scholarly journals Perception and implementation status of enhanced recovery after surgery

2021 ◽  
Vol 64 (12) ◽  
pp. 826-832
Author(s):  
Eun Young Kim
Keyword(s):  
Large Scale ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Current Status ◽  
Practical Implementation ◽  
Clinical Implementation ◽  
Before And After ◽  
Limited Application ◽  
Systematic Education ◽  
Implementation Status

Background: The enhanced recovery after surgery (ERAS) program that is being implemented in Korea is difficult to investigate because it is not a standardized protocol with a unified content, and it instead differs according to the details for each hospital. Herein, the author would like to introduce and analyze the results of a recently conducted large-scale survey on the current status and perception of the ERAS program in Korea among large domestic hospitals.Current Concepts: Surveys of domestic general surgeons in 2019 and hepatobiliary-pancreatic surgeons in 2020 both showed lower-than-expected response rates of less than 50% in questions related to perception and clinical implementation of the ERAS program. Thus, implementation of ERAS items related to the limited application of preoperative fasting and surgical drain insertion and active nutritional support before and after surgery remains low.Discussion and Conclusion: For surgeons in Korea, the implementation of ERAS programs and perception levels were low. In this regard, it is necessary to improve awareness through systematic education and promotion of the ERAS program, and supplementation of related multidisciplinary professional manpower and financial resources is essential to facilitate practical implementation of ERAS programs in clinical practice.

Health Management of Enhanced Recovery After Surgery in Thoracic Surgery

2020 ◽  
Vol 10 (6) ◽  
pp. 1301-1308
Author(s):  
Cuilian Li ◽  
Zhenling Cai ◽  
Meixia Wu ◽  
Guijiao Li ◽  
Yingmin Xie
Keyword(s):  
Thoracic Surgery ◽  
Clinical Application ◽  
Health Management ◽  
Comprehensive Evaluation ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Evaluation Criteria ◽  
Current Status ◽  
Clinical Implementation ◽  
Accelerated Rehabilitation

Objective: Although the concept of Enhanced Recovery After Surgery (ERAS) has gradually become familiar with surgeons and applied in clinical practice in recent years, the current status of the experience and application of ERAS in Chinese mainland thoracic surgeons is still not clear. This study is based on the results of a questionnaire survey of ERAS-related issues among participating thoracic surgeons and nurses, and analyzes the current status of accelerated rehabilitation surgery in thoracic surgery using bioinformatics. Methods: We analyze the 720 valid questionnaires that participated in the first session of the ERAS West China Forum. The content of the questionnaire mainly includes two parts: one is the situation of the respondent’s unit and the basic situation of the individual; the other is to accelerate the 10 problems related to rehabilitation surgery. Results: (1) The clinical application status of ERAS is more than practice, and 68.3% of doctors and 57.8% of nurses agree with this view; 87.9% of doctors and 86.2% of nurses believe that the ERAS concept applies to all surgical procedures. (2) The main reason for the poor compliance of ERAS clinical application was that the program was immature, without consensus and norms (56.4% of doctors and 68.8% of nurses). (3) The best team combination for ERAS clinical implementation is surgical-based discipline collaboration and healthcare (61.5% of physicians and 72.2% of nurses). (4) 75.1% of doctors and 82.6% of nurses believe that the evaluation criteria of ERAS should be: comprehensive evaluation of average hospitalization days, patient experience and social satisfaction. Conclusions: Accelerated rehabilitation surgery in the application of thoracic surgery is still the idea is greater than practice, the main reason is the lack of clinically available norms and programs. We can achieve the findings and verify them using statistical study.

scholarly journals Biological impact of an enhanced recovery after surgery programme in liver surgery

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
S Gonvers ◽  
J Jurt ◽  
G -R Joliat ◽  
N Halkic ◽  
E Melloul ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Multivariable Analysis ◽  
Albumin Concentration ◽  
Biological Impact ◽  
Reactive Protein ◽  
Before And After ◽  
Major Resection

Abstract Background The clinical and economic impacts of enhanced recovery after surgery (ERAS) programmes have been demonstrated extensively. Whether ERAS protocols also have a biological effect remains unclear. This study aimed to investigate the biological impact of an ERAS programme in patients undergoing liver surgery. Methods A retrospective analysis of patients undergoing liver surgery (2010–2018) was undertaken. Patients operated before and after ERAS implementation in 2013 were compared. Surrogate markers of surgical stress were monitored: white blood cell count (WBC), C-reactive protein (CRP) level, albumin concentration, and haematocrit. Their perioperative fluctuations were defined as Δvalues, calculated on postoperative day (POD) 0 for Δalbumin and Δhaematocrit and POD 2 for ΔWBC and ΔCRP. Results A total of 541 patients were included, with 223 and 318 patients in non-ERAS and ERAS groups respectively. Groups were comparable, except for higher rates of laparoscopy (24.8 versus 11.2 per cent; P < 0.001) and major resection (47.5 versus 38.1 per cent; P = 0.035) in the ERAS group. Patients in the ERAS group showed attenuated ΔWBC (2.00 versus 2.75 g/l; P = 0.013), ΔCRP (60 versus 101 mg/l; P <0.001) and Δalbumin (12 versus 16 g/l; P < 0.001) compared with those in the no-ERAS group. Subgroup analysis of open resection showed similar results. Multivariable analysis identified ERAS as the only independent factor associated with high ΔWBC (odds ratio (OR) 0.65, 95 per cent c.i. 0.43 to 0.98; P = 0.038), ΔCRP (OR 0.41, 0.23 to 0.73; P = 0.003) and Δalbumin (OR 0.40, 95 per cent c.i. 0.22 to 0.72; P = 0.002). Conclusion Compared with conventional management, implementation of ERAS was associated with an attenuated stress response in patients undergoing liver surgery.

