IMPLEMENTATION OF FAST-TRACK PROGRAM FOR STOMA REVERSAL PROCEDURES

AIM: evaluation of the effectiveness of the enhanced recovery protocol for stoma reversal procedures.PATIENTS AND METHODS: a single-center retrospective analysis of stoma reversal surgery in 130 ostomy patients in 2012-18 was performed. From 2012 to 2015, 56 (43.1%) patients were treated before the implementation of the Enhanced Recovery After Surgery (ERAS) protocol in clinical practice, 74(56.9%) patients were treated in accordance with the principles of fast-track.RESULTS: the introduction into clinical practice of the ERAS protocol reduced postoperative complications from 8.5% to 5.4% (p=0.002) and the hospital stay from 16,3±9,4 to 11,4±4,2 days (p=0.003).CONCLUSION: the fast-track strategy is an effective way to improve the results of stoma reversal procedures.

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Enhanced Recovery after Surgery (ERAS) Protocol Is a Safe and Effective Approach in Patients with Gastrointestinal Fistulas Undergoing Reconstruction: Results from a Prospective Study

Nutrients ◽

10.3390/nu13061953 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1953

Author(s):

Stanislaw Klek ◽

Jerzy Salowka ◽

Ryszard Choruz ◽

Tomasz Cegielny ◽

Joanna Welanyk ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Postoperative Nausea ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Consecutive Series ◽

Eras Protocol

Background and Aims: An enterocutaneous fistula (ECF) poses a major surgical problem. The definitive surgical repair of persistent fistulas remains a surgical challenge with a high rate of re-fistulation and mortality, and the reasons for that is not the surgical technique alone. Enhanced Recovery after Surgery (ERAS®) is an evidence-based multimodal perioperative protocol proven to reduce postoperative complications. The aim of the study was to assess the clinical value of the ERAS protocol in surgical patients with ECF. Methods: ERAS protocol was used in all patients scheduled for surgery for ECF at the Stanley Dudrick’s Memorial Hospital in Skawina between 2011 and 2020. A multidisciplinary team (MDT) was in charge of the program and performed annual audits. A consecutive series of 100 ECF patients (44 females, 56 males, mean age 54.1 years) were evaluated. Postoperative complications rate, readmission rate, length of hospital stay, prevalence of postoperative nausea and vomiting were assessed. Registered under ClinicalTrials.gov Identifier no. NCT04771832. Results: ERAS protocol was successfully introduced for ECF surgeries; however, eight modifications to the ERAS program was performed in 2015. They led to improvement of surgical outcomes: reduction of postoperative nausea and vomiting (15 vs. 17% patients, p = 0.025), overall complication rate (11 vs. 10, p = 0.021), median length of hospital stay (overall and after surgery, p = 0.022 and 0.002, respectively). Conclusions: ERAS protocol can be successfully used for ECF patients. Prescheduled audits can contribute to the improvement of care.

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Reduced postoperative complications and length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol

10.26226/morressier.58f5b030d462b80296c9e486 ◽

2017 ◽

Author(s):

Javier Ripollés-Melchor

Keyword(s):

Postoperative Complications ◽

Colorectal Surgery ◽

Hospital Stay ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Enhanced Recovery Protocol

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The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair

Surgical Endoscopy ◽

10.1007/s00464-019-07233-8 ◽

2019 ◽

Vol 34 (10) ◽

pp. 4638-4644 ◽

Cited By ~ 6

Author(s):

Walker Ueland ◽

Seth Walsh-Blackmore ◽

Michael Nisiewicz ◽

Daniel L. Davenport ◽

Margaret A. Plymale ◽

...

Keyword(s):

Hernia Repair ◽

Hospital Stay ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Eras Protocol

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

10.21203/rs.3.rs-273736/v1 ◽

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.

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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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Reduced Length of Hospital Stay in Laparoscopic Hysterectomy after Implementation of Enhanced Recovery after Surgery (ERAS) Protocol: a Pilot Program Result

Translational Perioperative and Pain Medicine ◽

10.31480/2330-4871/060 ◽

2017 ◽

Vol 4 (4) ◽

Author(s):

Huang Jeffrey ◽

◽

Vaught Jessica ◽

Meir Lea ◽

◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Laparoscopic Hysterectomy ◽

Pilot Program ◽

Eras Protocol

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Enhanced Recovery after Surgery for Radical Cystectomy Decreases Postoperative Complications at Different Times

Urologia Internationalis ◽

10.1159/000518163 ◽

2021 ◽

pp. 1-9

Author(s):

François Lannes ◽

Jochen Walz ◽

Thomas Maubon ◽

Stanislas Rybikowski ◽

Sami Fakhfakh ◽

...

