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
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Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review.
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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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Electrolyte Disorders Following Oral Sodium Phosphate Administration for Bowel Cleansing in Elderly Patients
TL;DR: Assessment of serum electrolytes, phosphorus, and calcium prior to sodium phosphate preparation is advised, and in selected patients, postprocedural assessment and correction may be required.
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Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion.
TL;DR: In this paper, the authors investigated whether chewing gum chewing in the immediate post-operative period facilitates a return to bowel function in patients undergoing cystectomy and urinary diversion in colorectal cancer patients.
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Hyponatremia and seizures after bowel preparation: report of three cases.
Frank A. Frizelle,B. M. Colls +1 more
TL;DR: Care must be taken with patients with a low seizure threshold and those with possible chronic sodium depletion, such as patients on thiazide diuretics, who are undertaking bowel preparation with oral sodium phosphate or sodium picosulfates/magnesium citrate combination.
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Does Gum Chewing Ameliorate Postoperative Ileus? Results of a Prospective, Randomized, Placebo-Controlled Trial
Evan Matros,Flavio Jaime Rocha,Michael J. Zinner,John E. Wang,Stanley W. Ashley,Elizabeth C. Breen,David I. Soybel,Brent Shoji,Anne Burgess,Ronald Bleday,Richard E. Kuntz,Edward E. Whang +11 more
TL;DR: A prospective, randomized, placebo-controlled clinical trial suggests that gum chewing, although safe, does not reduce duration of postcolectomy ileus.