The Impact of Enhanced Recovery after Surgery Protocol on Postoperative Hospital Stay

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

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Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000268 ◽

2019 ◽

Vol 29 (4) ◽

pp. 810-815 ◽

Cited By ~ 4

Author(s):

Basile Pache ◽

Jonas Jurt ◽

Fabian Grass ◽

Martin Hübner ◽

Nicolas Demartines ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gynecologic Oncology ◽

Length Of Hospital Stay ◽

Gynecologic Surgery ◽

Complication Rates ◽

Prolonged Length ◽

Academic Center ◽

The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

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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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RA03.03: THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) ON PATIENTS UNDERGOING OESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra03.03 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 23-23

Author(s):

Barry Dent ◽

Jillian Sturrock ◽

Janine Mckenna ◽

Claire Taylor ◽

Helen Jaretzke ◽

...

Keyword(s):

Hospital Stay ◽

Conflicts Of Interest ◽

Positive Impact ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Complication Rates ◽

Early Recovery ◽

Significant Difference ◽

The Impact ◽

Multi Disciplinary Team

Abstract Background Enhanced recovery after surgery (ERAS) is defined as a multimodal care pathway designed to achieve early recovery for patients undergoing surgery. For patients undergoing oesophagectomy such pathways are complex and must involve a wide multi-disciplinary team. The importance of peri-operative nutrition is especially relevant in this patient group. We describe our experience of the impact of an ERAS pathway in a high volume oesophago-gastric unit on both short and medium term patient outcomes. Methods Consecutive patients undergoing open 2 phase subtotal oesophagectomy with two field lymphadenectomy in a 12 month period following the introduction of an ERAS pathway were included in the study. Outcomes were compared with consecutive patients undergoing the same procedure over a 12 month period prior to the introduction of the ERAS pathway. All patients were treated in a single UK unit. Adherence to the ERAS pathway was monitored by a dedicated ERAS coordinator. All data were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test for continuous and Chi2 for categorical data. Results 189 patients were included (97 pre-ERAS and 92 ERAS). There were no demographic differences between the patient groups. The rate of severe post-operative complications (Accordion score 3 + ) was identical between groups (29%). Median length of hospital stay was significantly reduced with ERAS (10 days v 14 days pre-ERAS (P < 0.001)) as was the total readmission rate (21% v 39% P = 0.006). Weight loss following surgery was significantly reduced with ERAS. At 2 weeks 1% of patients had lost over 10% of their pre-operative weight compared with 32% pre-ERAS (P < 0.001). A significant difference was maintained at 6 weeks (9% v 55%), 3 months (19% v 66%) and 6 months (35% v 71%). Conclusion Our results demonstrate the positive impact of ERAS for patients undergoing oesophagectomy. Despite no reduction in post-operative complication rates, both hospital stay and readmission rates were reduced, suggesting a positive impact of ERAS on patients’ response to complications. Far fewer patients were readmitted for nutritional reasons/failure to thrive following the introduction of ERAS. Implementing an ERAS pathway requires a dedicated multi-disciplinary team to provide the required peri-operative care both in the hospital and community. Disclosure All authors have declared no conflicts of interest.

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Safe and effective protocol for discharge 3 days after cardiac surgery

Scientific Reports ◽

10.1038/s41598-021-88582-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Omar Asdrúbal Vilca Mejia ◽

Gabrielle Barbosa Borgomoni ◽

Nilza Lasta ◽

Mariana Yumi Okada ◽

Mariana Silva Biason Gomes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Latin American ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Postoperative Stay ◽

Eras Protocol ◽

The Impact

AbstractThe Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the “TotalCor protocol”. After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.

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Enhanced recovery after surgery (ERAS) decreases recovery time and improve the recovery effect versus for elective gastric cancer surgery: a single-center randomized controlled trial

10.21203/rs.3.rs-416991/v1 ◽

2021 ◽

Author(s):

Shuhong Lv ◽

Xin Fan ◽

Yan Li ◽

Jinling Yan ◽

Jing Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Cohort Analysis ◽

Postoperative Recovery ◽

Postoperative Hospital Stay ◽

Walking Distance ◽

Significant Difference

Abstract Background Enhanced recovery after surgery (ERAS) can help patients improve recovery speed, improve patient satisfaction, reduce postoperative pressure and reduce postoperative hospital stay. This study evaluated ERAS feasibility and effectiveness compared with conventional perioperative care and their significance in gastrectomy for patients with gastric cancer. Methods This article is a prospective cohort analysis of 272 patients. This paper investigates tumor morphology, operation information, exhaustion time, ambulation time, walking distance on the operation day and 1 day, 2 days and 3 days after the operation, While blood test indexes related to postoperative recovery and postoperative complications are evaluated. Results The recovery of gastrointestinal function was faster in ERAS patients. There was a significant difference in the time of first exhaust between ERAS group and CC group (54.60 ± 17.41 h vs. 76.71 ± 9.47 h; P < 0.001). There were significant differences in the amount of diet on the day of operation, 1 day, 2 days and 3 days after operation between the two groups (P < 0.001); There was a significant difference in the time of first ambulation between eras group and CC group (1.14 ± 0.76 D vs. 2.74 ± 0.98 D; P < 0.001). There were significant differences in walking distance between the two groups at operation day, 1 day, 2 days and 3 days after operation (P < 0.001). The postoperative hospital stay in the ERAS group was significantly shorter than that in the routine perioperative nursing group (8.38 ± 1.68 D, 11.18 ± 1.38 D; P < 0.001). Conclusion ERAS can reduce the stress after radical resection of gastric cancer, promote intestinal recovery, reduce pain intensity, and improve the recovery ability and satisfaction of patients.

