scholarly journals Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis

2021 ◽  
Author(s):  
Jacopo Weindelmayer ◽  
Valentina Mengardo ◽  
Angela Gasparini ◽  
Michele Sacco ◽  
Lorena Torroni ◽  
...  
Keyword(s):  
Propensity Score ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Neoadjuvant Treatment ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
The West ◽  
Median Reduction ◽  
Eras Protocol

Abstract Background Data on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center. Methods We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables. Results Compliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively. Conclusions ERAS for gastrectomy improved patients’ recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.

scholarly journals P-P34 Impact of an Enhanced Recovery After Surgery Protocol on Short-Term Outcomes in Elderly Patients Undergoing Pancreaticoduodenectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Syed Soulat Raza ◽  
Anisa Nutu ◽  
Sarah Powell-Brett ◽  
Amanda Carvalheiro Boteon ◽  
James Hodson ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Small Sample ◽  
Old Patients ◽  
Entire Cohort ◽  
Eras Protocol

Abstract Background In an effort to improve postoperative recovery and reduce complications, enhanced recovery after surgery (ERAS) pathways have been  introduced across a range of surgical disciplines. The demographics of patients being considered for PD have evolved over recent decades, with older patients undergoing increasingly more complex procedures. The feasibility and benefits of an ERAS protocol for elderly patients undergoing PD is debated, a recent study suggesting that age over 70 years is an independent risk factor for protocol failure . Existing studies on ERAS after PD in elderly patients are limited by small sample sizes and failure to include a pre-ERAS control. Methods 830 consecutive patients who underwent PD between January 2009 and March 2019 were divided according to age: elderly (≥75 years) vs. non-elderly patients (<75 years). Within each age group, cohort characteristics and outcomes were compared between patients treated pre- and post-ERAS (ERAS was systematically introduced in December 2012). Univariable and multivariable analysis were then performed, to assess whether ERAS was independently associated with length of hospital stay (LOS). Results Of the entire cohort, 577 of 830 patients (69.5%) were managed according to an ERAS protocol, and 170 patients (20.5%) were aged ≥ 75 years old. Patients treated post-ERAS were significantly more comorbid than those pre-ERAS, with a mean Charlson Comorbidity Index of 4.6 vs. 4.1 (p < 0.001) and 6.0 vs. 5.7 (p = 0.039) for the non-elderly and elderly subgroups, respectively. There were significantly fewer medical complications in non-elderly patients treated post-ERAS compared to pre-ERAS (12.4% vs. 22.4%; p = 0.002), but not in elderly patients (23.6% vs. 14.0%; p = 0.203). On multivariable analysis, ERAS was independently associated with reduced LOS in both elderly (14.8% reduction, 95% CI: 0.7-27.0%, p = 0.041) and non-elderly patients (15.6% reduction, 95%CI: 9.2-21.6%, p < 0.001), with the effect size being similar in each group. Conclusions ERAS protocol can be safely applied to patients undergoing pancreaticoduodenectomy irrespective of age. ERAS is associated with a significant reduction in postoperative LOS in elderly and non-elderly patients, despite higher comorbidity in the post-ERAS period.

The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair

2019 ◽  
Vol 34 (10) ◽  
pp. 4638-4644 ◽  
Author(s):  
Walker Ueland ◽  
Seth Walsh-Blackmore ◽  
Michael Nisiewicz ◽  
Daniel L. Davenport ◽  
Margaret A. Plymale ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hospital Stay ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Eras Protocol

scholarly journals Prevalence and Consequences of Preoperative Weight Loss in Gynecologic Surgery

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1094 ◽  
Author(s):  
Basile Pache ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Amaniel Kefleyesus ◽  
Patrice Mathevet ◽  
...  
Keyword(s):  
Weight Loss ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Preoperative Weight Loss ◽  
Nutritional Screening ◽  
Preoperative Weight ◽  
Eras Protocol ◽  
Extensive Surgery

