A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs

Abstract Background Carbohydrate-containing drinks (CCD) are administered preoperatively in most enhanced recovery after surgery (ERAS) programs. It is not known which types of CCDs are used, e.g., simple vs. complex carbohydrate, and if the choice of drink differs in patients with diabetes. Methods A national survey was performed to characterize the use of preoperative CCDs within the context of adult colorectal ERAS programs. The survey had questions regarding the use of preoperative CCDs, the types of beverages used, and the timing of beverage administration. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 78 unique hospitals with a colorectal ERAS program of which 68 (87.2%) reported administering a preoperative drink. Of these, 98.5%, 80.9%, and 60.3% of hospitals administered a beverage to patients without diabetes, patients with diabetes not taking insulin, and patients with diabetes taking insulin, respectively. Surprisingly, one third of programs that administered a beverage to patients with diabetes used a simple carbohydrate drink. Conclusions This survey finds a high use of CHO-containing beverages in colorectal ERAS programs. More than half of all programs administer a CHO-containing beverage to patients with diabetes, and surprisingly, there is significant use of simple carbohydrate beverages in patients with diabetes receiving insulin.

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Types of surgical patients enrolled in enhanced recovery after surgery (ERAS) programs in the USA

Perioperative Medicine ◽

10.1186/s13741-021-00185-5 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Sunitha M. Singh ◽

Asha Liverpool ◽

Jamie L. Romeiser ◽

Julie Thacker ◽

Tong J. Gan ◽

...

Keyword(s):

San Francisco ◽

Residency Program ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Positive Association ◽

Surgical Oncology ◽

Surgical Service ◽

Significant Positive Association ◽

The Usa ◽

Surgery Residency Program

Abstract Background Enhanced Recovery After Surgery (ERAS) programs have gained traction across US hospitals in the past two decades. Initially implemented for elective colorectal surgical procedures, ERAS has expanded to a variety of surgical service lines. There is little information regarding the extent to which various surgical service lines use ERAS. Methods A survey was performed to describe the prevalence of ERAS programs across surgical service lines in the USA. The survey had questions regarding the number of ERAS programs, operating rooms (ORs) and presence of anesthesia and/or surgery residency program at an institution. The survey was administered electronically to members of the American Society for Enhanced Recovery (ASER) and manually to participants at the 2018 Perioperative Quality and Enhanced Recovery Conference in San Francisco, CA. Results Responses were received from 88 unique institutions. The most commonly reported surgical service lines were colorectal (87%), gynecology (51%), orthopedic (49%), surgical oncology (39%), and urology (35%). A significant positive association was observed between the number of ORs and the number ERAS programs (Spearman’s Rho 0.5, p<0.0001). Furthermore, institutions that reported an anesthesia and/or surgery residency program had more ERAS programs (mean 5.0 ± 3.2) compared to those that did not (mean 2.0 ± 2.0) (Wilcoxon rank sum p< 0.001). Conclusions ERAS has expanded to a large extent outside of the colorectal surgery service line with increases notable in orthopedic surgery, obstetric/gynecology, surgical oncology, and urology procedures. Institutions with a higher number of ORs and the presence of an anesthesia and/or surgery residency program are associated with an increased number of ERAS programs.

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Effectiveness and Safety of Preoperative Oral Carbohydrates in Enhanced Recovery after Surgery Protocols for Patients with Diabetes Mellitus: A Systematic Review

BioMed Research International ◽

10.1155/2020/5623596 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Li-Na Ge ◽

Lin Wang ◽

Feng Wang

Keyword(s):

Diabetes Mellitus ◽

Randomized Controlled Trials ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Biomedical Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Patients With Diabetes

To evaluate the necessity and safety of preoperative oral carbohydrates in enhanced recovery after surgery (ERAS) protocols for diabetes mellitus patients. We searched PubMed, EMBASE, the Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG databases for articles published through September 2018. We used the Cochrane risk-of-bias tool to assess the methodological quality of included studies. Literature screening, data extraction, and quality evaluation were performed independently by two investigators. Of the 6328 retrieved articles, five eligible randomized controlled trials were included. Two were from China and three were from Germany, Sweden, and Canada. Preoperative oral carbohydrates may facilitate control of preoperative blood glucose, improve postoperative insulin resistance in diabetes patients, and decrease the occurrence of adverse reactions. However, the overall quality of the included studies was low. The available evidence shows that preoperative oral carbohydrates are probably beneficial for patients with diabetes mellitus. High-quality, large randomized controlled trials are needed to verify our findings and provide quantitative results.

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National survey of Korean hepatobiliary-pancreatic surgeons on attitudes about the enhanced recovery after surgery protocol

Annals of Hepato-Biliary-Pancreatic Surgery ◽

10.14701/ahbps.2020.24.4.477 ◽

2020 ◽

Vol 24 (4) ◽

pp. 477-483

Author(s):

Sang Hyun Shin ◽

Woo-hyoung Kang ◽

In Woong Han ◽

Yunghun You ◽

Huisong Lee ◽

...

Keyword(s):

National Survey ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery

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Enhanced Recovery After Surgery (ERAS) Program for Elderly Patients With Long-level Lumbar Fusion

10.21203/rs.3.rs-319354/v1 ◽

2021 ◽

Author(s):

PENG WANG ◽

CHAO KONG ◽

ZE TENG ◽

ZHONGEN LI ◽

SITAO ZHANG ◽

...

