Enhanced recovery after surgery (ERAS) protocols: Time to change practice?
TLDR
Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery as discussed by the authors.Abstract:
Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow. The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.read more
Citations
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Journal ArticleDOI
Enhanced Recovery in Bariatric Surgery: A Study of Short-Term Outcomes and Compliance
Amlish B. Gondal,Chiu Hsieh Hsu,Federico Serrot,Andrea Rodriguez-Restrepo,Audriana N. Hurbon,Carlos A. Galvani,Iman Ghaderi +6 more
TL;DR: Implementation of ERAS program for bariatric surgery is safe and feasible, it reduces hospital stay and postoperative morbidity, and easy to implement strategies such as checklists should be encouraged in bariatric programs to aid in implementation and compliance with ERAS elements for perioperative care.
Journal ArticleDOI
Optimizing senior's surgical care - Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives
Rachel G. Khadaroo,Rachel G. Khadaroo,Raj Padwal,Adrian Wagg,Fiona Clement,Lindsey M. Warkentin,Jayna Holroyd-Leduc +6 more
TL;DR: It is hypothesized that specific Elder-friendly Approaches to the Surgical Environment (EASE) interventions will similarly improve health outcomes in a cost-effective manner and validate a novel elder-friendly surgical model including assessment of both clinical and economic benefits.
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Predicting Patients at Risk of Early Postoperative Adverse Events
TL;DR: The preliminary findings suggest that preoperative identification of key factors may have utility in determining risk of early postoperative problems and hence, aid perioperative planning.
Journal ArticleDOI
Patient Health Engagement (PHE) model in enhanced recovery after surgery (ERAS): Monitoring patients' engagement and psychological resilience in minimally invasive thoracic surgery
TL;DR: The authors propose the Patient Health Engagement (PHE) model and the PHE scale as scientific and reliable tools to orient clinical actions and organizational strategies based on the patient engagement score.
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Malnourishment in bladder cancer and the role of immunonutrition at the time of cystectomy: an overview for urologists.
Gavish Munbauhal,Sarah J. Drouin,Pierre Mozer,Pierre Colin,Véronique Phé,Olivier Cussenot,Morgan Rouprêt +6 more
TL;DR: There is not enough evidence in malnourished urological study cohorts to establish a consensus on IM, and the role of IM should be considered investigational in patients with bladder cancer.
References
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Journal ArticleDOI
Enhanced recovery after surgery
TL;DR: A protocol is presented which is in current use by the ERAS Group and may provide a standard of care against which either current or future novel elements of an enhanced recovery approach can be tested for their effect on outcome.