Preoperative malnutrition and weight loss negatively impact postoperative outcomes in various surgical fields. However, for gynecologic surgery, evidence is still scarce, especially if surgery is performed within enhanced recovery after surgery (ERAS) pathways. This study aimed to assess the prevalence and impact of preoperative weight loss in patients undergoing major gynecologic procedures within a standardized ERAS pathway between October 2013 and January 2017. Out of 339 consecutive patients, 33 (10%) presented significant unintentional preoperative weight loss of more than 5% during the 6 months preceding surgery. These patients were less compliant to the ERAS protocol (>70% of all items: 70% vs. 94%, p < 0.001) presented more postoperative overall complications (15/33 (45%) vs. 69/306 (22.5%), p = 0.009), and had an increased length of hospital stay (5 ± 4 days vs. 3 ± 2 days, p = 0.011). While patients experiencing weight loss underwent more extensive surgical procedures, after multivariate analysis, weight loss ≥5% was retained as an independent risk factor for postoperative complications (OR 2.44; 95% CI 1.00–5.95), and after considering several surrogates for extensive surgery including significant blood loss (OR 2.23; 95% CI 1.15–4.31) as confounders. The results of this study suggest that systematic nutritional screening in ERAS pathways should be implemented.

scholarly journals P.233 Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol for Scheduled Spine Surgery

2021 ◽  
Vol 48 (s3) ◽  
pp. S87-S88
Author(s):  
J Smith-Forrester ◽  
R Greene ◽  
S Christie
Keyword(s):  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Current System ◽  
Length Of Hospital Stay ◽  
Care Program ◽  
Cost Of Care ◽  
Operative Care ◽  
Eras Protocol ◽  
Future Work

Background: Enhanced Recovery After Surgery (ERAS) Protocols improve post-surgical outcomes through decreased length of hospital stay, reduced readmission rates, decreased post-operative pain, and greater patient satisfaction. ERAS also has significant benefits to the healthcare system through reduced cost of post-operative care. While ERAS protocols are well established in many surgical fields, a complete guideline for spine surgery is lacking. Early ERAS studies in spine surgery suggest up to a 50% reduction in length of stay (LOS) and decreased cost of care. Methods: Primary literature review followed by multidisciplinary critical appraisal for optimization and redesign of our current system of care for scheduled spine surgery (SSS), including patient experience and team logistics from initial consultation through post-operative care and follow up. Results: An evidence-based guideline, optimizing pre-, intra-, and post-operative phases of care was developed. Specific focus catered to pre-operative education and patient barriers to discharge. Further improvements in pre-admission patient goal setting, introduction of a patient care “passport”, post-operative reduction in narcotic administration, and increased same day post-operative mobilization were means to reduce LOS. Conclusions: A spine ERAS pathway was developed, allowing our care program to better facilitate patient recovery after SSS. Future work will aim to determine economic impact of the pathway.

scholarly journals Defining postoperative ileus and associated risk factors in patients undergoing radical cystectomy with an Enhanced Recovery After Surgery (ERAS) program

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Connor M. Forbes ◽  
Ali Cyrus Chehroudi ◽  
Miles Mannas ◽  
Andrea Bisaillon ◽  
Tracey Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Radical Cystectomy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Hospital Length Of Stay ◽  
Eras Protocol

Introduction: Postoperative ileus (POI) is a common complication of radical cystectomy (RC), occurring in 1.6–23.5% of cases. It is defined heterogeneously in the literature. POI increases hospital length of stay and postoperative morbidity. Factors such as age, epidural use, length of procedure, and blood loss may impact POI. In this study, we aimed to evaluate risk factors that contribute to POI in a cohort of patients managed with a comprehensive Enhanced Recovery After Surgery (ERAS) protocol. Methods: A retrospective review of consecutive patients who underwent RC from March 2015 to December 2016 at Vancouver General Hospital was performed. POI was defined a priori as insertion of nasogastric tube for nausea or vomiting, or failure to advance to a solid diet by the seventh postoperative day. To illustrate heterogeneity in previous studies, we also evaluated POI using other previously reported definitions in the RC literature. The influence of potential risk factors for POI, including patient comorbidities, American Society of Anesthesiologists score, gender, age, prior abdominal surgery or radiation, length of operation, diversion type, extent of lymph node dissection, removal date of analgesic catheter, blood loss, and fluid administration volume was analyzed. Results: Thirty-six (27%) of 136 patients developed POI. Using other previously reported definitions for POI, the incidence ranged from <1–51%. Node positive status and age at surgery were associated with POI on univariate analysis but not multivariable analysis. Conclusions: A large range of POI incidence was observed using previously published definitions of POI. We advocate for a standardized definition of POI when evaluating RC outcomes. POI occurs frequently even with a comprehensive ERAS protocol, suggesting that additional measures are needed to reduce the rate of POI.