Keyword(s):

Elderly Patients ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Surgical Stress ◽

Surgical Complication ◽

Lumbar Fusion ◽

Group Versus ◽

Visual Analogue Score ◽

Lessons Learned ◽

American Society

Abstract Background: Currently, ERAS for spinal surgery field is still in its beginnings, the major protocol lessons learned from other surgical specialties and lack of ERAS program for elderly patients (>70 years old). Geriatric patients has its own special characteristics resulting in more harmed by surgical stress. The enhanced recovery after surgery (ERAS) are designed to improving recovery after surgery and can result in substantial benefits in both clinical outcomes and cost-effectiveness. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improved satisfaction and outcomes in elderly patients (>70 years old) with long-level lumbar fusion. Methods: A total of 144 patients were included, 62 in the ERAS group and 82 case-matched patients in the non-ERAS group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. ERAS interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication and length of stay (LOS).Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists (ASA) grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the ERAS and non-ERAS groups. In addition, the mean preoperative Visual Analogue Score (VAS) for the back and legs and Oswestry Disability Index (ODI) score were not significantly different between the two groups. Overall, ERAS pathway compliance was 91.5%. There were no significant differences in the mortality rates between the ERAS and non-ERAS groups. However, we observed a statistically significant decrease in the complications in the ERAS group(6 in the ERAS group versus 23 in the non-ERAS group, p=0.006) and LOS in the ERAS group (17.74±5.56 of ERAS group versus 22.13±12.21 in non-ERAS group, p=0.041). Multivariable linear regression showed that comorbidities (p=0.028) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS. Multivariable logistic regression showed that comorbidities (p=0.029)， implementation of ERAS program (p=0.043) and preoperative VAS Back (p=0.046), were correlated with complications. Conclusions: This report describes the first ERAS protocol used in elderly patients after long-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS and complication in elderly patients with long-level lumbar fusion.

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Enhanced recovery after surgery protocols improve time to return to intended oncology treatment following interval cytoreductive surgery for advanced gynecologic cancers

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002495 ◽

2021 ◽

pp. ijgc-2021-002495

Author(s):

Joan Isabelle Tankou ◽

Olivia Foley ◽

Michele Falzone ◽

Rajeshwari Kalyanaraman ◽

Kevin M Elias

Keyword(s):

Adjuvant Chemotherapy ◽

Cytoreductive Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Oncology ◽

Multivariate Logistic Regression Analysis ◽

Gynecologic Cancers ◽

Oncology Treatment ◽

American Society ◽

Eras Protocol

ObjectiveThe objective of this study was to determine whether the implementation of an enhanced recovery after surgery (ERAS) protocol is associated with earlier return to intended oncology treatment following interval cytoreductive surgery for advanced gynecologic cancers.MethodsParticipants comprised consecutive patients (n=278) with a preoperative diagnosis of stage IIIC or IV ovarian cancer, divided into those that received treatment before versus after implementation of an ERAS protocol at our institution. All patients received at least three cycles of neoadjuvant chemotherapy with a platinum based regimen and underwent interval cytoreduction via laparotomy with the intent to deliver additional cycles of chemotherapy postoperatively. The primary outcome was defined as the timely return to intended oncologic treatment, defined as the percentage of patients initiating adjuvant chemotherapy within 28 days postoperatively.ResultsThe study cohorts included 150 pre-ERAS patients and 128 post-ERAS patients. Median age was 65 years (range 58–71). Most patients (211; 75.9%) had an American Society of Anesthesiologists score of 3, and the median operative time was 174 min (range 137–219). Median length of stay was 4 days (range 3–5 days) in the pre-ERAS cohort versus 3 days (range 3–4) in the post-ERAS cohort (p<0.0001). At 28 days after operation, 80% of patients had resumed chemotherapy in the post-ERAS cohort compared with 64% in the pre-ERAS cohort (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.36 to 3.84; p=0.002). In multivariate logistic regression analysis, the ERAS protocol was the strongest predictor of timely return to intended oncology treatment (OR 10.18, 95% CI 5.35 to 20.32).ConclusionAn ERAS protocol for gynecologic oncology patients undergoing interval cytoreductive surgery is associated with earlier resumption of adjuvant chemotherapy.

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Psychological influences on wound healing

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.312-314 ◽

2019 ◽

Vol 98 (8) ◽

pp. 312-314

Keyword(s):

Wound Healing ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Wound Complications ◽

State Of Mind ◽

Life Threatening ◽

Psychological Influences ◽

Fear And Anxiety ◽

Care Costs

Surgical wound complications remain a major cause of morbidity; although usually not life threatening, they reduce the quality of life. They are also associated with excessive health care costs. Wound healing is affected by many factors – wound characteristics, infection, comorbidities and nutritional status of the patient. In addition, though, psychological stress and depression may decrease the inflammatory response required for bacterial clearance and so delay wound healing, as well. Although the patient´s state of mind can be influenced only to a certain extent, we should nevertheless stick to ERAS (Enhanced Recovery After Surgery) guidelines and try to diminish fear and anxiety by providing enough information preoperatively, pay due attention to postoperative analgesia and seek to provide an agreeable environment.

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