A Clinical Observational Study on the Application of Enhanced Recovery After Laparoscopic Pancreaticoduodenectomy

Abstract Background: The safety and feasibility of enhanced recovery after surgery (ERAS) for laparoscopic pancreaticoduodenectomy (LPD) are unclear. The aim of this retrospective clinical study was to evaluate the impact of ERAS protocols for LPD.Methods: Between March 2016 and December 2018, a total of 34 consecutive patients with ERAS for LPD were prospectively enrolled and compared with 68 consecutive patients previously treated for non-ERAS after LPD during an equal time frame. The intraoperative and postoperative data were collected and comparatively analyzed. Results: The mean length of postoperative hospital stay (15.8±3.4 and 23.1±5.1 days, P<0.001) and total medical costs (¥14.3±4.8 x104 and ¥15.8±4.9 x104, P=0.017) were reduced significantly in ER group than those in non-ER group. The operation time (462.7±117.0 vs 450.9±109.8 min, P=0.627) and intraoperative blood loss (523.5±270.0 vs 537.5±241.8 mL, P=0.800) were similar in the two groups. The complications of patients with ERAS protocols were not increased (P>0.05). No difference in mortality and readmission rates was found.Conclusions: The ERAS is safe and effective in the perioperative period of LPD. It could effectively reduce the length of postoperative stay and medical costs, and does not increase the incidence of postoperative complications.

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The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001198 ◽

2018 ◽

Vol 28 (3) ◽

pp. 581-585 ◽

Cited By ~ 9

Author(s):

Alberto A. Mendivil ◽

Justin R. Busch ◽

David C. Richards ◽

Heather Vittori ◽

Bram H. Goldstein

Keyword(s):

Enhanced Recovery ◽

Gynecologic Oncology ◽

Hospital Costs ◽

Hospital Setting ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Readmission Rates ◽

Historical Cohort ◽

Eras Protocol ◽

The Impact

ObjectivesThe purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion.MethodsWe retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates.ResultsThere were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282).ConclusionsThe results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

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Enhanced recovery after surgery (ERAS) protocols is extremely beneficial in liver surgeries – A metaanalysis

10.1101/2020.04.11.20061689 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Blood Loss ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Hospital Costs ◽

Complete Recovery ◽

Morbidity And Mortality ◽

Readmission Rates ◽

Cochrane Database ◽

Stay Time ◽

The Impact

ABSTRACTBACKGROUNDEnhanced recovery after surgery (ERAS) programs aim to improve postoperative outcomes.. This metaanalysis aims to evaluate the impact of ERAS programmes on outcomes following liver surgeries.METHODSEMBASE, MEDLINE, PubMed and the Cochrane Database were searched for studies comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those patients receiving conventional care. The primary outcome was occurrence of 30 day morbidity and mortality. Secondary outcomes included length of stay, functional recovery, readmission rates,time to pass flatus,blood loss and hospital costs.RESULTSTen articles were included in the metaanalysis. 30 days morbidity and mortality was significantly less in ERAS group.Hospital stay, time to pass flatus, time to complete recovery and hospital costs were also significantly reduced due to ERAS protocols. Blood loss and readmission rates were also significantly less in ERAS group.CONCLUSIONSThe adoption of ERAS protocols significantly reduced morbidity, mortality hospital stay, readmission rates, time to recovery, hospital costs, time to pass flatus, blood loss and readmission rates.

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The effect of preoperative stoma training for patients undergoing colorectal surgery in an enhanced recovery programme

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0145 ◽

2020 ◽

Vol 102 (3) ◽

pp. 180-184 ◽

Cited By ~ 1

Author(s):

