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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Intensive insulin therapy for the critically ill patients with stress hyperglycemia
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Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review.
TL;DR: A systematic review of the literature was performed using surgery, endocrine response, systemic inflammatory response, cortisol, IL-6, white cell count, and C-reactive protein (CRP) as discussed by the authors.
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Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence.
TL;DR: This narrative review presents a model ERAS pathway that can be applied to perioperative care of patients undergoing hip or knee arthroplasty, and identifies interventions lacking high-quality evidence.
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Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery.
Michał Pędziwiatr,Judene Mavrikis,Jan Witowski,Alexandros Adamos,Piotr Major,Michał Nowakowski,Andrzej Budzyński +6 more
TL;DR: The role of ERAS in several surgical disciplines was reviewed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions.
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Alvimopan accelerates gastrointestinal recovery after radical cystectomy: A multicenter randomized placebo-controlled trial
Cheryl T. Lee,Sam S. Chang,Ashish M. Kamat,Gilad E. Amiel,Timothy L. Beard,Amr Fergany,R. Jeffrey Karnes,Andrea Kurz,Venu Menon,Wade J. Sexton,Joel W. Slaton,Robert S. Svatek,Shandra Wilson,Lee Techner,Richard Bihrle,Gary D. Steinberg,Michael O. Koch +16 more
TL;DR: Alvimopan is a useful addition to a standardized care pathway in patients undergoing radical cystectomy for bladder cancer by accelerating GI recovery and shortening LOS, with a safety profile similar to placebo.
References
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Delayed gastric emptying and postoperative ileus after nongastric abdominal surgery: part I.
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Gum chewing reduces postoperative ileus? A systematic review and meta-analysis
TL;DR: Chewing sugarless gum following elective intestinal resection is associated with improved outcomes and an adequately powered, methodologically rigorous trial of gum chewing is required to confirm if there are any benefits and if these result in differences in clinical outcomes such as infection.
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Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique.
TL;DR: The results indicate that insulin resistance after elective abdominal surgery is due to a postreceptor deficit in glucose utilization, as indicated by the downward shift of the dose‐response curves.
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Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery
TL;DR: Chewing-gum therapy following open gastrointestinal surgery is beneficial in reducing the period of postoperative ileus, although without a significant reduction in length of hospital stay.
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Bowel Preparation Is Associated With Spillage of Bowel Contents in Colorectal Surgery
TL;DR: Spillage of bowel contents into the peritoneal cavity during colon and rectal surgery may increase the rate of postoperative infectious complications, and inadequate mechanical bowel preparation, leading to liquid bowel contents, increases the rates of intraoperative spillage.