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Enhanced recovery after surgery

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https://www.readbyqxmd.com/read/27926560/using-modified-frailty-index-to-predict-safe-discharge-within-48-hours-of-ileostomy-closure
#1
Yuxiang Wen, Murad A Jabir, Eslam M G Dosokey, Dongjin Choi, Clayton C Petro, Justin T Brady, Scott R Steele, Conor P Delaney
BACKGROUND: Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery. OBJECTIVE: The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure...
January 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/27924202/randomized-trial-of-subfascial-infusion-of-ropivacaine-for-early-recovery-in-laparoscopic-colorectal-cancer-surgery
#2
Sang Hyun Lee, Woo-Seog Sim, Go Eun Kim, Hee Cheol Kim, Joo Hyun Jun, Jin Young Lee, Byung-Seop Shin, Heejin Yoo, Sin-Ho Jung, Joungyoun Kim, Seung Hyeon Lee, Deok Kyu Yo, Yu Ri Na
BACKGROUND: There is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse 'v' shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery. METHODS: Forty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours...
December 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27923484/implementation-of-a-novel-enhanced-recovery-after-surgery-program-in-thoracoscopic-bilateral-bullectomy
#3
Zhihua Guo, Shuben Li, Weiqiang Yin, Jianxing He
No abstract text is available yet for this article.
November 12, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27922866/quality-and-safety-in-health-care-part-xix-variants-of-the-eras-program
#4
Jay A Harolds
The integrated recovery pathway is a variant of the enhanced recovery pathway after surgery program, which saw a further decrease in complications and mean length of stay after a change in culture was instituted with more accountability of the staff to following the pathway. This was accomplished using a team-based comprehensive unit-based safety program. It has also been found that another variant of the enhanced recovery pathway after surgery program had a further improvement of patient outcomes after instituting a "preventive surgical site infection bundle...
December 3, 2016: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/27918332/isoflurane-impairs-motor-function-recovery-by-increasing-neuroapoptosis-and-degeneration-during-spinal-ischemia-reperfusion-injury-in-rats
#5
Shih-Yuan Fang, Jung-Shun Lee, Jun-Neng Roan, Yu-Chuan Tsai, Chen-Fuh Lam
BACKGROUND: Spinal cord ischemia (SCI) leads to variable degrees of neurologic deficit in patients undergoing major cardiovascular surgery. The effect of intraoperative neuroprotection against SCI and the subsequent ischemia-reperfusion injury is still limited. Because isoflurane is a commonly used anesthetic agent during major operation, and its neuroprotective and neurotoxicity effects have both been discussed, this study aimed to investigate the effect of isoflurane on the spinal cord's functional recovery in a rat model of cord ischemia...
December 1, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27913253/vibrissal-paralysis-produces-increased-corticosterone-levels-and-impairment-of-spatial-memory-retrieval
#6
William E Patarroyo, Milady García-Perez, Marisol Lamprea, Alejandro Múnera, Julieta Troncoso
This research was aimed at establishing how the absence of active whisking in rats affects acquisition and recovery of spatial memory. The mystacial vibrissae were irreversibly paralyzed by cutting the facial nerve's mandibular and buccal branches bilaterally in the facial nerve lesion group (N=14); control animals were submitted to sham-surgery (N=15). Sham-operated (N=11) and facial nerve-lesioned (N=10) animals were trained (one session, eight acquisition trials) and tested 24hours later in a circular Barnes maze...
November 29, 2016: Behavioural Brain Research
https://www.readbyqxmd.com/read/27903590/anterior-cruciate-ligament-derived-stem-cells-transduced-with-bmp2-accelerate-graft-bone-integration-after-acl-reconstruction
#7
Yohei Kawakami, Koji Takayama, Tomoyuki Matsumoto, Ying Tang, Bing Wang, Yutaka Mifune, James H Cummins, Ryan J Warth, Ryosuke Kuroda, Masahiro Kurosaka, Freddie H Fu, Johnny Huard
BACKGROUND: Strong graft-bone integration is a prerequisite for successful graft remodeling after reconstruction of the anterior cruciate ligament (ACL) using soft tissue grafts. Novel strategies to accelerate soft tissue graft-bone integration are needed to reduce the need for bone-tendon-bone graft harvest, reduce patient convalescence, facilitate rehabilitation, and reduce total recovery time after ACL reconstruction. HYPOTHESIS: The application of ACL-derived stem cells with enhanced expression of bone morphogenetic protein 2 (BMP2) onto soft tissue grafts in the form of cell sheets will both accelerate and improve the quality of graft-bone integration after ACL reconstruction in a rat model...