MJ Hughes ◽

W Cunningham ◽

S Yalamarthi

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Colorectal Resection ◽

Enhanced Recovery ◽

Interquartile Range ◽

Secondary Outcome ◽

Readmission Rates ◽

Stoma Formation ◽

Significant Difference ◽

The Impact

Introduction Stoma formation following colorectal resection is often anticipated prior to surgery. Becoming independent with stoma handling can sometimes delay discharge beyond achievement of discharge criteria. The aim of this study was to assess the impact of preoperative stoma training on length of stay. Methods Patients undergoing colorectal resection within an enhanced recovery after surgery (ERAS) programme were prospectively entered into a database. Retrospective analysis was performed of those who received a stoma as part of their operation. Patients who underwent preoperative stoma training were compared with those who had conventional postoperative training. The primary outcome measure was length of hospital stay. Secondary outcome measures included overall morbidity, stoma related morbidity, ERAS milestone achievement and readmission rates. Results The median length of stay was improved in the patients receiving preoperative stoma training (8 days [interquartile range: 6–10] vs 9 days [interquartile range: 7–19.5], p=0.025). No statistically significant difference was observed in overall morbidity rates, stoma specific morbidity, ERAS milestones or readmission rates. Conclusions Preoperative stoma training can reduce length of stay and could be employed routinely for patients who are planned to have colorectal surgery. Such training can be incorporated within ERAS pathways.

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Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity

Neurosurgery ◽

10.1093/neuros/nyaa399 ◽

2020 ◽

Cited By ~ 2

Author(s):

Emmanuel A Adeyemo ◽

Salah G Aoun ◽

Umaru Barrie ◽

Madelina L Nguyen ◽

Olatunde Badejo ◽

...

Keyword(s):

Urinary Retention ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Opioid Consumption ◽

Unplanned Readmission ◽

Elderly Adult ◽

Degenerative Scoliosis ◽

Readmission Rates ◽

Severe Constipation ◽

The Impact

Abstract BACKGROUND The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients. OBJECTIVE To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates. METHODS In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window. RESULTS There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05 vs 314.05 MED, P = .04), a lower rate of urinary retention requiring catheterization (5.97% vs 19.3%, P = .024) and of severe constipation (1.49% vs 31.57%, P < .0001), and fewer readmissions after their surgery (2.98% vs 28.07%, P = .0001). CONCLUSION A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study (Preprint)

10.2196/preprints.26597 ◽

2020 ◽

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

BACKGROUND Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. OBJECTIVE The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. METHODS Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. RESULTS The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. CONCLUSIONS Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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Impact of patient engagement on the design of a mobile health technology for cardiac surgery

10.1101/2020.07.22.20159848 ◽

2020 ◽

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

Future Research ◽

Advisory Panel ◽

Patient Journey ◽

Mhealth Technology ◽

The Impact

Objective The aims of this study were to describe the impact of patient engagement on the initial design and content of a mobile health (mHealth) technology that supports enhanced recovery protocols (ERPs) for cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients that underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and consented to be contacted about future research, and their caregivers, were approached for participation. A qualitative exploration was undertaken to determine advisory panel members key messages about, and the impact of, patient engagement on mHealth technology design and content. Results Ten individuals participated in the advisory panel. Key design-specific messages centered around access, tracking, synchronization, and reminders. Key content-specific messages centered around roles of cardiac surgery team members and medical terms, educational videos, information regarding cardiac surgery procedures, travel before/after surgery, nutrition (i.e., what to eat), medications (i.e., drug interactions), resources (i.e., medical devices), and physical activity (i.e., addressing fears and providing information, recommendations, and instructions). These key messages were a rich source of information for mHealth technology developers and were incorporated as supported by the existing capabilities of the underlying technology platform. Conclusions Patient engagement facilitated the development of a mHealth technology whose design and content were driven by the lived experiences of cardiac surgery patients and caregivers. The result was a detail-oriented and patient-centered mHealth technology that helps to empower and inform patients and their caregivers about the patient journey across the perioperative period of cardiac surgery.

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Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study

JMIR Perioperative Medicine ◽

10.2196/26597 ◽

2021 ◽

Vol 4 (2) ◽

pp. e26597

Author(s):

Anna M Chudyk ◽

Sandra Ragheb ◽

David Kent ◽

Todd A Duhamel ◽

Carole Hyra ◽

...

Keyword(s):

Cardiac Surgery ◽

Mobile Health ◽

Patient Engagement ◽

Enhanced Recovery ◽

Perioperative Period ◽

End Users ◽

Advisory Panel ◽

Patient Centered ◽

Recovery Protocols ◽

The Impact

Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

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Coming-of-Age Cinema in New Zealand

10.3366/edinburgh/9781474429443.001.0001 ◽

2017 ◽

Author(s):

Alistair Fox

Keyword(s):

Coming Of Age ◽

Belief Systems ◽

Time Frame ◽

New Wave ◽

Art Cinema ◽

Literary Sources ◽

French New Wave ◽

Significant Phenomenon ◽

The Impact ◽

New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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