Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

2021 ◽  
Author(s):  
Shuaikang Wang ◽  
Peng Wang ◽  
Xiangyu Li ◽  
Wenzhi Sun ◽  
Chao Kong ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lumbar Fusion ◽  
Wound Dehiscence ◽  
Wound Complications ◽  
Rehabilitation Center ◽  
Postoperative Wound ◽  
Posterior Lumbar Fusion ◽  
The Relationship

Abstract Background. Wound complications were associated with worse satisfaction and additional costs in patients underwent posterior lumbar fusion(PLF) surgery ,the relationship between enhanced recovery after surgery(ERAS)pathway and wound complications remains poorly characterized.Methods. In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between ERAS program and the incidence of postoperative wound related complications and other complications following PLF surgery, other outcomes included the length of stay(LOS), 90-day hospital and rehabilitation center readmission.Results. Average patient age was 65yr. There were more patients with old cerebral infarction in ERAS group (p<0.01), other demographics and comorbidities were similar between both groups. Patients in ERAS group had a lower incidence of postoperative wound-related complications compared with non-ERAS group(12.4 vs 17.8%, p=0.02).The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing(6% vs 3%, p=0.02). ERAS group had a lower incidence of server postoperative hypoalbuminemia(serum albumin less than 30g/L)(15.8% vs 9.0% p<0.01).Additionally, ERAS patients had a shorter postoperative LOS (8.0±1.5 vs 9.5±1.7 p<0.01), lower rate of readmission within 90 days (1.9% vs 6.4%, p<0.01) and discharge to rehabilitation center (4.2% vs 1.0%, p<0.01).Conclusion. ERAS pathway may help to decrease the rates of postoperative wound complications and server hypoalbuminemia following PLF surgery, additionally, we demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90-day.

Psychological influences on wound healing

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.

21. Adoption of enhanced recovery after surgery (ERAS) protocol for lumbar fusion decreases in hospital postoperative opioid consumption

2021 ◽  
Vol 21 (9) ◽  
pp. S11
Author(s):  
Ehsan Jazini ◽  
Alexandra Thomson ◽  
Andre Sabet ◽  
Leah Y. Carreon ◽  
Rita Roy ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lumbar Fusion ◽  
Opioid Consumption ◽  
Eras Protocol

139. Adoption of enhanced recovery after surgery (ERAS) protocol for lumbar fusion decreases in-hospital postoperative opioid consumption

2020 ◽  
Vol 20 (9) ◽  
pp. S68
Author(s):  
Ehsan Jazini ◽  
Colin M. Haines ◽  
Lindsay Orosz ◽  
Niteesh Bharara ◽  
Thomas C. Schuler ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lumbar Fusion ◽  
Opioid Consumption ◽  
Eras Protocol

scholarly journals Enhanced Recovery After Surgery (Eras) Program for Elderly Patients With Short-level Lumbar Fusion

2020 ◽  
Author(s):  
Peng Wang ◽  
Qiang Wang ◽  
Chao Kong ◽  
Ze Teng ◽  
Zhongen Li ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Lumbar Fusion ◽  
Japanese Orthopaedic Association ◽  
Group Versus ◽  
Major Surgery ◽  
Fusion Surgery ◽  
The Mean

Abstract Background:Degenerative disorders of the lumbar spinedecrease the mobility and quality of life of elderly patients.Lumbar fusion surgery is the primary methodof treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly,resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery (ERAS) significantly improvedsatisfaction and outcomes in elderly patients(>65 years old) with short-level lumbar fusion.Methods:A total of 192 patients were included, 96 in the ERAS group and 96 case-matched patients in the non-ERAS group.Data including demographic, comorbidity and surgical informationwere collected from electronic medical records. ERAS interventionswere categorisedas preoperative,intraoperative and postoperative. We also evaluated primary outcome,surgicalcomplication, length of stay (LOS), postoperative pain scores and 30-day readmissionrates.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 Japanese Orthopaedic Association (JOA) score、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 92.1%. There were no significant differences inthe number of complicationsor themortality rates between the ERAS and non-ERAS groups. Furthermore, the mean postoperative JOA score、VAS for the back and legs,ODI and readmission ratesscore revealed no significant differencesbetween the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in LOS in the ERAS group (12.30±3.03 of ERAS group versus 15.50±1.88 in non-ERAS group, p=0).Multivariable linear regression showed thatcomorbidities (p=0.023) and implementation of ERAS program (p=0.002) were correlated with prolonged LOS.Multivariable logistic regression showed that no characteristics were associated with complications.Conclusions:This report describes the first ERAS protocol used in elderly patients after short-level lumbar fusion surgery. Our ERAS program is safe and could help decreases LOS in elderly patients with short-level lumbar fusion.

