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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Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African colorectal cancer cohort.
TL;DR: Preoperative physical activity and functional performance levels are predictors of acute postoperative outcomes in a private South African cohort of patients with colorectal cancer.
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Jejum inferior a oito horas em cirurgias de urgência e emergência versus complicações
Adelita de Jesus Carvalho Martins,Cristiane Alves de Souza Serva,Tatiane Helena da Fonseca,Maria Joana de Lima Martins,Vanessa de Brito Poveda +4 more
TL;DR: Las complicaciones intra y posoperatorias no estuvieron asociadas al tiempo de ayuno de los pacientes, sino a las condiciones clinicas de ellos.
Journal ArticleDOI
Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway.
Kai W. Cheng,Ankeet Shah,Soroush T. Bazargani,Gus Miranda,Jie Cai,Monish Aron,Anne Schuckman,Mihir M. Desai,Inderbir S. Gill,Siamak Daneshmand,Hooman Djaladat +10 more
TL;DR: ICU admission is uncommon following RC with ERAS protocol, and advanced age and comorbidity index are significantly associated with unplanned ICU transfer.
Journal ArticleDOI
One-year Unplanned Readmission After Colorectal Cancer Surgery in Western China.
TL;DR: One-year unplanned readmission occurs frequently after CRC in Western China and is strongly associated with preoperative comorbidity, which should be paid to wound healing at the early stage of discharge, and bowel obstruction 3 months after discharge.
Journal ArticleDOI
Effects of the Enhanced Recovery Program on the Recovery and Stress Response in Patients With Cancer Undergoing Pancreatoduodenectomy.
Maria Kapritsou,Elizabeth Papathanassoglou,Evangelos Konstantinou,Dimitrios P. Korkolis,Meropi Mpouzika,Ioannis Kaklamanos,Margarita Giannakopoulou +6 more
TL;DR: Despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain.
References
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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.