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Fast track (ERAS)

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80 papers 25 to 100 followers
By Giovanni Gambino M.D. Ph.D.
C Williamsson, N Karlsson, C Sturesson, G Lindell, R Andersson, B Tingstedt
BACKGROUND: Fast-track (FT) programmes are multimodal, evidence-based approaches to optimize patient outcome after surgery. The aim of this study was to evaluate the safety, clinical outcome and patients' experience of a FT programme after pancreaticoduodenectomy (PD) in a high-volume institution in Sweden. METHODS: Consecutive patients undergoing PD were studied before and after implementation of the FT programme. FT changes included earlier mobilization, standardized removal of the nasogastric tube and drain, and earlier start of oral intake...
August 2015: British Journal of Surgery
John E Scarborough, Christopher R Mantyh, Zhifei Sun, John Migaly
OBJECTIVE: To determine the association between preoperative bowel preparation and 30-day outcomes after elective colorectal resection. METHODS: Patients from the 2012 Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database who underwent elective colorectal resection were included for analysis and assigned to 1 of 4 groups based on the type of preoperative preparation they received [combined mechanical and oral antibiotic preparation (OAP), mechanical preparation only, OAP only, or no preoperative bowel preparation]...
August 2015: Annals of Surgery
Ahmad Elnahas, David Urbach, Gerald Lebovic, Muhammad Mamdani, Allan Okrainec, Fayez A Quereshy, Timothy D Jackson
BACKGROUND: Routine preoperative mechanical bowel preparation (MBP) for left-sided colorectal resections remains controversial. This study aims to evaluate the association between MBP and 30-day anastomotic leaks. METHODS: A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program from 2011 to 2012. Multiple imputation was used for missing data, and a multivariable logistic regression was performed to adjust for clinically relevant variables...
November 2015: American Journal of Surgery
Nathalie Bakker, Hamit Cakir, H J Doodeman, A P J Houdijk
BACKGROUND: Perioperative treatment of patients with colorectal cancer according to the Enhanced Recovery After Surgery (ERAS) protocol has proven to reduce complications and duration of stay. However, strict adherence remains a challenge and the benefits may decrease with lower adherence. In this study, we report on 8 years of adherence to the ERAS protocol and its effect on postoperative outcome in patients with colon cancer. METHODS: In 2006, the ERAS protocol was introduced for treatment of colon cancer patients in the Medical Center Alkmaar, a large teaching hospital...
June 2015: Surgery
Hans Pieter van't Sant, Arnoud Kamman, Wim C J Hop, Martijn van der Heijden, Johan F Lange, Caroline M E Contant
BACKGROUND: In this study, we evaluated long-term survival in patients treated with and without mechanical bowel preparation (MBP) before colorectal surgery for cancer. METHODS: Long-term outcome of patients of 2 main participating hospitals in a prior multicenter randomized trial comparing clinical outcome of MBP versus no MBP was reviewed. Primary endpoint was cancer-related mortality and secondary endpoint was all-cause mortality. RESULTS: A total of 382 patients underwent potentially curative surgery for colorectal cancer...
July 2015: American Journal of Surgery
A Ehrlich, S Kellokumpu, B Wagner, H Kautiainen, I Kellokumpu
BACKGROUND: This study examined short-term clinical outcomes and in-hospital costs of laparoscopic and open colonic resection within fast-track and traditional care pathways. MATERIAL AND METHODS: A case-control study was performed. From 2007 to 2009, 116 patients underwent laparoscopic or open colonic resection for benign or malignant disease within fast-track care pathway. The control group consisted of 116 age-, sex-, comorbidity-, type of surgery-, and diagnosis-matched patients who received a traditional perioperative care from 2000 to 2007...
December 2015: Scandinavian Journal of Surgery: SJS
(no author information available yet)
BACKGROUND: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood. OBJECTIVE: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection...
June 2015: Annals of Surgery
E Patchen Dellinger
No abstract text is available yet for this article.
June 2015: Annals of Surgery
T C van den Heijkant, L M M Costes, D G C van der Lee, B Aerts, M Osinga-de Jong, H R M Rutten, K W E Hulsewé, W J de Jonge, W A Buurman, M D P Luyer
BACKGROUND: Postoperative ileus (POI) is a common complication following colorectal surgery that delays recovery and increases length of hospital stay. Gum chewing may reduce POI and therefore enhance recovery after surgery. The aim of the study was to evaluate the effect of gum chewing on POI, length of hospital stay and inflammatory parameters. METHODS: Patients undergoing elective colorectal surgery in one of two centres were randomized to either chewing gum or a dermal patch (control)...
February 2015: British Journal of Surgery
Akira Umemura, Keisuke Koeda, Akira Sasaki, Hisataka Fujiwara, Yusuke Kimura, Takeshi Iwaya, Yuji Akiyama, Go Wakabayashi
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG...
April 2015: Asian Journal of Surgery
Junhyun Lee, Haemyung Jeon
BACKGROUND: Radical gastrectomy for gastric cancer is one of the most invasive procedures in gastrointestinal surgery. A few studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in radical gastrectomy. The aim of this study was to evaluate the appropriate indication and feasibility of an ERAS protocol in radical gastrectomy. METHODS: We studied the clinical characteristics in 147 patients managed with an ERAS protocol after radical gastrectomy...
