scholarly journals Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery

2021 ◽  
Vol 10 (8) ◽  
pp. 1634
Author(s):  
Henry John Golder ◽  
Vassilios Papalois
Keyword(s):  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Goal Directed Fluid Therapy ◽  
Enhanced Recovery Pathways ◽  
Recovery Protocols ◽  
Recovery Pathways ◽  
Improve Patient

Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.

scholarly journals The effectiveness of acupuncture point stimulation for the prevention of post-operative sore throat: a meta-analysis.

2020 ◽  
Author(s):  
Pin-Yu Jau ◽  
Shang-Chih Chang
Keyword(s):  
General Anesthesia ◽  
Sore Throat ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Acupuncture Point ◽  
Cochrane Central Register ◽  
Enhanced Recovery Pathways ◽  
Secondary Outcomes ◽  
Recovery Pathways ◽  
Acupoint Stimulation

Background: Enhanced recovery pathways can be further improved for postoperative sore throat (POST) which usually occurs after surgery with general anesthesia. Medications have shown some effectiveness in treating and preventing POST, but acupuncture or related techniques with better safety and less cost likely can be used as an alternative or adjuvant therapy to treat perioperative symptoms by stimulating acupuncture point (acupoint). Therefore, we aim to conduct a meta-analysis to assess whether acupoint stimulation help patients prevent or treat POST in adults undergoing tracheal intubation for general anesthesia. Methods: Publication in PubMed, the Cochrane Central Register, ScienceDirect, and ClinicalTrial.gov were surveyed from Jan. 2000 through Jan. 2020. Studies that compared intervention between point stimulation and none or sham point stimulation, were included. Primary outcomes were the incidence and severity of POST at 24h. Secondary outcomes were the incidence of postoperative nausea and vomiting, choking cough, and sputum. Results: Three randomized control trials and one comparative study involving 1358 participants were included. Compared with control, acupoint stimulation was associated with a reduced incidence (risk ratio, 0.3; 95% confidence interval (CI), 0.2 to 0.45; p < 0.001) and severity (standardized mean difference, -2.21; 95% CI, -2.67 to -1.76; p < 0.001) of POST. Secondary outcomes are also in favor of acupoint stimulation. There were no significant adverse events related to acupoint stimulation. Subgroup, the sensitivity, and the trial sequence analyses confirmed that the finding for POST was adequate. Conclusions: Acupoint stimulation with various methods may reduce the occurrence of POST. It could be considered as one of nonpharmacological ways to prevent POST in enhanced recovery pathways. Further rigorous studies are needed to determine the effectiveness of acupoint stimulation.

Opioid Requirements in Laparoscopic Colectomies: Do Enhanced Recovery After Surgery Protocols Make a Difference?

2020 ◽  
pp. 000313482095631
Author(s):  
Samer Kawak ◽  
Joanna F. Wasvary ◽  
Matthew A. Ziegler
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Pain Scores ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways

Background With the growing opioid epidemic and recent focus on the quantity of opioids prescribed at discharge after surgery, enhanced recovery pathways provide another tool to counteract this epidemic. The aim of this current study is to analyze the differences in opioid requirements and pain scores in the immediate postoperative period for patients who underwent laparoscopic colectomies before and after the implementation of enhanced recovery after surgery (ERAS) protocols. Materials and Methods This study is a retrospective review of patients and was conducted at an academically affiliated tertiary care hospital. In patients undergoing elective laparoscopic colectomies before December 1, 2013-July 31, 2015 and after September 1, 2015-May 31, 2018, the implementation of enhanced recovery pathways was included. The primary end point was opioid consumption from the end of surgery until 48 hours after surgery. Secondary end points included pain scores, surgery length of time, and hospital length of stay after surgery. Results A total of 242 patients (122 pre- and 120 postimplementation) were analyzed. Patient characteristics were similar between groups. Pain scores were higher in the preimplementation patients for postoperative day (POD) 0 scores ( P = .019). There was a decrease in the morphine milligram equivalents (MME) on POD 0-2 for the postimplementation patients. This decrease resulted in a 61% reduction in opioid requirements after implementation of ERAS protocols (32 vs. 12.5 MME, P < .0001). Discussion Enhanced recovery after surgery protocols can reduce opioid requirements after elective laparoscopic colectomies without negatively affecting pain scores.

scholarly journals Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes?

2019 ◽  
Vol 32 (02) ◽  
pp. 109-113 ◽  
Author(s):  
Julia Berian ◽  
Clifford Ko ◽  
Kristen Ban
Keyword(s):  
Colorectal Surgery ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Process Measures ◽  
Improved Outcomes ◽  
Preoperative Carbohydrate Loading ◽  
Eras Protocol ◽  
Implementation Data ◽  
Improve Patient

AbstractEnhanced Recovery after Surgery (ERAS) protocols are multimodal perioperative care pathways designed to accelerate recovery by minimizing the physiologic stress of a surgical procedure. Benefits of ERAS implementation in colorectal surgery include reduced length of stay and decreased complications without an increase in readmissions. Though there is evidence associating individual ERAS protocol elements (e.g., preoperative carbohydrate loading, judicious perioperative fluid administration, and early initiation of postoperative nutrition) with improved outcomes, ensuring high compliance with all elements of an ERAS protocol will maximize benefits to the patient. After ERAS implementation, data collection on protocol process measures can help providers target education and interventions to improve protocol compliance and patient outcomes.

scholarly journals Systematic Review: Enhanced Recovery After Cholecystectomy Surgery

2019 ◽  
Author(s):  
Meghan Cole
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Improve Patient Care ◽  
Healthcare Spending ◽  
Patient Centered ◽  
Systems Model ◽  
Lengths Of Stay ◽  
Improve Patient

This systematic review aimed to answer the clinical question, which perioperative enhanced recovery after surgery (ERAS) techniques are most effective in decreasing recovery time and length of stay for adults, aged 18-65, undergoing cholecystectomy surgery? In an effort to curb healthcare spending, ERAS is one way to reduce hospital- associated costs. Originally developed in Denmark, ERAS is a patient-centered initiative that aims to reduce the body’s stress response, leading to improved patient outcomes and decreased hospital lengths of stay. Betty Neuman’s Systems Model was used as a theoretical framework to enrich the understanding of enhanced recovery and how it works to improve patient care.

scholarly journals Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis

2015 ◽  
Vol 95 (4) ◽  
pp. 382-395 ◽  
Author(s):  
Jeanny J.A. de Groot ◽  
Stephanie M.C. Ament ◽  
José M.C. Maessen ◽  
Cornelis H.C. Dejong ◽  
Jos M.P. Kleijnen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Gynecologic Surgery ◽  
Enhanced Recovery Pathways ◽  
Recovery Pathways
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