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Enhanced Recovery After Surgery ERAS

Emanuele Rinninella, Roberto Persiani, Domenico D'Ugo, Francesco Pennestrì, Americo Cicchetti, Eugenio Di Brino, Marco Cintoni, Giacinto Abele Donato Miggiano, Antonio Gasbarrini, Maria Cristina Mele
BACKGROUND: Postoperative complications and length of hospital stay (LOS) are major issues and affect hospital costs. Enhanced Recovery After Surgery (ERAS) protocols are effective in reducing morbidity and LOS after major surgery. We propose a nutritional protocol within ERAS programs in colorectal surgery, starting from preadmission. METHODS: We compared the ERAS + NutriCatt approach versus the ERAS standard program adopted in our center in the previous months...
February 5, 2018: Nutrition
Shawn Dason, Alvin C Goh
PURPOSE OF REVIEW: More than a century of development has led to contemporary urinary diversion. It is paramount that robotic intracorporeal diversions uphold the principles defined by open surgery. RECENT FINDINGS: In this review, we discuss the fundamental open surgical principles that have led to contemporary techniques of urinary diversion. We then outline the technical aspects of several recently described robotic intracorporeal urinary diversions in the context of these surgical principles...
March 15, 2018: Current Urology Reports
Balázs Bánky, Miklós Lakatos, Krisztina Varga, Edit Hansági, Éva Horváth, Géza Járay
INTRODUCTION: Enhanced recovery after surgery (ERAS) programme has been described and practiced for twenty years in the perioperative management of colorectal patients. ERAS is a complex, evidence based strategy which proved to be extremely effective when linked to laparoscopy in reducing morbidity, length of hospital stay, as well as reducing cost of colorectal service. AIMS: We gradually adapted elements of ERAS protocol along with laparoscopy in the colorectal surgical treatment at a county hospital from 2013...
March 2018: Magyar Sebészet
Zaina AlBalawi, Leah Gramlich, Gregg Nelson, Peter Senior, Erik Youngson, Finlay A McAlister
BACKGROUND: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. METHODS: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery...
March 12, 2018: World Journal of Surgery
Robert M Van Haren, Reza J Mehran, Arlene M Correa, Mara B Antonoff, Carla M Baker, Ta Charra Woodard, Wayne L Hofstetter, Gabriel E Mena, Jack A Roth, Boris Sepesi, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, David C Rice
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways aim to improve postoperative recovery through evidence-based practices including early ambulation, multimodal opioid-sparing analgesia, and reduction of surgical stress. The purpose of this study was to evaluate outcomes following implementation of ERAS in patients undergoing resection for pulmonary malignancy. METHODS: A retrospective review compared outcomes for patients undergoing pulmonary resection for primary lung cancer...
March 9, 2018: Annals of Thoracic Surgery
Patricia Lavand'homme
PURPOSE OF REVIEW: Cesarean section is the most common surgical procedure performed in the world. Postoperative pain management remains a challenge, particularly in a context of enhanced recovery after surgery. Several barriers related to the specific condition of 'postpartum recovery' may prevent application of effective analgesia in this population. The present review focuses on novel approaches of cesarean section postoperative pain assessment, beyond pain-rating intensity, including objective patient-centered recovery parameters...
March 7, 2018: Current Opinion in Anaesthesiology
Rafael Uña Orejón, Estrella Mateo Torres, Iván Huercio Martínez, Cristina Jofré Escudero, Juan Gómez Rivas, Jesús Díez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol...
March 2018: Archivos Españoles de Urología
José Luis Muñoz, María Oliva Alvarez, Vicent Cuquerella, Elena Miranda, Carlos Picó, Raquel Flores, Marta Resalt-Pereira, Pedro Moya, Ana Pérez, Antonio Arroyo
BACKGROUND: C-reactive protein (CRP) and procalcitonin (PCT) have been described as good predictors of anastomotic leak after colorectal surgery, obtaining the highest diagnostic accuracy on the 5th postoperative day. However, if an enhanced recovery after surgery (ERAS) program is performed, early predictors are needed in order to ensure a safe and early discharge. The aim of this study was to investigate the efficacy of CRP, PCT, and white blood cell (WBC) count determined on first postoperative days, in predicting septic complications, especially anastomotic leak, after laparoscopic colorectal surgery performed within an ERAS program...
March 8, 2018: Surgical Endoscopy
Jaime Ruiz-Tovar, José Luis Muñoz, Pablo Royo, Manuel Duran, Elisabeth Redondo, Jose Manuel Ramirez
INTRODUCTION: The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care...
March 8, 2018: Minimally Invasive Therapy & Allied Technologies: MITAT
Man Li, Junjie Zhang, Tong J Gan, Gang Qin, Lu Wang, Maoen Zhu, Zhong Zhang, Yundan Pan, Zhi Ye, Fan Zhang, Xuliang Chen, Guoqiang Lin, Lingjin Huang, Wanjun Luo, Qulian Guo, E Wang
OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways have not been reported in cardiac surgery. The aim of this study was to evaluate the clinical effectiveness and safety profile of ERAS pathways compared with routine care for patients undergoing cardiac valvular surgery. METHODS: A randomized clinical trial was conducted between July 2015 and November 2016. A total of 226 patients who underwent elective valvular surgery were randomly assigned to the ERAS pathway or routine care (control) group...
