Actual compliance rate of Enhanced Recovery After Surgery protocol in laparoscopic distal gastrectomy

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.

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Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial

Annals of Surgical Oncology ◽

10.1245/s10434-018-6625-0 ◽

2018 ◽

Vol 25 (11) ◽

pp. 3231-3238 ◽

Cited By ~ 20

Author(s):

So Hyun Kang ◽

Yoontaek Lee ◽

Sa-Hong Min ◽

Young Suk Park ◽

Sang-Hoon Ahn ◽

...

Keyword(s):

Gastric Cancer ◽

Clinical Trial ◽

Randomized Clinical Trial ◽

Perioperative Care ◽

Distal Gastrectomy ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Prospective Randomized Clinical Trial ◽

Totally Laparoscopic Distal Gastrectomy ◽

Totally Laparoscopic

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Compliance with D2 lymph node dissection in reduced-port totally laparoscopic distal gastrectomy in patients with gastric cancer

Scientific Reports ◽

10.1038/s41598-021-83386-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sung Eun Oh ◽

Jeong Eun Seo ◽

Ji Yeong An ◽

Min-Gew Choi ◽

Tae Sung Sohn ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Distal Gastrectomy ◽

Compliance Rate ◽

Laparoscopic Distal Gastrectomy ◽

D2 Lymphadenectomy ◽

Reduced Port Surgery ◽

Totally Laparoscopic Distal Gastrectomy ◽

Reduced Port ◽

Totally Laparoscopic

AbstractThis phase II clinical trial was performed to determine whether reduced-port laparoscopic surgery with complete D2 lymph node (LN) dissection for gastric cancer is a safe and feasible surgical technique. The prospectively enrolled 65 gastric cancer patients underwent reduced-port surgery (i.e., triple-incision totally laparoscopic distal gastrectomy [Duet TLDG] with D2 lymphadenectomy). Compliance rate was the primary outcome, which was defined as cases in which there was no more than one missing LN station during D2 LN dissection. The secondary outcomes were the numbers of dissected and retrieved LNs in each station and other short-term surgical outcomes and postoperative course. The compliance rate was 58.5%. The total number of retrieved LNs was 41 (range: 14–83 LNs). The most common station missing from LN retrieval was station no. 5 (35/65; 53.8%), followed by station no. 1 (24/65; 36.9%). The overall postoperative complication rate was 20.0% (13/65). One patient underwent surgical treatment for postoperative complications. There was no instances of mortality. Duet TLDG is an oncologically and technically safe surgical method of gastrectomy and D2 lymphadenectomy.

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The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

International Surgery ◽

10.9738/intsurg-d-19-00014.1 ◽

2020 ◽

Vol 104 (3-4) ◽

pp. 131-137

Author(s):

Y. B. Gao ◽

W. D. Jin ◽

J. Cao ◽

Z. Y. Zhang ◽

X. Cai ◽

...

Keyword(s):

Gastric Cancer ◽

Hospital Stay ◽

Distal Gastrectomy ◽

Enhanced Recovery ◽

Operation Time ◽

Laparoscopic Distal Gastrectomy ◽

Short Term ◽

Therapeutic Benefits ◽

Significant Difference ◽

Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 h versus 84.11 ± 12.18 h, P < 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 h versus 108.58 ± 13.08 h, P < 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 d versus 9.97 ± 4.53 d, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P > 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

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The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

International Surgery ◽

10.9738/intsurg-d-18-00006.1 ◽

2020 ◽

Vol 104 (3-4) ◽

pp. 116-122

Author(s):

You-Bing Gao ◽

Jin Wei-Dong ◽

Cao Jun ◽

Zhang Zhi-Yong ◽

Cai Xun ◽

...

Keyword(s):

Gastric Cancer ◽

Hospital Stay ◽

Distal Gastrectomy ◽

Enhanced Recovery ◽

Operation Time ◽

Laparoscopic Distal Gastrectomy ◽

Short Term ◽

Therapeutic Benefits ◽

Significant Difference ◽

Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 hours versus 84.11 ± 12.18 hours, P < 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 hours versus 108.58 ± 13.08 hours, P < 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 days versus 9.97 ± 4.53 days, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P > 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

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