Keyword(s):

Postoperative Complications ◽

Length Of Stay ◽

Radical Cystectomy ◽

Positive Impact ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Fast Recovery ◽

Significant Difference ◽

Eras Protocol ◽

Over Time

Introduction: This study aimed to assess whether enhanced recovery after surgery (ERAS) improves, at different time points, postoperative complications in patients undergoing radical cystectomy. Methods: We performed a retrospective monocentric study using prospectively maintained databases including all patients treated by radical cystectomy between January 2015 and July 2019. An ERAS protocol was applied in all patients from February 2018. We analyzed and compared between non-ERAS and ERAS groups early and 90-day postoperative complications and 90-day readmission. ERAS was analyzed to know its implication in fast recovery improvement over time. Results: A total of 150 patients underwent radical cystectomy, 74 without ERAS and 76 with ERAS protocol. ERAS decreased significantly early (p = 0.039) and 90-day (0.012) postoperative complications. In multivariate analysis, ERAS was an independent factor associated with less early (OR: 0.48, 95% CI: 0.25–0.96; p = 0.37) and 90-day (OR: 0.31, 95% CI: 0.14–0.68; p = 0.004) postoperative complications. There was no significant difference between groups for 90-day readmission (p = 0.349). Mean length of stay did not differ significantly between ERAS and non-ERAS groups (12.7 ± 6.2 and 13.1 ± 5.7 days, respectively; p = 0.743). Discussion/Conclusion: Our study shows that ERAS has an early positive impact that lasts over time on postoperative complications. ERAS implementation has decreased early and 90-day postoperative complications without increasing 90-day readmission. In our cohort, length of stay was not improved with ERAS protocol.

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Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol

Neurosurgical FOCUS ◽

10.3171/2019.1.focus18646 ◽

2019 ◽

Vol 46 (4) ◽

pp. E7 ◽

Cited By ~ 20

Author(s):

Victor E. Staartjes ◽

Marlies P. de Wispelaere ◽

Marc L. Schröder

Keyword(s):

Adverse Events ◽

Hospital Stay ◽

Spine Surgery ◽

Surgical Procedures ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Perioperative Outcomes ◽

Degenerative Spine ◽

Concomitant Decrease ◽

Eras Protocol

OBJECTIVEEnhanced recovery after surgery (ERAS) has led to a paradigm shift in various surgical specialties. Its application can result in substantial benefits in perioperative healthcare utilization through preoperative physical and mental patient optimization and modulation of the recovery process. Still, ERAS remains relatively new to spine surgery. The authors report their 5-year experience, focusing on ERAS application to a broad population of patients with degenerative spine conditions undergoing elective surgical procedures, including anterior lumbar interbody fusion (ALIF).METHODSA multimodal ERAS protocol was applied between November 2013 and October 2018. The authors analyze hospital stay, perioperative outcomes, readmissions, and adverse events obtained from a prospective institutional registry. Elective tubular microdiscectomy and mini-open decompression as well as minimally invasive (MI) anterior or posterior fusion cases were included. Their institutional ERAS protocol contains 22 pre-, intra-, and postoperative elements, including preoperative patient counseling, MI techniques, early mobilization and oral intake, minimal postoperative restrictions, and regular audits.RESULTSA total of 2592 consecutive patients were included, with 199 (8%) undergoing fusion. The mean hospital stay was 1.1 ± 1.2 days, with 20 (0.8%) 30-day and 36 (1.4%) 60-day readmissions. Ninety-four percent of patients were discharged after a maximum 1-night hospital stay. Over the 5-year period, a clear trend toward a higher proportion of patients discharged home after a 1-night stay was observed (p < 0.001), with a concomitant decrease in adverse events in the overall cohort (p = 0.025) and without increase in readmissions. For fusion procedures, the rate of 1-night hospital stays increased from 26% to 85% (p < 0.001). Similarly, the average length of hospital stay decreased steadily from 2.4 ± 1.2 days to 1.5 ± 0.3 days (p < 0.001), with a notable concomitant decrease in variance, resulting in an estimated reduction in nursing costs of 46.8%.CONCLUSIONSApplication of an ERAS protocol over 5 years to a diverse population of patients undergoing surgical procedures, including ALIF, for treatment of degenerative spine conditions was safe and effective, without increase in readmissions. The data from this large case series stress the importance of the multidisciplinary, iterative improvement process to overcome the learning curve associated with ERAS implementation, and the importance of a dedicated perioperative care team. Prospective trials are needed to evaluate spinal ERAS on a higher level of evidence.

