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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EARLY ORAL RE-FEEDING ON ONCOLOGY PATIENTS SUBMITTED TO GASTRECTOMY FOR GASTRIC CANCER Realimentação precoce via oral em pacientes oncológicos submetidos à gastrectomia por câncer gástrico
TL;DR: In this paper, the authors evaluated the evolution and tolerance of early oral diet in postoperative period after gastrectomy for gastric cancer, and found that the early feeding up to 48 hours can be beneficial, because it reduces infectious complications and hospital stay.
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Selection and perioperative management of patients undergoing radical cystectomy and urinary reconstruction
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References
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Journal ArticleDOI
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Henrik Kehlet,Douglas W. Wilmore +1 more
TL;DR: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge.
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.