scholarly journals Is It Possible to Maintain High Compliance with the Enhanced Recovery after Surgery (ERAS) Protocol?—A Cohort Study of 400 Consecutive Colorectal Cancer Patients

2018 ◽  
Vol 7 (11) ◽  
pp. 412 ◽  
Author(s):  
Magdalena Pisarska ◽  
Natalia Gajewska ◽  
Piotr Małczak ◽  
Michał Wysocki ◽  
Piotr Major ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Short Term ◽  
Entire Study ◽  
High Compliance ◽  
Eras Protocol ◽  
Mean Compliance

The aim of our study was to evaluate the implementation and degree of adherence to the Enhanced Recovery after Surgery (ERAS) protocol in a group of 400 patients operated laparoscopically for colorectal cancer, and to assess its impact on the short-term results. The prospective study included patients with histologically confirmed colorectal cancer undergoing elective laparoscopic resection from years 2012 to 2017. For the purpose of further analysis, patients were divided into four groups: 100 consecutive patients were in each group. There were no statistically significant differences between groups in demographic parameters. The mean compliance with the ERAS protocol in the entire study group was 84.8%. Median adherence differed between the groups 76.9% vs. 92.3% vs. 84.6% vs. 84.6%, respectively (p < 0.0001). There were statistically significant differences between groups in the tolerance of oral diet (54% vs. 83% vs. 83% vs. 64%) and mobilization (74% vs. 92% vs. 91% vs. 94%) on the first postoperative day. In subsequent groups, time to first flatus decreased (2.5 vs. 2.1 vs. 2.0 vs. 1.7 days, p = 0.0001). There were no statistical differences in the postoperative morbidity rate between groups (p = 0.4649). The median length of hospital stay in groups was 5 vs. 4 vs. 4 vs. 4 days, respectively (p = 0.0025). Maintaining high compliance with the ERAS protocol is possible, despite the slight decrease that occurs within a few years after its implementation. This decrease in compliance does not affect short-term results, which are comparable to those shortly after overcoming the learning curve.

scholarly journals Swiss Validation of the Enhanced Recovery After Surgery (ERAS) Database

2021 ◽  
Author(s):  
Basile Pache ◽  
David Martin ◽  
Valérie Addor ◽  
Nicolas Demartines ◽  
Martin Hübner
Keyword(s):  
Missing Data ◽  
Large Scale ◽  
Urinary Catheter ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Prospective Audit ◽  
Audit System ◽  
Validation Criteria ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet. Methods Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15–20). Results Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables “urinary catheter removal” (16.4%) and “mobilization on day 1” (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria. Conclusion EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset.

scholarly journals The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tshering Tamang ◽  
Tashi Wangchuk ◽  
Choning Zangmo ◽  
Tshering Wangmo ◽  
Karma Tshomo
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Care Program ◽  
Postoperative Recovery ◽  
Successful Implementation ◽  
Hospital Data ◽  
Postoperative Length ◽  
Eras Protocol

Abstract Background Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care program to optimize and enhance postoperative recovery. It has a beneficial role in decreasing the length of hospital stay and improving the quality of care. This study aims to observe the successful implementation of ERAS in reducing the length of hospital stay (LOS) among caesarean deliveries. Methods A pre-and post-implementation study of ERAS protocol was conducted, among cohort of women who underwent caesarean deliveries from January to December 2020 in the Department of Obstetrics and Gynaecology, Mongar Regional Referral hospital. Data collected retrospectively and analyzed in SPSS (IBM SPSS trial version); and comparison of length of hospital stay between the two groups were tested by t-test. Results One hundred seventy-one patients were included in the study: 87 in the pre-ERAS and 84 in the post-ERAS cohort. Post implementation, LOS decreased by an average of 21.0 (CI 16.11–24.64; p-value < 0.001) hours in the postoperative period. A greater proportion of patients were discharged on day-2 (2.3% in pre-ERAS and 81% in ERAS; p-value < 0.001). Conclusion Implementation of ERAS protocol can significantly decrease the postoperative length of hospital stay without increasing the complications and readmission rates.

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