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
Updates on enhanced recovery after surgery for radical cystectomy
TL;DR:
Journal ArticleDOI
A 6-month audit of epidural analgesia in a teaching hospital
TL;DR: EA in the setting is safe but not effective and requires further and frequent scrutiny in terms of procedures, technical skill, education and perhaps looking at its cost-effectiveness and need for standardization.
Posted ContentDOI
Enhanced recovery after surgery (ERAS) protocols is extermely beneficial in liver surgeries – A metaanalysis
Bhavin Vasavada,Hardik Patel +1 more
TL;DR: The adoption of ERAS protocols significantly reduced morbidity, hospital stay, readmission rates, time to recovery, hospital costs, and time to pass flatus in patients undergoing liver surgeries.
Journal ArticleDOI
A Protocol to Decrease Surgical Site Infection Rates in Colorectal Surgical Procedures.
Ayman N Abunimer,Sandy L. Fogel +1 more
TL;DR: The hypothesis that patients undergoing colorectal surgical procedures would benefit from an updated and optimized ERP was confirmed and it was surprising that the expanded protocol would be able to reduce patient LOS in the hospital by over a day more than by the standard ERP alone.
Journal ArticleDOI
Pre-Operative Enhanced Recovery After Surgery (ERAS) Protocol Compliance Towards Major Surgery Patients at Dr. Soetomo General Hospital, Surabaya
TL;DR: Pre-operative elements of ERAS protocol in major surgery including digestive, thoracic and cardiovascular, and gynecologic surgery in Dr. Soetomo General Hospital, Surabaya needs to be improved.
References
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Journal ArticleDOI
Intensive Insulin Therapy in Critically Ill Patients
Greet Van den Berghe,Pieter Wouters,Frank Weekers,Charles Verwaest,Frans Bruyninckx,Miet Schetz,Dirk Vlasselaers,Patrick Ferdinande,Peter Lauwers,Roger Bouillon +9 more
TL;DR: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
Journal ArticleDOI
Multimodal approach to control postoperative pathophysiology and rehabilitation.
TL;DR: While no single technique or drug regimen has been shown to eliminate postoperative morbidity and mortality, multimodal interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative mortality and overall costs.
Journal ArticleDOI
Multimodal strategies to improve surgical outcome.
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.