Importance of Enhanced Recovery After Surgery (ERAS) Protocol Compliance for Length of Stay in Ovarian Cancer Surgery

Abstract Purpose Major surgery for ovarian cancer is associated with significant morbidity. Recently, guidelines for perioperative care in gynecologic oncology with a structured “Enhanced Recovery after Surgery (ERAS)” program were presented. Our aim was to evaluate if implementation of ERAS reduces postoperative complications in patients undergoing extensive cytoreductive surgery for ovarian cancer. Methods 134 patients with ovarian cancer (FIGO I-IV) were included. 47 patients were prospectively studied after implementation of a mandatory ERAS protocol (ERAS group) and compared to 87 patients that were treated before implementation (pre-ERAS group). Primary endpoints of this study were the effects of the ERAS protocol on postoperative complications and length of stay in hospital. Results Preoperative and surgical data were comparable in both groups. Only the POSSUM score was higher in the ERAS group (11.8% vs. 9.3%, p < 0.001), indicating a higher surgical risk in the ERAS group. Total number of postoperative complications (ERAS: 29.8% vs. pre-ERAS: 52.8%, p = 0.011), and length of hospital stay (ERAS: 11 (6–23) vs pre-ERAS: 13 (6–50) days; p < 0.001) differed significantly. A lower fraction of patients of the ERAS group (87.2%) needed postoperative admission to the ICU compared to the pre-ERAS group (97.7%), p = 0.022). Mortality within the ERAS group was 0% vs. 3.4% (p = 0.552) in the pre-ERAS group. Conclusion The implementation of a mandatory ERAS protocol was associated with a lower rate of postoperative complications and a reduced length of stay in hospital. If ERAS has influence on long-term outcome needs to be further evaluated.

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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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Randomised controlled trial confirms benefit of enhanced recovery after surgery on length of stay in ovarian cancer: How low can we go?

European Journal of Cancer ◽

10.1016/j.ejca.2020.08.015 ◽

2020 ◽

Vol 139 ◽

pp. 90-91

Author(s):

Steven Bisch ◽

Gregg Nelson

Keyword(s):

Ovarian Cancer ◽

Randomised Controlled Trial ◽

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Randomised Controlled

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Implementation of an ERAS Pathway in Colorectal Surgery

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0038-1676474 ◽

2019 ◽

Vol 32 (02) ◽

pp. 102-108 ◽

Cited By ~ 9

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.

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Enhanced recovery after surgery (ERAS) in clinical practice

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i3.1287 ◽

2020 ◽

Vol 24 (3) ◽

Author(s):

Robert Leger ◽

Jon Livelsberger ◽

Ashish Sinha

Keyword(s):

Clinical Practice ◽

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Evidence Based ◽

Wide Spread ◽

Postsurgical Complications ◽

Protocol Compliance ◽

Care Practices ◽

Multidisciplinary System

‘Enhanced Recovery After Surgery’ (ERAS) protocols are an evidence-based, multidisciplinary system for patient care that— since its emergence in 2001— has shown remarkable efficacy in reducing surgical complications, shortening length of stay (LoS), and the incidence of hospital re-admission. Unfortunately, wide spread acceptance of ERAS has been slow, as it conflicts with some traditional perioperative care practices. However, with protocol compliance >70%, studies have shown significant reduction in mortality and postsurgical complications, with 30-50% reduction in LoS and approximately a 50% reduction in complications.

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Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

BMC Anesthesiology ◽

10.1186/s12871-021-01509-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yiwei Shen ◽

Feng Lv ◽

Su Min ◽

Gangming Wu ◽

Juying Jin ◽

...

Keyword(s):

Patient Satisfaction ◽

Postoperative Complications ◽

Length Of Stay ◽

Postoperative Complication ◽

Patient Experience ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Early Mobilization ◽

Urinary Drainage ◽

Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) pathways have been shown to improve clinical outcomes after surgery. Considering the importance of patient experience for patients with benign surgery, this study evaluated whether improved compliance with ERAS protocol modified for gynecological surgery which recommended by the ERAS Society is associated with better clinical outcomes and patient experience, and to determine the influence of compliance with each ERAS element on patients’ outcome after benign hysterectomy. Methods A prospective observational study was performed on the women who underwent hysterectomy between 2019 and 2020. A total of 475 women greater 18 years old were classified into three groups according to their per cent compliance with ERAS protocols: Group I: < 60% (148 cases); Group II:≥60 and < 80% (160 cases); Group III: ≥80% (167 cases). Primary outcome was the 30-day postoperative complications. Second outcomes included QoR-15 questionnaire scores, patient satisfaction on a scale from 1 to 7, and length of stay after operation. After multivariable binary logistic regression analyse, a nomogram model was established to predict the incidence of having a postoperative complication with individual ERAS element compliance. Results The study enrolled 585 patients, and 475 completed the follow-up assessment. Patients with compliance over 80% had a significant reduction in postoperative complications (20.4% vs 41.2% vs 38.1%, P < 0.001) and length of stay after surgery (4 vs 5 vs 4, P < 0.001). Increased compliance was also associated with higher patient satisfaction and QoR-15 scores (P < 0.001),. Among the five dimensions of the QoR-15, physical comfort (P < 0.05), physical independence (P < 0.05), and pain dimension (P < 0.05) were better in the higher compliance groups. Minimally invasive surgery (MIS) (P < 0.001), postoperative nausea and vomiting (PONV) prophylaxis (P < 0.001), early mobilization (P = 0.031), early oral nutrition (P = 0.012), and early removal of urinary drainage (P < 0.001) were significantly associated with less complications. Having a postoperative complication was better predicted by the proposed nomogram model with high AUC value (0.906) and sensitivity (0.948) in the cohort. Conclusions Improved compliance with the ERAS protocol was associated with improved recovery and better patient experience undergoing hysterectomy. MIS, PONV prophylaxis, early mobilization, early oral intake, and early removal of urinary drainage were of concern in reducing postoperative complications. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019178. Registered on 30/10/2018.

