present study: 56 patients formed the pre-Enhanced Recovery After Surgery® group and 56 the Enhanced Recovery After Surgery® group. The overall adherence to the protocol increased from 35.7% to 80.8%. There was a decrease in length of stay, time to return of bowel function and medical complications.Discussion: The Enhanced Recovery After Surgery® program is safe and seems to shorten length of stay and improve patient recovery and clinical outcome.Conclusion: This study showed that the implementation of the Enhanced Recovery After Surgery® program was possible in Hospital Beatriz Ângelo, with a positive impact in the immediate postoperative recovery of colorectal patients.

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