“Enhanced recovery after surgery – ERAS in elective craniotomies-a non-randomized controlled trial”

Abstract Background Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups. Methods In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative –family education, complex-carbohydrate drink, flupiritine; Intraoperative – scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group. Results Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group – 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups. Conclusion The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results. Trial registration Clinical Trial Registry of India (CTRI/2018/04/013247), registered retrospectively on April 2018.

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Enhanced Recovery After Surgery – ERAS in Elective Craniotomies-a Non-randomized Controlled Trial

10.21203/rs.3.rs-54581/v1 ◽

2020 ◽

Author(s):

Anirudh Elayat ◽

Sritam Swarup Jena ◽

Rabi Narayan Sahu ◽

Sukdev Nayak ◽

Swagata Tripathy

Keyword(s):

Randomized Controlled Trial ◽

Glycemic Control ◽

Hospital Stay ◽

Perioperative Care ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Early Recovery ◽

Randomized Controlled ◽

Pain Scores

Abstract Background: Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups.Methods: This was a pragmatic non-randomized controlled trial (CTRI/2017/07/015451). Consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Patients in the ERAS group received a fixed bundle of care. Pre-operative –family education,, complex-carbohydrate drink, scalp blocks, and flupiritine ; Intraoperative –limited opioids,fluid and temperature regulation; Post operative- early mobilization, removal of catheters and initiation of feeds. In the control group, standard practice and protocols of perioperative care were followed. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control and the overall duration of stay in the hospital. Results: Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 hrs after surgery, the cumulative insulin requirement and the episodes of VAS scores > 4 in first 48 hours after surgery was significantly less in the ERAS group – 40.6% vs 65.7%, 0.6 (±2.5) units vs 3.6 (±8.1 ) units and 1 vs 10 episodes ( p= 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups.Conclusion: The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 hrs. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results.

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Compliance with enhanced recovery after surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial

Colorectal Disease ◽

10.1111/codi.13253 ◽

2016 ◽

Vol 18 (6) ◽

pp. 603-611 ◽

Cited By ~ 30

Author(s):

H. M. Forsmo ◽

F. Pfeffer ◽

A. Rasdal ◽

G. Østgaard ◽

A. C. Mohn ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Colorectal Surgery ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Randomized Controlled

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Enhanced recovery after surgery (ERAS) in patients undergoing emergency laparotomy after trauma: a prospective, randomized controlled trial

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000698 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000698

Author(s):

Vijayan Purushothaman ◽

Pratyusha Priyadarshini ◽

Dinesh Bagaria ◽

Mohit Joshi ◽

Narendra Choudhary ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Bowel Function ◽

Emergency Laparotomy ◽

Duration Of Hospital Stay ◽

Randomized Controlled ◽

Pain Scores ◽

Eras Protocol

BackgroundThe role of enhanced recovery after surgery (ERAS) has been established in elective operations. However, its role in emergency operations especially in trauma is under-recognized. The aim of this study was to explore the safety and efficacy of ERAS program in patients undergoing emergency laparotomy for trauma.MethodsIn this single-center study, patients who underwent emergency laparotomy after trauma were randomized to the ERAS protocol or conventional care. The ERAS protocol included early removal of catheters, early initiation of diet, use of postoperative prophylaxis and optimal usage of analgesia. The primary endpoint was duration of hospital stay. The secondary endpoints were recovery of bowel function, pain scores, complications and readmission rate.ResultsThirty patients were enrolled in each arm. The ERAS group had significant reduction in duration of hospital stay (3.3±1.3 vs. 5.0±1.7; p<0.01). Time to remove nasogastric tube (1.1±0.1 vs. 2.2±0.9; p<0.01), urinary catheter (1.1±0.1 vs. 3.5±1.6; p<0.01), and drain (1.0±0.2 vs. 3.7±1.6; p<0.01) was shorter in the ERAS group. In ERAS group, there was earlier initiation of liquid diet (1.1±0.1 vs. 2.3±1.0; p<0.01) and solid diet (2.1±0.1 vs. 3.6±1.3; p<0.01). The usage of epidural analgesia (63% vs. 30%; p=0.01), non-steroidal anti-inflammatory drugs (93% vs. 67%; p-0.02) and deep vein thrombosis prophylaxis (100% vs. 70%; p<0.01) was higher in the ERAS group. There was no difference in the recovery of bowel function (2.4±1.0 vs. 2.1±0.9; p=0.15), pain scores (3.2±1.0 vs. 3.1±1.1; p=0.87), complications (27% vs. 23%; p=0.99) and readmission rates (07% vs. 10%; p=0.99) between the two groups.ConclusionERAS protocol, when implemented in patients undergoing laparotomy for trauma, has decreased duration of hospital stay with no additional complications.Level of evidenceLevel 1, randomized controlled trial, care management.Trial registration numberClinical Trials Registry of India (CTRI/2019/06/019533).

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PD47-11 A RANDOMIZED CONTROLLED TRIAL COMPARING PERIOPERATIVE OUTCOMES, LENGTH OF HOSPITAL STAY AND COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY WITH AND WITHOUT ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL

The Journal of Urology ◽

10.1097/01.ju.0000556767.69488.ff ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Devanshu Bansal ◽

Brusabhanu Nayak* ◽

Prabhjot Singh ◽

Rishi Nayyar ◽

Amlesh Seth ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Hospital Stay ◽

Radical Cystectomy ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Randomized Controlled ◽

Eras Protocol

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Enhanced recovery after surgery for radical cystectomy with ileal urinary diversion: a multi-institutional, randomized, controlled trial from the Chinese bladder cancer consortium

World Journal of Urology ◽

10.1007/s00345-017-2108-3 ◽

2017 ◽

Vol 36 (1) ◽

pp. 41-50 ◽

Cited By ~ 17

Author(s):

Tianxin Lin ◽

Kaiwen Li ◽

Hao Liu ◽

Xueyi Xue ◽

Ning Xu ◽

...

Keyword(s):

Bladder Cancer ◽

Randomized Controlled Trial ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Randomized Controlled

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

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00116-4 ◽

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.

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