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Reduction of Postoperative Opioid Use After Elective Spine and Peripheral Nerve Surgery Using an Enhanced Recovery After Surgery Program

Pain Medicine ◽

10.1093/pm/pnaa233 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3283-3291

Author(s):

Tracy M Flanders ◽

Joseph Ifrach ◽

Saurabh Sinha ◽

Disha S Joshi ◽

Ali K Ozturk ◽

...

Keyword(s):

Length Of Stay ◽

Peripheral Nerve ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Foley Catheter ◽

Control Group ◽

Opioid Use ◽

Historical Cohort ◽

Eras Protocol ◽

Nerve Surgery

Abstract Objective Enhanced recovery after surgery (ERAS) pathways have previously been shown to be feasible and safe in elective spinal procedures. As publications on ERAS pathways have recently emerged in elective neurosurgery, long-term outcomes are limited. We report on our 18-month experience with an ERAS pathway in elective spinal surgery. Methods A historical cohort of 149 consecutive patients was identified as the control group, and 1,141 patients were prospectively enrolled in an ERAS protocol. The primary outcome was the need for opioid use one month postoperation. Secondary outcomes were opioid and nonopioid consumption on postoperative day (POD) 1, opioid use at three and six months postoperation, inpatient pain scores, patient satisfaction scores, postoperative Foley catheter use, mobilization/ambulation on POD0–1, length of stay, complications, and intensive care unit admissions. Results There was significant reduction in use of opioids at one, three, and six months postoperation (38.6% vs 70.5%, P < 0.001, 36.5% vs 70.9%, P < 0.001, and 23.6% vs 51.9%, P = 0.008) respectively. Both groups had similar surgical procedures and demographics. PCA use was nearly eliminated in the ERAS group (1.4% vs 61.6%, P < 0.001). ERAS patients mobilized faster on POD0 compared with control (63.5% vs 20.7%, P < 0.001). Fewer patients in the ERAS group required postoperative catheterization (40.7% vs 32.7%, P < 0.001). The ERAS group also had decreased length of stay (3.4 vs 3.9 days, P = 0.020). Conclusions ERAS protocols for all elective spine and peripheral nerve procedures are both possible and effective. This standardized approach to patient care decreases opioid usage, eliminates the use of PCAs, mobilizes patients faster, and reduces length of stay.

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Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000622 ◽

2019 ◽

Vol 29 (9) ◽

pp. 1417-1424 ◽

Cited By ~ 8

Author(s):

Maria D Iniesta ◽

Javier Lasala ◽

Gabriel Mena ◽

Andrea Rodriguez-Restrepo ◽

Gloria Salvo ◽

...

Keyword(s):

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Surgery ◽

Complication Rates ◽

Operative Outcomes ◽

Tertiary Center ◽

Operative Complications ◽

Eras Protocol ◽

Post Operative Complications

ObjectiveThe aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and re-operations) in gynecologic surgery at a tertiary center.MethodsWe included 584 patients who had open gynecologic surgery between November 1, 2014 and December 31, 2016. Patients were categorized into subgroups according to their date of surgery from the time of the ERAS protocol implementation. Patients were categorized by their per cent compliance into two groups:<80% versus ≥80%. We analyzed compliance with the elements of the protocol over time and its relation with post-operative outcomes, length of stay, post-operative complications, readmission, and re-operations rates. We modeled the probability of having a post-operative complication within 30 days of surgery as a function of overall compliance.ResultsOverall compliance was 72.3%. Patients with compliance ≥80% had significantly less complications (P<0.001) and shorter length of stay (P<0.001). Readmission and re-operation rates were not impacted by compliance (P=0.182, P=0.078, respectively). Avoidance of salt water overload, early mobilization, early oral nutrition, and early removal of Foley catheter were significantly associated with less post-operative complications within 30 days.ConclusionsCompliance with an ERAS pathway exceeding 80% was associated with lower complication rates and shorter length of stay without impacting on re-operations or readmissions.

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Successful Implementation of Enhanced Recovery After Surgery in a Single-Surgeon Bariatric Practice

The American Surgeon ◽

10.1177/00031348211033532 ◽

2021 ◽

pp. 000313482110335

Author(s):

Hung-Chieh Lo

Keyword(s):

Gastric Bypass ◽

Length Of Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Operation Time ◽

Successful Implementation ◽

Low Volume ◽

Eras Protocol ◽

And Control

The feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. Retrospectively, review patients undergoing bariatric surgeries between 2015 and 2018 were included, and those receiving non-primary procedures or with BMI <32.5 kg/m2 were excluded. Demographics and 30-day outcomes were collected and compared between the ERAS (2017-2018) and control (2015-2016) groups. 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS. No differences in baseline demographics, except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min) and shortened length of stay (2.6 days vs. 3.3 days) were observed with no increment of ER visits, readmissions (1.1% vs. 4.8%), or total complications between the groups (5.5% vs. 9.7%). Unselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and shortened LOS without increased complications.

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