scholarly journals Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

2018 ◽  
Vol 35 (6) ◽  
Author(s):  
Michał Pędziwiatr ◽  
Judene Mavrikis ◽  
Jan Witowski ◽  
Alexandros Adamos ◽  
Piotr Major ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gastrointestinal Surgery ◽  
Current Status ◽  
Eras Protocol

A Single Surgeons Experience with Enhanced Recovery after Surgery: An Army of One

2016 ◽  
Vol 82 (7) ◽  
pp. 594-601 ◽  
Author(s):  
Catalina Mosquera ◽  
Nicholas J. Koutlas ◽  
Timothy L. Fitzgerald
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Univariate Analysis ◽  
Intestinal Resection ◽  
High Volume ◽  
Before And After ◽  
Individual Surgeon ◽  
The Mean ◽  
Eras Protocol ◽  
Surgical Oncologist

The benefits of enhanced recovery after surgery (ERAS) have been demonstrated for multiple surgical procedures in high-volume programs. However, resources required for its implementation may be daunting to individual surgeons. Patients undergoing elective abdominal procedures from June 2013 to April 2015 by a surgical oncologist before and after the implementation of an ERAS protocol were reviewed. A total of 179 patients were included. The mean age of the patients was 63 years, and a majority of them were females (53.6%), white (61.5%), had a Charlson score of 0 to 2 (45.8%), and a Clavien complication grade of 0 to I (60.1%). The univariate analysis revealed that the ERAS protocol was associated with shorter length of stay (LOS) (6.2 vs 9.6 days), lower cost ($21,674 vs $30,380), and lower mortality (0 vs 3.3%); P < 0.05. Differences were noted in LOS and costs for all procedures, the differences were the greatest for hepatic resection (3.8 vs 8.4 days and $16,770 vs $28,589), intestinal resection/stoma closure (4.8 vs 7.6 days and $18,391 vs $22,239), and other abdominal procedures (5.0 vs 10.8 and $17,713 vs $30,900); P < 0.05. The differences were less for patients undergoing procedures for which postoperative pathways were already in place such as pancreatic (9 vs 10.8 days and $30,524 vs $34,291) and colorectal (5.3 vs 6.5 days and $20,733 vs $25,150) surgeries. P > 0.05. An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality.

Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed

2020 ◽  
Vol 86 (9) ◽  
pp. 1078-1082
Author(s):  
Miles Landry ◽  
Rachel Lewis ◽  
Andrew Antill ◽  
R. Eric Heidel ◽  
Jessica Taylor ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cost Of Care ◽  
Longitudinal Impact ◽  
Anatomic Site ◽  
Elective Colorectal Surgery ◽  
Before And After ◽  
Eras Protocol ◽  
The Impact ◽  
Over Time

Background Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. Methods A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. Results A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days ( P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. Conclusion After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

scholarly journals Swiss Validation of the Enhanced Recovery After Surgery (ERAS) Database

2021 ◽  
Author(s):  
Basile Pache ◽  
David Martin ◽  
Valérie Addor ◽  
Nicolas Demartines ◽  
Martin Hübner
Keyword(s):  
Missing Data ◽  
Large Scale ◽  
Urinary Catheter ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Prospective Audit ◽  
Audit System ◽  
Validation Criteria ◽  
Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet. Methods Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15–20). Results Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables “urinary catheter removal” (16.4%) and “mobilization on day 1” (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria. Conclusion EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset.

scholarly journals MP26-20 ROBOTIC RADICAL CYSTECTOMY OUTCOMES BEFORE AND AFTER ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAY

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Matthew Winter ◽  
Pierre Heuber* ◽  
Wesley Yip ◽  
Aliasger Shakir ◽  
Alessandro Tafuri ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Before And After ◽  
Robotic Radical Cystectomy

scholarly journals The Pertinent Literature of Enhanced Recovery after Surgery Programs: A Bibliometric Approach

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 172
Author(s):  
Cheng Li ◽  
Yang Cheng ◽  
Zhao Li ◽  
Donara Margaryan ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Bibliometric Analysis ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Linear Regression Analysis ◽  
Gastrointestinal Surgery ◽  
The United States ◽  
Current Status ◽  
Strong Positive Correlation

Background and Objectives: The programs of enhanced recovery after surgery are the new revolution in surgical departments; however, features of this concept have not been systematically explored. Therefore, the purpose of this study was to explore Enhanced recovery after surgery (ERAS)-related research using bibliometric analysis. Materials and Methods: The search strategy of ERAS programs was conducted in the Web of Science database. Bibliometric analysis was further performed by Excel and Bibliometrix software. The relationship between citation counts and Mendeley readers was assessed by linear regression analysis. Results: 8539 studies from 1994–2019 were included in the present research, with reporting studies originating from 91 countries using 18 languages. The United States (US) published the greatest number of articles. International cooperation was discovered in 82 countries, with the most cooperative country being the United Kingdom. Henrik Kehlet was found to have published the highest number of studies. The journal Anesthesia and Analgesia had the largest number of articles. Linear regression analysis presented a strong positive correlation between citations and Mendeley readers. Most research was related to gastrointestinal surgery in this field. Conclusion: This bibliometric analysis shows the current status of ERAS programs from multiple perspectives, and it provides reference and guidance to scholars for further research.

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