Enhanced recovery after surgery protocol versus conventional care in emergency abdominal trauma surgery: a prospective, randomised, controlled study

Background: Since 1990s there has been a defined role of ERAS in elective surgeries, to optimize the peri-operative care, reducing post-operative complications and length of stay and hence, the overall costs. However, there is paucity of literature in its effectiveness in emergency trauma surgeries. The aim of the study was to investigate the feasibility and outcomes of ERAS protocol in emergency abdominal surgery in the setting of trauma.Methods: Institutional IEC approved study. A prospective randomized of 52 patients with abdominal trauma undergoing emergency laprotomy were included in the study and divided into two groups: ERP and conventional group. The ERP included early feeding, early urinary catheter removal, early mobilization/physiotherapy, early intravenous line removal and early optimal oral analgesia. The primary end-points were the length of hospital stay and secondary end-points included complication rate and re-admission rate.Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS score. Hospital stay was significantly shorter in the ERAS group: 4.67 days verses 13.36 days (p<0.001). There were 15 and 11 complications in the control and study group respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p=0.306).Conclusions: This study shows that early recovery programs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing emergency laparotomy for abdominal trauma.

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RA03.03: THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) ON PATIENTS UNDERGOING OESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra03.03 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 23-23

Author(s):

Barry Dent ◽

Jillian Sturrock ◽

Janine Mckenna ◽

Claire Taylor ◽

Helen Jaretzke ◽

...

Keyword(s):

Hospital Stay ◽

Conflicts Of Interest ◽

Positive Impact ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Complication Rates ◽

Early Recovery ◽

Significant Difference ◽

The Impact ◽

Multi Disciplinary Team

Abstract Background Enhanced recovery after surgery (ERAS) is defined as a multimodal care pathway designed to achieve early recovery for patients undergoing surgery. For patients undergoing oesophagectomy such pathways are complex and must involve a wide multi-disciplinary team. The importance of peri-operative nutrition is especially relevant in this patient group. We describe our experience of the impact of an ERAS pathway in a high volume oesophago-gastric unit on both short and medium term patient outcomes. Methods Consecutive patients undergoing open 2 phase subtotal oesophagectomy with two field lymphadenectomy in a 12 month period following the introduction of an ERAS pathway were included in the study. Outcomes were compared with consecutive patients undergoing the same procedure over a 12 month period prior to the introduction of the ERAS pathway. All patients were treated in a single UK unit. Adherence to the ERAS pathway was monitored by a dedicated ERAS coordinator. All data were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test for continuous and Chi2 for categorical data. Results 189 patients were included (97 pre-ERAS and 92 ERAS). There were no demographic differences between the patient groups. The rate of severe post-operative complications (Accordion score 3 + ) was identical between groups (29%). Median length of hospital stay was significantly reduced with ERAS (10 days v 14 days pre-ERAS (P < 0.001)) as was the total readmission rate (21% v 39% P = 0.006). Weight loss following surgery was significantly reduced with ERAS. At 2 weeks 1% of patients had lost over 10% of their pre-operative weight compared with 32% pre-ERAS (P < 0.001). A significant difference was maintained at 6 weeks (9% v 55%), 3 months (19% v 66%) and 6 months (35% v 71%). Conclusion Our results demonstrate the positive impact of ERAS for patients undergoing oesophagectomy. Despite no reduction in post-operative complication rates, both hospital stay and readmission rates were reduced, suggesting a positive impact of ERAS on patients’ response to complications. Far fewer patients were readmitted for nutritional reasons/failure to thrive following the introduction of ERAS. Implementing an ERAS pathway requires a dedicated multi-disciplinary team to provide the required peri-operative care both in the hospital and community. Disclosure All authors have declared no conflicts of interest.