2014: Digestive Surgery
Lawrence Lee, Juan Mata, Gabriela A Ghitulescu, Marylise Boutros, Patrick Charlebois, Barry Stein, A Sender Liberman, Gerald M Fried, Nancy Morin, Franco Carli, Eric Latimer, Liane S Feldman
OBJECTIVE: To determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery. BACKGROUND: ERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown. METHODS: A multi-institutional prospective cohort cost-effectiveness analysis was performed. Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled...
December 2015: Annals of Surgery
Michael J Hughes, Nicholas T Ventham, Stephen McNally, Ewen Harrison, Stephen Wigmore
IMPORTANCE: The optimal analgesic technique following open abdominal surgery within an enhanced recovery protocol remains controversial. Thoracic epidural is often recommended; however, its role is increasingly being challenged and alternative techniques are being suggested as suitable replacements. OBJECTIVE: To determine by meta-analysis whether epidurals are superior to alternative analgesic techniques following open abdominal surgery within an enhanced recovery setting in terms of postoperative morbidity and other markers of recovery...
December 2014: JAMA Surgery
Deborah S Keller, Bridget O Ermlich, Nicholas Schiltz, Bradley J Champagne, Harry L Reynolds, Sharon L Stein, Conor P Delaney
BACKGROUND: Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking. OBJECTIVE: The aim of this study was to determine whether transversus abdominis plane blocks improve early postoperative outcomes in patients undergoing laparoscopic colorectal resection already on an optimized enhanced recovery pathway. DESIGN: This study is based on a prospective, randomized, double-blind controlled trial...
November 2014: Diseases of the Colon and Rectum
A G Renehan
No abstract text is available yet for this article.
November 2014: British Journal of Surgery
Rita Compagna, Giovanni Aprea, Davide De Rosa, Maurizio Gentile, Giovanni Cestaro, Gabriele Vigliotti, Tommaso Bianco, Guido Massa, Maurizio Amato, Salvatore Massa, Bruno Amato
BACKGROUND: Fast-track program has been applied in several surgical fields. However, currently many surgical patients are elderly over 70 years of age, and discussion about the application of such protocols for elderly patients is inadequate. MATERIALS AND METHODS: The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients. A total of 76 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program (n = 40) or the conventional perioperative care protocol (control group, n = 36)...
2014: International Journal of Surgery
Usama Ahmed Ali, Tony Dunne, Brooke Gurland, Jon D Vogel, Ravi P Kiran
BACKGROUND: The aim of this study was to determine factors associated with deviation in length of hospital stay (LOS) from that determined by diagnosis-related groups. METHODS: A cohort study from a prospectively collected database was conducted, including consecutive patients undergoing surgery in a high-volume colorectal surgery department in 2009. RESULTS: For 1,461 included patients, average expected and actual LOS were 8.17 days (interquartile range, 4...
October 2014: American Journal of Surgery
Marielle M E Coolsen, Ronald M van Dam, Arwind Chigharoe, Steven W M Olde Damink, Cornelis H C Dejong
BACKGROUND: Pancreaticoduodenectomies (PDs) are complex surgical procedures that require high-standard perioperative care. The objective of this study was to evaluate the effects of implementing an Enhanced Recovery After Surgery (ERAS) program for PD on patient outcome. METHODS: 230 patients undergoing PD in the Maastricht University Medical Centre between January 1995 and January 2012 were included. Group 1 (no ERAS; 1995-2005) received traditional care. From January 2006, several elements of an ERAS pathway for pancreatic surgery were implemented (group 2: 'ERAS-like')...
2014: Digestive Surgery
J Hausel, J Nygren, A Thorell, M Lagerkranser, O Ljungqvist
BACKGROUND: A carbohydrate-rich drink (CHO) has been shown to reduce preoperative discomfort. It was hypothesized that it may also reduce postoperative nausea and vomiting (PONV). METHODS: Patients undergoing elective laparoscopic cholecystectomy under inhalational anaesthesia (127 women and 45 men; mean(s.d.) 48(15) years) were randomized to either preoperative fasting, intake of CHO (50 kcal/100 ml, 290 mOsm/kg) or placebo. The non-fasting groups were double-blinded; patients ingested 800 ml of liquid on the evening before surgery and 400 ml 2 h before anaesthesia...
April 2005: British Journal of Surgery
Asa Wallström, Gunilla Hollman Frisman
AIMS AND OBJECTIVES: To determine how restored gastrointestinal motility can be accelerated after colorectal surgery. BACKGROUND: Regaining normal bowel functions after surgery is described as unexpectedly problematic. Postoperative ileus is expected after all surgery where the peritoneum is entered, and the length of surgery has little or no impact in terms of the duration of Postoperative ileus. There is some speculation about the best way to facilitate bowel motility after colorectal surgery...
January 2014: Journal of Clinical Nursing
2014-08-16 14:50:01
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