scholarly journals Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1418
Author(s):  
Madhivanan Elango ◽  
Vassilios Papalois

Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of complications. We have analysed the literature in pancreatic and transplantation surgery to identify the necessary preoperative, intra-operative and postoperative components of an ERAS pathway in pancreas transplantation.

2020 ◽  
Vol 85 (5-6) ◽  
pp. 121-125
Author(s):  
Mikołaj Dąbrowski ◽  
◽  
Łukasz Kubaszewski

The enhanced recovery after surgery protocol (ERAS) – is generally modern comprehensive perioperative care to improve the treatment results. It is more widely used in surgery, including orthopedics. Implementation of the ERAS protocol has been shown to accelerate post-operative recovery, shorten hospital stays, increase patient satisfaction, and improve clinical outcome. This article describes the main elements of the ERAS protocol with the stages that are possible to implement in Polish conditions.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tshering Tamang ◽  
Tashi Wangchuk ◽  
Choning Zangmo ◽  
Tshering Wangmo ◽  
Karma Tshomo

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.


2020 ◽  
Vol 3 (1) ◽  
pp. 28
Author(s):  
Ahmad Sabili Rifa'i ◽  
Gadis Meinar Sari ◽  
Vicky Sumarki Budipramana

Introduction: The implementation of ERAS protocol can optimize patients after surgery, which in turn can reduce burdens both for patient and hospital. The purpose of this study is to describe the compliance and consistency of ERAS in the pre-operative period of surgery patients in Dr. Soetomo General Hospital Surabaya. Methods: We conducted consecutive observation of major surgical patients for 4 weeks. The type of surgery observed was digestive, thoracic and cardiovascular, and gynecological surgery. The pre-operative period will be calculated for compliance based on the ERAS international protocol. All data of compliance presented descriptively.s.Results: A total of 36 major surgery patients of which 7 (19,4%) were digestive surgeries, 14 (38,9%) were thoracic and cardiovascular surgeries, and 15 (41,7%) were gynecological surgeries. Overall compliance of the ERAS protocol in the pre-operative period of major surgery patients was 91%. The compliance of ERAS protocol in the pre-operative period of digestive surgery patients was 80%, in thoracic and cardiovascular surgery patients was 93,4% and gynecologic surgery patients was 84.3%. Major surgery patients with ≥90% compliance was 25%. Digestive surgery patients with ≥90% compliance was 0%. Thoracic and cardiovascular surgery patients with ≥90% compliance was 64,3%. Gynecologic surgery patients with ≥90% compliance was 0%.Conclusion: : Pre-operative elements of ERAS protocol in major surgery including digestive, thoracic and cardiovascular, and gynecologic surgery in Dr. Soetomo General Hospital, Surabaya needs to be improved.


2020 ◽  
Vol 156 (2) ◽  
pp. 284-287 ◽  
Author(s):  
Zachary L. Gentry ◽  
Teresa K.L. Boitano ◽  
Haller J. Smith ◽  
Dustin K. Eads ◽  
John F. Russell ◽  
...  

2018 ◽  
Vol 155 (4) ◽  
pp. 1843-1852 ◽  
Author(s):  
Luke J. Rogers ◽  
David Bleetman ◽  
David E. Messenger ◽  
Natasha A. Joshi ◽  
Lesley Wood ◽  
...  

Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.


BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e023651 ◽  
Author(s):  
Ashleigh C N Gibb ◽  
Megan A Crosby ◽  
Caraline McDiarmid ◽  
Denisa Urban ◽  
Jennifer Y K Lam ◽  
...  

IntroductionEnhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society.MethodsA research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study.Ethics and disseminationThis study has been registered with the ERAS Society. Human ethics approval (REB 18–0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.


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