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The successful implementation of the Enhanced Recovery After Surgery (ERAS) program among caesarean deliveries in Bhutan to reduce the postoperative length of hospital stay

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04105-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tshering Tamang ◽

Tashi Wangchuk ◽

Choning Zangmo ◽

Tshering Wangmo ◽

Karma Tshomo

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Care Program ◽

Postoperative Recovery ◽

Successful Implementation ◽

Hospital Data ◽

Postoperative Length ◽

Eras Protocol

Abstract Background Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care program to optimize and enhance postoperative recovery. It has a beneficial role in decreasing the length of hospital stay and improving the quality of care. This study aims to observe the successful implementation of ERAS in reducing the length of hospital stay (LOS) among caesarean deliveries. Methods A pre-and post-implementation study of ERAS protocol was conducted, among cohort of women who underwent caesarean deliveries from January to December 2020 in the Department of Obstetrics and Gynaecology, Mongar Regional Referral hospital. Data collected retrospectively and analyzed in SPSS (IBM SPSS trial version); and comparison of length of hospital stay between the two groups were tested by t-test. Results One hundred seventy-one patients were included in the study: 87 in the pre-ERAS and 84 in the post-ERAS cohort. Post implementation, LOS decreased by an average of 21.0 (CI 16.11–24.64; p-value < 0.001) hours in the postoperative period. A greater proportion of patients were discharged on day-2 (2.3% in pre-ERAS and 81% in ERAS; p-value < 0.001). Conclusion Implementation of ERAS protocol can significantly decrease the postoperative length of hospital stay without increasing the complications and readmission rates.

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Enhanced recovery after surgery (ERAS) protocol in Oblique lumbar interbody fusion(OLIF): a case-controlled study

10.21203/rs.3.rs-35270/v2 ◽

2020 ◽

Author(s):

Renjie Li ◽

Xiaofeng Shao ◽

Weimin Jiang

Keyword(s):

Postoperative Complications ◽

Interbody Fusion ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Study ◽

Lumbar Interbody Fusion ◽

Financial Costs ◽

Significant Difference ◽

Oblique Lumbar Interbody Fusion ◽

Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it have not been widely utilized in spinal surgery. This study is to evaluate the implementation of an ERAS pathway for patients undergoing oblique lumbar interbody fusion (OLIF) surgery.Methods This was a retrospective cohort study of patient who underwent OLIF in 2018 prior to ERAS (“pre-ERAS” ,n=23) and in 2019 after ERAS was instituted (“ERAS”, n=24). Major outcomes were collected included demographics, length of hospital stay, financial cost, postoperative complications, off-bed time and perioperative factors. Visual Analogue Scale (VAS) was used to evaluate the pain. The ERAS pathway and compliance with pathway elements were also recorded.Results After ERAS implementation, we found no significant differences in the baseline characteristics between the two groups. In our study, the mean stay in the hospital was significantly lower (p= 0.033) in the ERAS group (15.3±3.9 days) compared to the standard pathway group (13.0±3.1 days). In comparison to the standard group, we also found a variation between the financial costs of surgery and hospitalization [(16446.5±4353.3)vs(14237.7±2784.9) USD, P < 0.05]. The ERAS group manifested a lower blood loss compared with the pre-ERAS group with statistical significance [(68.3±57.1)vs(119.3±104.8) ml, P < 0.05]. There was no significant difference in operative time, complications, and 30-d readmission rates ( P > 0.05 ). Pain scores between the two groups showed a significant difference during the 3th hour and 6th hour (P < 0.05).Conclusion Institution of an ERAS protocol appears to accelerate functional recovery and reduce length of stay, financial costs and decreased pain.

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