March 5, 2018: European Journal of Cardio-thoracic Surgery
Linda Martin, Bethany Sarosiek, Meredith Harrison, Traci Hedrick, James Isbell, Alexander Krupnick, Christine Lau, Hunter Mehaffey, Robert Thiele, Dustin Walters, Randal Blank
BACKGROUND: To minimize the stress of surgery, improve the patient experience, reduce variability and optimize resource utilization, we implemented a thoracic Enhanced Recovery After Surgery (ERAS) protocol and evaluated progress after one year. METHODS: Two protocols were developed: video assisted thoracic surgery (ERAS-VATS) and thoracotomy (ERAS-T). Each incorporated preoperative patient education, carbohydrate loading, opioid-sparing analgesia, conservative fluid management, and early ambulation...
March 3, 2018: Annals of Thoracic Surgery
Christopher Noss, Christopher Prusinkiewicz, Gregg Nelson, Prakash A Patel, John G Augoustides, Alexander J Gregory
Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest...
January 31, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Fabian Grass, Basile Pache, Christiane Petignat, Estelle Moulin, Dieter Hahnloser, Nicolas Demartines, Martin Hübner
OBJECTIVE: The present study aimed to evaluate whether teaching had an influence on surgical site infections (SSI) after colonic surgery. DESIGN: Colonic surgeries between January 2014 and December 2016 were retrospectively reviewed. Demographics, surgical details, and SSI rates were compared between teaching procedures vs. experts. Risk factors for SSI were identified by multinominal logistic regression. SETTING: SSI were prospectively assessed by an independent National Surveillance Program (www...
February 27, 2018: Journal of Surgical Education
D Zhao, X L Ma, W L Wang, L Zhang
Objective: To investigate the clinical effect of enhanced recovery after surgery (ERAS) in unilateral total knee arthroplasty (TKA). Methods: Retrospective analysis of 98 patients received unilateral TKA from September 2015 to September 2016 in the Orthopaedic Departmentof Affiliated Hospital of Logistics University of Chinese People's Armed Police Forces.Of the patients, 52 cases were treated by traditional operation (routine group) and the other 46 cases were treated with ERAS concept (ERAS group). The following data were gathered and statistically analyzed between the groups: gender, age, body mass index, preoperative hemoglobin, preoperative visual analogue scale (VAS) score, postoperative visible blood loss, postoperative hemoglobin at 24 hour after operation, blood transfusion rate, postoperative VAS score, length of hospital stay, the satisfaction rate, preoperative and 1 and 6 months postoperative evaluation with hospital for special surgery knee score (HSS), postoperative range of motion (ROM) of knees after 2 weeks, 1 month and 6 months of surgery, incidence rate of complications after surgery...
February 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
K Schubert Samuelsson, M Egenvall, I Klarin, J Lökk, U Gunnarsson, M Iwarzon
AIMS AND OBJECTIVES: To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery. BACKGROUND: Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made. DESIGN: Qualitative descriptive study...
March 1, 2018: Journal of Clinical Nursing
Ola S Ahmed, Ailín C Rogers, Jarlath C Bolger, Achille Mastrosimone, William B Robb
BACKGROUND: Enhanced recovery after surgery (ERAS) guidelines, fast-track protocols, and alternative clinical pathways have been widely promoted in a variety of disciplines leading to improved outcomes in post-operative morbidity and length of stay (LOS). This meta-analysis assesses the implications of standardized management protocols in bariatric surgery. METHODS: The PRISMA guidelines were adhered to. Databases were searched with the application of pre-defined inclusion and exclusion criteria...
February 27, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
E M de Leede, N J van Leersum, H M Kroon, V van Weel, J R M van der Sijp, B A Bonsing
BACKGROUND: Postoperative ileus is a common complication of abdominal surgery, leading to patient discomfort, morbidity and prolonged postoperative length of hospital stay (LOS). Previous studies suggested that chewing gum stimulates bowel function after abdominal surgery, but were underpowered to evaluate its effect on LOS and did not include enhanced recovery after surgery (ERAS)-based perioperative care. This study evaluated whether chewing gum after elective abdominal surgery reduces LOS and time to bowel recovery in the setting of ERAS-based perioperative care...
February 22, 2018: British Journal of Surgery
William R Vincent, Paul Huiras, Jennifer Empfield, Kevin J Horbowicz, Keith Lewis, David McAneny, David Twitchell
PURPOSE: Results of an interprofessional formulary initiative to decrease postoperative prescribing of i.v. acetaminophen are reported. SUMMARY: After a medical center added i.v. acetaminophen to its formulary, increased prescribing of the i.v. formulation and a 3-fold price increase resulted in monthly spending of more than $40,000, prompting an organizationwide effort to curtail that cost while maintaining effective pain management. The surgery, anesthesia, and pharmacy departments applied the Institute for Healthcare Improvement's Model for Improvement to implement (1) pharmacist-led enforcement of prescribing restrictions, (2) retrospective evaluation of i...
February 21, 2018: American Journal of Health-system Pharmacy: AJHP
Alberto A Mendivil, Justin R Busch, David C Richards, Heather Vittori, Bram H Goldstein
OBJECTIVES: The purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion. METHODS: We retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014...
March 2018: International Journal of Gynecological Cancer
Feiyu Liu, Wei Wang, Chengde Wang, Xiaonu Peng
BACKGROUND: Esophageal cancer is one of the worst malignant digestive neoplasms with poor treatment outcomes. Esophagectomy plays an important role and offers a potential curable chance to these patients. However, esophagectomy with radical lymphadenectomy is known as one of the most invasive digestive surgeries which are associated with high morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol is a patient-centered, surgeon-led system combining anesthesia, nursing, nutrition, and psychology, which is designed for reducing complications, promoting recovery, and improving treatment outcomes...
February 2018: Medicine (Baltimore)
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