scholarly journals Application of Enhanced Recovery after Surgery Protocols in Colorectal Cancer, Complicated by Malignant Bowel Obstruction: a Review of the Literature

2021 ◽  
Vol 14 (1) ◽  
pp. 10-15
Author(s):  
Vasil M. Dimitrov
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Recovery Period ◽  
Disease Free Survival ◽  
Elective Colorectal Surgery ◽  
Colorectal Obstruction ◽  
Emergency Colorectal Surgery

Summary Enhanced recovery after surgery (ERAS) protocols are standard in elective colorectal surgery. They lead to decreasing postoperative complications and shorten the hospital stay and the recovery period. Following these protocols is associated with better short-term results and better and disease-free survival in cases of respectable colorectal carcinomas. There is clear evidence of the beneficial effect of the protocols in reducing the rate of postoperative complications and shortening the hospital stay after elective colorectal surgery. There remains the question of whether these protocols are applicable effective in patients after emergency colorectal surgery. Over the last years, safe and effective ERAS protocols have been reported in patients with life-threatening conditions such as colorectal obstruction and intraabdominal infection.

Caution: Increased Acute Kidney Injury in Enhanced Recovery after Surgery (ERAS) Protocols

2019 ◽  
Vol 85 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Crystal P. Koerner ◽  
Alexandra G. Lopez-Aguiar ◽  
Mohammad Zaidi ◽  
Shelby Speegle ◽  
Glen Balch ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Elective Colorectal Surgery ◽  
Baseline Serum ◽  
Increased Risk ◽  
Postoperative Aki

Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P = 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3–9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6–16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5–5.8; P < 0.01). On multi-variable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5–7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P = 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.

scholarly journals Flexible Ureteroscopic Lithotripsy Based on the Concept of Enhanced Recovery After Surgery

2021 ◽  
Author(s):  
Ling Shu ◽  
Ping Ao ◽  
Zhenxing Zhang ◽  
Dong Zhuo ◽  
Changbin Dong ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Hospital Stay ◽  
Control Group ◽  
Ureteroscopic Lithotripsy ◽  
Total Cost ◽  
Stone Removal

Abstract Background: To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURSL) based on the concept of enhanced recovery after surgery (ERAS).Methods: 435 patients with upper urinary calculi between 2017-2020 were retrospectively analysed and assigned to ERAS group (ERAS management) and control group (traditional management). Operative time, postoperative ambulation time, postoperative hospital stay, total cost of hospitalization, postoperative complications and stone removal were compared. Results: 427 cases were successfully performed FURSL procedure with 4 cases of ERAS group (n = 216) and 4 cases of control group (n = 219) failed respectively. No postoperative complications occurred in either group except for fever and hematuria. There were no significant difference in postoperative fever and stone removal between the two groups (all p > 0.05). The patients in ERAS group had shorter operative time, shorter postoperative ambulation time, less postoperative severe hematuria, shorter postoperative hospital stay and lower total cost of hospitalization than those in control group (all p < 0.05).Conclusions: FURSL based on the concept of ERAS for the treatment of upper urinary tract calculi is safe and reliable, with rapid postoperative recovery, low cost of hospitalization and worthy of clinical promotion.

scholarly journals Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

JAMA Surgery ◽  
2019 ◽  
Vol 154 (8) ◽  
pp. 725 ◽  
Author(s):  
Javier Ripollés-Melchor ◽  
José M Ramírez-Rodríguez ◽  
Rubén Casans-Francés ◽  
César Aldecoa ◽  
Ane Abad-Motos ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery
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