scholarly journals Background for the introduction of enhanced recovery after surgery and patient outcomes

2021 ◽  
Vol 64 (12) ◽  
pp. 801-805
Author(s):  
Do Joong Park
Keyword(s):  
Patient Outcomes ◽  
Multidisciplinary Approach ◽  
Treatment Process ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Techniques ◽  
Postoperative Recovery ◽  
Surgical Quality ◽  
Improvement Project ◽  
Entire Treatment

Background: To facilitate early postoperative recovery of surgical patients, various efforts have been made to develop effective treatment methods since 1990; moreover, these efforts have not been limited to surgical techniques and include multiple aspects of the entire treatment process. Enhanced recovery after surgery (ERAS) is a surgical quality improvement project that has advanced substantially since it was first introduced in 1995 and has now been firmly established in the field of perioperative care.Current Concepts: ERAS consists of many components that cover each stage before, during, and after surgery, and its clinical application changes according to the results of evidence-based research for each item. To date, more than 20 ERAS guidelines have been created for each disease, and more guidelines are expected in the future. Many studies have reported that ERAS is associated with meaningful improvements in clinical outcomes and reductions of medical costs in many surgical fields.Discussion and Conclusion: ERAS remains a work in progress, and continuous research and improvement is needed in relation to the components, areas of application, audit of compliance and results, education, and a multidisciplinary approach.

Investigation of the enhanced recovery after surgery protocol outcome on post colectomy patients

2020 ◽  
pp. 175045892092536
Author(s):  
Sharon D Baoas ◽  
Toni Beninato ◽  
Michael Zenilman ◽  
Gokhan Ozuner
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Care ◽  
Final Analysis ◽  
Surgical Quality ◽  
Improvement Project ◽  
American College Of Surgeons ◽  
The Mean ◽  
Eras Protocol ◽  
Colorectal Procedures

Background An enhanced recovery after surgery (ERAS) protocol was implemented to improve quality and cost effectiveness of surgical care in elective colorectal procedures. Methods A retrospective study was conducted from July 2017 to June 2018. The ERAS protocol was initiated on 9 July 2018 and retrospectively reviewed in July 2019 by chart review, the American College of Surgeons National Surgical Quality Improvement Project database and risk stratification using Clavien–Dindo classification for all elective colorectal procedures. Results A total of 109 patients, 55 (pre-ERAS) and 54 (post-ERAS) are included in the final analysis. There were no differences in complications were recorded ( p = 0.37) and 30-day readmissions ( p = 0.785). The mean hospital stay was 5.89 ± 2.62 days in pre-ERAS and 4.94 ± 2.27 days in post-ERAS group which was statistically significant ( p = 0.047). Conclusions An ERAS protocol for colorectal surgery harmonised perioperative care and decreased length of stay.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

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.

Buprenorphine management: a conundrum for the anesthesiologist and beyond - a one-act play

2020 ◽  
Vol 45 (8) ◽  
pp. 656-659
Author(s):  
Shilen Thakrar ◽  
Josh Lee ◽  
Caitlin E Martin ◽  
John Butterworth IV
Keyword(s):  
Patient Outcomes ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Local Level ◽  
Evidence Based ◽  
National Guidelines ◽  
Evidence Based Guidelines ◽  
One Act ◽  
Patient Centric

We have witnessed a worldwide upsurge of streamlined enhanced recovery after surgery (ERAS) pathways advocating for consistency and compliance within their guidelines. At a recent national conference, two experts defended their institutional policies on perioperative management of buprenorphine, one defending its continuation, while the other suggesting its discontinuation. The moderator diplomatically proclaimed the need to have guidance at the institutional level and following it for favorable patient outcomes. Unfortunately, perioperative management of buprenorphine remains an understudied topic with a lack of national guidelines leading to variations at a local level despite its increased use nationally in the current opioid crisis. Although the moderator made a valid statement, we demonstrate via our one-act play the importance of recognizing a subset of the population within an ERAS pathway that necessitates multidisciplinary discussion, communication, and patient-centric care to formulate a perioperative plan coordinating a patient’s care. More robust research is needed to minimize variability in current practices and to further develop comprehensive evidence-based guidelines that encompass risk factors and anticipated postsurgical and peripartum pain for patients on buprenorphine.

scholarly journals Enhanced recovery after surgery: importance of compliance audits