November 30, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27900463/a-model-for-lymphocyte-activation-in-open-versus-laparoscopic-surgery-in-colorectal-cancer-patients-in-enhanced-recovery-after-surgery-eras-protocols
#8
Ana Belén Martínez, J Longás, J M Ramírez
PURPOSE: Given the high mortality and morbidity associated with colon cancer worldwide and the advantages inherent to the use of the laparoscopy technique with respect to open surgery in oncological colorectal surgery, a study was designed to observe and compare the lymphocyte activation model between open surgery (OS) and laparoscopic surgery (LS) for this type of patient as part of an ERAS protocol. METHODS: A prospective study was conducted with 38 patients who underwent surgery due to colorectal disease and were included in an ERAS protocol...
November 30, 2016: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/27884220/multimodal-pain-management-for%C3%A2-enhanced-recovery-reinforcing-the-shift-from-traditional-pathways-through-nurse-led-interventions
#9
Robert Montgomery, Sharon A McNamara
Despite recent advances in perioperative patient care, postsurgical pain continues to be undermanaged. There is increasing acceptance of the concept that effective postsurgical pain management is best achieved through combined use of more than one analgesic agent or technique, and overreliance on opioids produces unwanted side effects limiting their utility. Accordingly, a balanced, multimodal approach to pain management within the larger framework of an Enhanced Recovery After Surgery (ERAS) pathway has become standard at many institutions for perioperative care, to control postsurgical pain, reduce opioid-related adverse events, hasten postsurgical recovery, and shorten length of hospital stay...
December 2016: AORN Journal
https://www.readbyqxmd.com/read/27882418/compliance-with-guidelines-of-enhanced-recovery-after-surgery-in-elderly-patients-undergoing-gastrectomy
#10
Oh Jeong, Young Kyu Park, Mi Ran Jung, Seong Yeob Ryu
BACKGROUND: Enhanced recovery after surgery (ERAS) aims at expediting postoperative recovery by implementing specific strategies in perioperative management. However, the tolerance to such fast-tracking protocols is under debate, especially in elderly patients. We aimed to investigate rate of compliance with the main ERAS guidelines in elderly gastrectomy patients. METHODS: Using data for 168 gastric cancer patients who underwent ERAS after gastrectomy as part of Clinical Trial NCT01653496, we calculated the rates of compliance with nine main ERAS guidelines and compared the compliance rates of elderly (≥70 years) and non-elderly (<70 years) patients...
November 23, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27878754/efficiency-and-safety-effects-of-applying-eras-protocols-to-bariatric-surgery-a-systematic-review-with-meta-analysis-and-trial-sequential-analysis-of-evidence
#11
REVIEW
Preet Mohinder Singh, Rajesh Panwar, Anuradha Borle, Basavana Goudra, Anjan Trikha, Bart A van Wagensveld, Ashish Sinha
Application of the enhanced recovery after surgery (ERAS) to the bariatric surgical procedures is at its early stages with little consolidated evidence. This meta-analysis evaluates present literature and indicates pathways for development of evidence-based standardized ERAS protocols for bariatric surgery. Comparative trials between ERAS and conventional bariatric surgery published till June 2016 were searched in the medical database. Comparisons were made for length of stay (LOS), readmission, complications (major/minor), and reoperation rates...
November 23, 2016: Obesity Surgery
https://www.readbyqxmd.com/read/27875094/laparoscopic-radical-gastrectomy-for-resectable-advanced-gastric-cancer-within-enhanced-recovery-programs-a-prospective-randomized-controlled-trial
#12
Xia Mingjie, Zhang Luyao, Tang Ze, Zhao YinQuan, Wang Quan
BACKGROUND: Enhanced recovery programs have become an important focus of perioperative management. A few studies have demonstrated the efficacy of an enhanced recovery after surgery (ERAS, which includes optimized pain control, restricted I.V. fluids, early initiation of postoperative oral feeding, and enforced mobilization) protocol in patients undergoing radical gastrectomy. We investigated the feasibility and safety of laparoscopic radical gastrectomy within ERAS programs. METHODS: In this single-center prospective randomized controlled trial conducted between September 2013 and August 2014, 149 consecutive locally advanced gastric cancer patients (T2-4, any N, M0) diagnosed by the CT scanning were allocated to either ERAS group (N = 73) or conventional pathway group (N = 76)...
November 22, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27871679/discharge-criteria-after-colon-resection-is-return-of-bowel-function-necessary
#13
C Neal Ellis
BACKGROUND: This study was performed to evaluate tolerance of liquids as discharge criteria in a perioperative enhanced recovery protocol. METHODS: Patients undergoing elective colon resections were prospectively enrolled in a standardized perioperative enhanced recovery process. Patients were eligible for discharge when able to tolerate sufficient oral liquids, as determined by clinical means, that intravenous fluids were no longer needed. RESULTS: Over an 18 month period, 94 patients were evaluated; 75 (80%) tolerated sufficient liquids such that intravenous fluids were no longer needed by the second and all by the third postoperative day...