Enhanced Recovery After Surgery in Emergency Resection for Obstructive Colorectal Cancer: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Varut Lohsiriwat ◽  
Romyen Jitmungngan ◽  
Weeraput Chadbunchachai ◽  
Patompong Ungprasert
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complication ◽  
Lower Incidence ◽  
Primary Outcome ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Conventional Care ◽  
Obstructive Colorectal Cancer ◽  
Length Of Hospitalization ◽  
Emergency Resection

Abstract Background: Enhanced recovery after surgery (ERAS) improves outcomes after elective colorectal operations. Whether it is beneficial for emergency colorectal surgery is unclear. This study aimed to systematically review and summarize evidence from all studies comparing ERAS versus conventional care in patients having emergency colectomy and/or proctectomy for obstructive colorectal cancer.Methods: EMBASE and MEDLINE from inception to October 2019 were systematically searched. Any studies comparing our primary outcome of interest (length of hospitalization) among patients having emergency resection for obstructive colorectal cancer who received ERAS versus conventional care were selected. Primary outcome was length of hospitalization. Secondary outcomes were gastrointestinal recovery, postoperative complication, 30-day readmission and mortality, and time to start adjuvant therapy.Results: Three cohort studies with 818 participants (418 received ERAS and 400 received conventional care) were included. Length of hospitalization (mean reduction 3.07 days; 95% CI, - 3.91 to -2.23) and risk of overall postoperative complication (risk ratio 0.78; 95% CI, 0.63 to 0.97) were significantly lower in ERAS than in conventional care. ERAS was also associated with quicker time to gastrointestinal recovery, a lower incidence of ileus, and a shorter interval between operation and commence of adjuvant chemotherapy. There was no significant difference in the rates of anastomotic leakage, re-operation, readmission and mortality within 30 days after an operation between groups.Conclusions: ERAS had advantages over conventional care in patients undergoing emergency resection for obstructive colorectal cancer - including a shorter length of hospitalization, a lower incidence of complication and quicker gastrointestinal recovery.

Influence of Smoking on Wound Complications in Adults Undergoing Elective Posterior Lumbar Fusion

2015 ◽  
Vol 15 (10) ◽  
pp. S252
Author(s):  
Javier Guzman ◽  
Nathan J. Lee ◽  
John I. Shin ◽  
Dante M. Leven ◽  
Branko Skovrlj ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Wound Complications ◽  
Posterior Lumbar Fusion

Enhanced recovery after surgery protocols as a management strategy following major pancreatic surgery.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 396-396
Author(s):  
Lavanniya Kumar Palani Velu ◽  
Vishnuvardhan Chandrabalan ◽  
Ross Carter ◽  
Colin McKay ◽  
Nigel B Jamieson ◽  
...  
Keyword(s):  
Management Strategy ◽  
Pancreatic Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
Readmission Rates ◽  
Operative Morbidity ◽  
Positive Effects ◽  
Drain Removal ◽  
Eras Protocol

396 Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to have positive effects on lengths of stay (LOHS) and resource utilisation without a rise in readmission and post-operative morbidity rates in colorectal, hepatic and oesophago-gastric surgery. This study aimed to investigate the effects of an ERAS protocol on postoperative morbidity and readmission rates following pancreatic surgery in a tertiary referral centre. Methods: The perioperative care of patients undergoing pancreatic surgery was guided by a locally developed ERAS protocol incorporating pre-operative counselling and carbohydrate loading. Intra-thecal opiate and Patient Controlled Analgesia devices were utilised for postoperative analgesia. Supplemental intravenous fluid prescription was protocolised. Oral intake was restarted from post-operative day (PoD) 1 and escalated on an on-demand basis. Patients were mobilised from PoD 1 and escalated daily. Drain removal and step down care decisions were guided by serum markers and clinical progress. Results: 212 consecutive patients from 2010 to 2014 were included (conventional, N = 108, ERAS protocol, N = 104). 134 (63.2%) patients underwent pancreaticoduodenectomy, 41 (19.3%) patients underwent distal pancreatectomy, 11 (5.2%) patients underwent total pancreatectomy and the rest underwent palliative bypass or other procedures. There was a statistically significant reduction in the volume of supplemental intravenous fluids received with no significant renal impairment noted. Median LOHS was reduced to 10 days (Inter-quartile range [IQR] 7 – 19) from 16 days (IQR 12 – 26) (P < 0.001). Median critical care stay was reduced from 7 days (IQR 5 – 10) to 6 (IQR 4 -7) (P = 0.020). There was a statistically significant reduction in clinically significant wound complications (P = 0.019). There were no statistically significant increases in readmission rates, pancreas-specific or other generic post-operative morbidity rates. Conclusions: ERAS protocols are a viable peri-operative management strategy after major pancreatic surgery, and data suggests that LOHS can be reduced without an associated increase in readmission or post-operative morbidity rates.

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