2021 ◽  
Vol 64 (12) ◽  
pp. 820-825
Author(s):  
Jung Hoon Bae
Keyword(s):  
Clinical Outcomes ◽  
Multidisciplinary Approach ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Term Survival ◽  
High Compliance ◽  
Almost All ◽  
Eras Protocol

Background: The enhanced recovery after surgery (ERAS) protocol is associated with improved clinical outcomes. However, implementation of ERAS in clinical practice is difficult because it requires a multidisciplinary approach and complex standardization. Moreover, maintenance and auditing of ERAS protocols is another challenge.Current Concepts: The ERAS society provides guidelines for surgery in almost all areas, and each guideline consists of approximately 20 items. Audits are performed to determine whether the items are being applied appropriately in a compliant manner as well as monitor and improve ERAS protocols. Numerous studies have reported that even with the application of the same ERAS protocol, postoperative short-term outcomes such as reductions of hospital stay and postoperative complications were better in the high-compliance group than in the low-compliance group. In addition, some recent studies have reported that application of ERAS protocols with high compliance can improve the long-term survival outcomes in cancer patients. In this regard, ERAS has been hypothesized to improve long-term oncological outcomes by minimizing surgical stress and reducing the postoperative inflammatory response and damage to immune function.Discussion and Conclusion: In addition to the development of appropriate protocols, auditing of compliance is also an important part of ERAS implementation. High compliance may lead to improved clinical outcomes.

scholarly journals Protocolo ERAS® en cirugía colorrectal

2021 ◽  
Vol 113 (2) ◽  
pp. 176-188
Author(s):  
William Maclean ◽  
◽  
Paul Mackenzie ◽  
Chris Limb ◽  
Timothy Rockall
Keyword(s):  
Colorectal Surgery ◽  
Stress Reduction ◽  
Multidisciplinary Approach ◽  
Physiological Stress ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Care ◽  
Evidence Based ◽  
High Quality ◽  
High Quality Research

Enhanced Recovery After Surgery (ERAS®) in colorectal surgery is a protocol that promotes quicker return to function. It follows the latest evidence-based research to promote stress reduction related to surgery. The recommended perioperative pathway is fine-tuned, dynamic and in line with the latest evidence-based research to enhance all aspects of the patient’s surgical care. We describe the four aspects for a patient undergoing colorectal surgery – pre-admission, pre-operative, intra-operative and post-operative. The running theme is to reduce overall physiological stress related to surgery and interventions overlap throughout the patient’s pathway. Using a multidisciplinary approach, adherence to ERAS® in colorectal surgery with ≥70 % compliance to the ERAS interventions has shown a risk reduction of 5-year cancer-related death by 42%. The optimum interventions are not only determined through the publication of high-quality research, but regular international collaboration enables experience and research to be shared and care standardised

Enhanced recovery after surgery (ERAS): a literature review of implications for ostomates and stoma care nurses

2020 ◽  
Vol 18 (1) ◽  
pp. 32-37
Author(s):  
Jenny Marsden
Keyword(s):  
Patient Education ◽  
Literature Review ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Hospital Service ◽  
Patient Support ◽  
Elective Patient ◽  
Added Benefit ◽  
Stoma Care

This article explores the rationale behind enhanced recovery after surgery (ERAS), and the implications for both patients and stoma care nurses (SCNs). ERAS is used for many elective patient surgical pathways worldwide. The aim is to reduce hospital stay, maximise patient outcomes and minimise complications, with the added benefit of reducing cost for the hospital service provider. The literature demonstrates that centres adhere to the various modalities of the ERAS pathway differently; however, the outcomes follow similar trends. The SCN plays a key role in the education of stoma patients on the ERAS pathway. With intensive pre- and postoperative training, the need for patient education in stoma self-care should not delay discharge. The SCN also needs to be easily accessible for patient support and review, preventing unnecessary readmission to hospital. When asked, patients are happy with their pathway and level of support received from the SCN.

Enhanced recovery after surgery and mini-invasive approaches in rectal cancer surgery – short-term outcomes

2020 ◽  
Vol 99 (12) ◽  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Rectal Surgery ◽  
Postoperative Recovery ◽  
Control Group ◽  
Rectal Cancer Surgery ◽  
Short Term ◽  
Postoperative Stay ◽  
Surgical Data ◽  
Eras Protocol

Introduction: The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. Methods: A prospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. Results: A total of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. A significantly lower incidence of paralytic ileus (20.9% vs. 3%) and a shorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. Conclusions: Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

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