November 8, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27871557/effect-of-adjunctive-dexmedetomidine-on-postoperative-intravenous-opioid-administration-in-patients-undergoing-thyroidectomy-in-an-ambulatory-setting
#14
Kristin Long, Joseph Ruiz, Spencer Kee, Alicia Kowalski, Farzin Goravanchi, Jeff Cerny, Katy French, Mike Hernandez, Nancy Perrier, Elizabeth Rebello
STUDY OBJECTIVE: Two of the most feared complications for patients undergoing thyroid surgery are pain and postoperative nausea and vomiting. Thyroidectomy is considered high risk for postoperative nausea and vomiting, and recent studies have looked at adjuncts to treat pain, limit narcotic use, "fast-track" the surgical process, and enhance recovery without compromising the patient's safety. One such perioperative medication of interest is dexmedetomidine (Dex), a centrally acting α-2 agonist that has been associated with reducing pain and postoperative opioid consumption...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27865279/enhanced-recovery-pathways-in-pancreatic-surgery
#15
REVIEW
Joshua G Barton
Enhanced recovery after surgery (ERAS) protocols were first introduced to help recovery after colorectal surgery. They have now been applied to multiple surgical specialties, including pancreatic surgery. ERAS protocols in pancreatic surgery have been shown to decrease length of stay and possibly postoperative morbidity.
December 2016: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27863944/how-to-introduce-a-program-of-enhanced-recovery-after-surgery-the-experience-of-the-capio-group
#16
J-F Verrier, C Paget, F Perlier, F Demesmay
The traditional model of hospital care has been challenged by the development of a care-management process that allows early patient autonomy (outpatient surgery, Enhanced Recovery after Surgery). Hospitalization has been transformed in response to this development, based on innovative medical and organizational strategies. Within a surgical service, the deployment of these processes requires the creation of a support structure, with re-organization of existing structures, analysis of potential obstacles, implementation of management tools, and ongoing follow-up of organizational function, clinical results, organizational and patient satisfaction...
November 15, 2016: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/27857048/myocardial-scarring-after-repair-of-anomalous-origin-of-the-left-coronary-artery-from-pulmonary-artery
#17
(no author information available yet)
OBJECTIVES: Prognosis of patients with anomalous origin of the left coronary artery from pulmonary artery has dramatically improved as a result of both, early diagnosis and improvements in surgical techniques. Post surgical complications are rare and most patients show quick improvement of the left ventricular performance after repair with complete functional recovery within one year after surgery. Exercise-induced electrocardiographic changes have been found in patients postoperatively and scars and perfusion deficits of the left ventricle may not be detected by standard echocardiographic evaluation...
September 18, 2016: Neuro Endocrinology Letters
https://www.readbyqxmd.com/read/27855087/impact-of-weekday-surgery-on-application-of-enhanced-recovery-pathway-a-retrospective-cohort-study
#18
Benoît Romain, Fabian Grass, Valérie Addor, Nicolas Demartines, Martin Hübner
OBJECTIVE: To compare the enhanced recovery after surgery (ERAS) protocol compliance and clinical outcomes depending on the weekday of surgery. SETTINGS: Cohort of consecutive non-selected patients undergoing elective colorectal surgery from January 2012 to March 2015. This retrospective analysis of our prospective database compared patients operated early in the week (Monday and Tuesday) with patients operated in the second half (late: Thursday, Friday). PRIMARY OUTCOME MEASURES: Compliance with the ERAS protocol, functional recovery, complications and length of stay...
October 7, 2016: BMJ Open
https://www.readbyqxmd.com/read/27847094/pain-management-in-an-enhanced-recovery-pathway-after-thoracic-surgical-procedures
#19
Reza J Mehran, Linda W Martin, Carla M Baker, Gabriel E Mena, David C Rice
Pain management is the backbone of enhanced recovery after thoracic surgery (ERATS) care maps, which aim to save time in the operating room, shorten hospital stays, and reduce pain-related adverse events. We describe a systematic approach developed at our institutions to manage pain in patients undergoing thoracic surgical procedures.
December 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27831970/spontaneous-closure-of-a-macular-hole-after-four-failed-vitrectomies-in-the-setting-of-nf-1
#20
Kendall W Wannamaker, Robert A Sharpe, Jan A Kylstra
PURPOSE: To present the case of a patient who developed spontaneous closure of an idiopathic macular hole after four failed attempts at surgical closure. METHODS: This is a retrospective case review of the medical record of a single patient. No statistical analysis was performed. The patient is a 71-year-old white woman with neurofibromatosis Type 1 who presented to the retina clinic of one of the authors. RESULTS: The patient underwent four vitrectomies with long acting gas by two surgeons over the course of 2 years...
November 9, 2016: Retinal Cases & Brief Reports
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