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An Institutional Experience of Introducing an Enhanced Recovery After Surgery (ERAS) Program for Pancreaticoduodenectomy

International Surgery ◽

10.9738/intsurg-d-16-00002.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 542-549 ◽

Cited By ~ 1

Author(s):

Toru Aoyama ◽

Keisuke Kazama ◽

Masaaki Murakawa ◽

Koichiro Yamaoku ◽

Yosuke Atsumi ◽

...

Keyword(s):

Hospital Stay ◽

Perioperative Care ◽

Readmission Rate ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Gastrointestinal Surgery ◽

Postoperative Mortality ◽

Postoperative Hospital Stay ◽

Cancer Center ◽

Institutional Experience

This study assessed whether our enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is safe and feasible. The subjects included 109 consecutive patients who underwent PD between 2012 and 2014 at the Department of Gastrointestinal Surgery, Kanagawa Cancer Center. They received perioperative care according to the ERAS program. All data were retrieved retrospectively. Outcome measures included postoperative mortality, morbidity, hospitalization, and 30-day readmission rate. Our ERAS program included 12 elements (4 preoperative, 3 intraoperative, and 5 postoperative elements). Of the 109 patients studied, the overall incidence of morbidity was 51.4%, the incidence of mortality was 1.8%, and the incidence of readmission was 1.8%. The median postoperative hospital stay (23 days) was significantly shorter than the pre-ERAS value (29 days). Though 4 preoperative and 2 intraoperative elements were feasible, only 1 among 5 postoperative elements was applicable. Our ERAS program for PD has succeeded in shortening the postoperative hospital stay without increasing the risk of morbidity or mortality. The cutoff values of postoperative ERAS elements, however, were not feasible and should be reconsidered.

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Enhanced recovery after surgery in pediatric gastrointestinal surgery

Journal of International Medical Research ◽

10.1177/0300060519865350 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4815-4826 ◽

Cited By ~ 1

Author(s):

Ruyue Gao ◽

Heying Yang ◽

Yanan Li ◽

Lingbing Meng ◽

Yaping Li ◽

...

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Hospital Costs ◽

Gastrointestinal Surgery ◽

Postoperative Hospital Stay ◽

Patient Comfort ◽

Control Group ◽

Time Duration ◽

Surgical Data

Objective Enhanced recovery after surgery (ERAS) protocols help optimize inpatient care and minimize discomfort. This study was performed to explore the safety, feasibility, and clinical and social value of ERAS in pediatric gastrointestinal surgery. Methods This study included all children (n = 125) who underwent appendectomy, pyloromyotomy, transabdominal Soave’s procedure, Meckel’s diverticulum resection, or reduction of intussusception in our institution from January to September 2018. We compared surgical outcomes between children who underwent surgery under conventional perioperative regimens (control group, n = 57) and those who were treated with ERAS protocols (ERAS group, n = 68). Results There were no significant intergroup differences in demographic or surgical data. However, the bowel function recovery time, postoperative intravenous nutrition time, duration of postoperative hospital stay, and hospital costs were significantly lower in the ERAS group than control group. There was no significant intergroup difference in the complication rate. Conclusions Our results indicate that implementation of ERAS protocols is safe and feasible in pediatric gastrointestinal surgery. They can improve patient comfort, shorten the duration of the postoperative hospital stay, reduce hospital costs, and accelerate postoperative rehabilitation without increasing the risk of postoperative complications. Therefore, ERAS protocols deserve wider implementation and promotion.

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P382 Application of enhanced recovery after surgery in single-port laparoscopic partial small intestine resection in the treatment of Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.511 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S357-S357

Author(s):

Y LI ◽

Z Zhou ◽

D Yao ◽

L Zheng ◽

Y Duan ◽

...

Keyword(s):

Crohn’S Disease ◽

Laparoscopic Surgery ◽

Crohn's Disease ◽

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Operation Time ◽

Postoperative Hospital Stay ◽

Control Group ◽

Single Incision Laparoscopic Surgery

Abstract Background Single-incision laparoscopic surgery (SILS) with enhanced recovery after surgery (ERAS) can reduce operation trauma and accelerate postoperative rehabilitation. This study aims to investigate the safety and feasibility of SILS with ERAS in the treatment of Crohn’s disease. Methods Thirty patients with Crohn’s disease were randomly assigned to receive traditional laparoscopic surgery plus ERAS (n = 20) and SILS plus ERAS (n = 18)，respectively. Comparisons and analysis were made between the two groups in the perioperative conditions. Results There were significant differences in the mean operation time between the two groups (p < 0.01)，There were no significant differences in the intra-operative blood loss, postoperative complications rates, the time to first flatus and treatment cost (p > 0.05). There were significant differences in the postoperative hospital stay between the two groups (p < 0.05). WBC, CRP and PCT in SILS plus ERAS group were lower than those in the control group at the first days and the third days after operation, the differences were statistically significant (p < 0.05). Conclusion SILS plus ERAS can shorten postoperative hospital stay and facilitate bowel function recovery in the treatment of Crohn’s disease. It is worthwhile to mention the nice cosmetic benefits of SILS, the perioperative SILS plus ERAS program is safe and effective and should be popularised in Crohn’s disease.

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