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

BMC Neurology ◽

10.1186/s12883-021-02150-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anirudh Elayat ◽

Sritam S. Jena ◽

Sukdev Nayak ◽

R. N. Sahu ◽

Swagata Tripathy

Keyword(s):

Randomized Controlled Trial ◽

Glycemic Control ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Early Recovery ◽

Randomized Controlled ◽

Pain Scores ◽

High Dependency

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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Nondrainage after Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis Does Not Increase the Postoperative Morbidity

BioMed Research International ◽

10.1155/2018/8436749 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Jianguo Qiu ◽

Ming Li

Keyword(s):

Laparoscopic Cholecystectomy ◽

Hospital Stay ◽

Postoperative Recovery ◽

End Points ◽

Acute Calculous Cholecystitis ◽

Vas Score ◽

Estimated Blood Loss ◽

Number Of Patients ◽

Significant Difference ◽

Calculous Cholecystitis

Background. It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage.Methods. Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result.Results. There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P=0.03 andP= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p<0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome.Conclusion. Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

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Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy

Journal of Nepal Medical Association ◽

10.31729/jnma.2699 ◽

2015 ◽

Vol 53 (197) ◽

pp. 24-27 ◽

Cited By ~ 2

Author(s):

Rajeev Bhandari ◽

You Yong-hao

Keyword(s):

Pleural Effusion ◽

Hospital Stay ◽

Chest Tube ◽

Enhanced Recovery ◽

Task Force ◽

Length Of Hospital Stay ◽

Control Group ◽

Tube Removal ◽

Significant Difference ◽

Chest Tube Removal

Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient.Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS). The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them.Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group（p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups（p＞0.05).Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.

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Regional Anaesthesia in Enhanced Recovery After Surgery Pathways – A Quintessential Component

10.13107/ijra.2021.v02i02.033 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Abhijit S. Nair ◽

Sandeep Diwan

Keyword(s):

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Care Pathway ◽

Early Discharge ◽

Major Surgery ◽

Emergency Laparotomy ◽

Early Recovery ◽

Recovery Pathways ◽

Perioperative Care Pathway ◽

The Cost

Enhanced recovery after surgery (ERAS) is a multimodal, perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. [1] Initially described by Henry Kehlet in 1995 for colonic surgeries, the enhanced recovery pathways have now evolved and are now validated for more than 30 different types of surgery which include but are not limited to emergency laparotomy, neonatal surgeries, and lower segment cesarean sections. [2] Not only is the patient benefited from this by having an enhanced recovery and early discharge from the hospital, the cost of treatment is reduced and also leads to more turnover of patients thereby reducing the waiting list of patients scheduled for various surgeries. [3]

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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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Enhanced recovery care versus traditional non- ERAS care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

10.21203/rs.2.21179/v2 ◽

2020 ◽

Author(s):

Jin Li ◽

Saroj Rai ◽

Renhao Ze ◽

Xin Tang ◽

Ruikang Liu ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Perioperative Complications ◽

Length Of Hospital Stay ◽

Developmental Dysplasia ◽

Control Group ◽

Postoperative Fever ◽

Vas Score ◽

Significant Difference ◽

Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

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Early recovery after surgery in elective obstetrics-gynaecology surgeries: prospective single-center pilot study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212166 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2302

Author(s):

Ritu V. Jain ◽

Vaibhav Jain

Keyword(s):

Pilot Study ◽

Postoperative Complications ◽

Hospital Stay ◽

Urinary Catheter ◽

Enhanced Recovery ◽

Statistical Significance ◽

Catheter Removal ◽

Control Group ◽

Early Recovery ◽

Oral Analgesia

Background: Enhanced recovery after surgery (ERAS) programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased hospital stay without increase in postoperative complications. The aim of the study was to explore role and benefits, if any, of ERAS/ERP (early recovery protocols) implemented in patients undergoing elective obstetrics-gynaecological surgeries.Methods: Prospective cohort of 48 consecutive patients undergoing elective obstetrics-gynaecological surgeries were included. ERP included early feeding, urinary catheter removal, mobilisation/physiotherapy, intravenous line removal and optimal oral analgesia. This was compared to control group of 50 patients undergoing similar operations prior to introduction of ERP, SPC group-standard perioperative care. Demographics and indications of surgeries were similar for both groups. The primary end-points were length of stay (LOS) and incidence of complications (Clavien-Dindo classification). Difference in means was tested using the t test assuming unequal variances. Statistical significance was defined as p<0.05.Results: Two groups, A (non-ERAS/SPC) and B (ERAS) were comparable with regards to demographics and indication of surgery. The mean time to solid diet, urinary catheter removal, mobilization, iv fluid removal and shift to oral analgesia was 2.57, 1.13 (p<0.00001), 1.99 ,1.03 (p<0.00268), 1.63, 1.2 (p<0.00001), 1.72, 1.14 (p<0.00001), 1.8, 1.37 (p<0.00001) days respectively. There were 31 and 21 complications in both groups, respectively (p<0.0097). Hospital stay was significantly shorter in the ERAS group, 2.87, 2.61 (p<0.0378).Conclusions: This pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without increase in postoperative complications in elective obstetrics-gynecology patients.

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Recovery Pattern in Different Surgical Approaches on Thoracic Enhanced Recovery based Fourteen-Step Protocol in Patients Undergoing Cardio-thoracic Surgery at University Hospital of Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v18i2.33260 ◽

2020 ◽

Vol 18 (2) ◽

pp. 78-82

Author(s):

R.M. Karmacharya ◽

R. Shakya ◽

A.K. Singh ◽

S. Baidya ◽

S. Dahal ◽

...

Keyword(s):

Thoracic Surgery ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

University Hospital ◽

Early Recovery ◽

Video Assisted Thoracic Surgery ◽

Icu Stay ◽

Video Assisted ◽

Surgery Group

Background Cardio-thoracic surgery involves open and minimally invasive techniques. Enhanced recovery after surgery is used for early recovery from surgery. Enhanced recovery after surgery decreases hospital stay duration. Patients undergoing Enhanced recovery after surgery after video assisted thoracic surgery use less pain killers and have less hospital cost. There has not been any study on outcomes on patient who follow physiotherapy protocol designed in our setting. Objective To find the physiotherapy outcomes in patients undergoing thoracic enhanced recovery after surgery (T-ERAS) based 14 step protocol locally designed at Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH). Method This is a retrospective cross sectional observational study. All the cases who underwent cardiothoracic surgery were classified based on the approach of chest surgery performed into groups Sternotomy, Thoracotomy and Video Assisted Thoracic Surgery (VATS) groups. Patients were advised for Thoracic Enhanced recovery after surgery based on the protocol that has been devised at Dhulikhel Hospital. The recovery of patients based on activities they could perform was noted and analyzed. Result Both ICU stay and hospital stay in number of days were highest in thoracotomy (6.04 days) group while that was lowest in video assisted thoracic surgery group (1.67 days). There is a similar recovery until step 5, i.e. 2 days and rapid progression in further steps in video assisted thoracic surgery group while it is much slower in both sternotomy and thoracotomy groups. Conclusion Postoperative mobilization and physiotherapy enhance early healing and decrease hospital stay. Mean hospital stay and ICU stay were shorter for video assisted thoracic surgery cases compared to Thoracotomy and Sternotomy groups and the mean days to achieve different steps varied within the protocol between groups compared.

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Enhanced recovery care versus traditional care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

10.21203/rs.2.21179/v1 ◽

2020 ◽

Author(s):

Jin Li ◽

Saroj Rai ◽

Renhao Ze ◽

Xin Tang ◽

Ruikang Liu ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Perioperative Complications ◽

Length Of Hospital Stay ◽

Developmental Dysplasia ◽

Care Group ◽

Vas Score ◽

Significant Difference ◽

Traditional Care ◽

Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children of developmental dysplasia of the hip (DDH) between ERAS and traditional care group.Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). Pain response was better in the ERAS group than traditional care group in terms of mean 3-day VAS score (2.9±0.8 vs. 4.0±0.8, P<0.001) and maximum VAS score (4.1±0.8 vs. 4.9±0.8, P<0.001). However, there was no significant difference in the frequency of break-out pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276 ). The frequency of fever is lower in the ERAS group, possibly due to better temperature monitoring and management in the operating room. The frequency of urinary infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

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