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
More filters
Journal Article
Intensive insulin therapy for the critically ill patients with stress hyperglycemia
TL;DR: Intensive insulin therapy and keeping blood glucose at 4.4 to 6.1 mmol/L can improve the clinical curative effect and reduce the mortality for the critically ill patients with stress hyperglycemia.
Journal ArticleDOI
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.
Journal ArticleDOI
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.
Journal ArticleDOI
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.
Journal ArticleDOI
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
More filters
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
Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials
TL;DR: There seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection, and theoretically, early enteral feeding improves tissue healing and reduces septic complications after gastrointestinal surgery.
Journal Article
Intensive insulin therapy for the critically ill patients with stress hyperglycemia
TL;DR: Intensive insulin therapy and keeping blood glucose at 4.4 to 6.1 mmol/L can improve the clinical curative effect and reduce the mortality for the critically ill patients with stress hyperglycemia.
Journal ArticleDOI
Management of patients in fast track surgery
Douglas W. Wilmore,Henrik Kehlet +1 more
TL;DR: A review of recent advances made in this newly developing specialty of fast track surgery will emphasise techniques that facilitate early recovery after major surgical procedures, including early enteral (oral) nutrition and ambulation.
Journal ArticleDOI
Systematic review of enhanced recovery programmes in colonic surgery.
Jan Wind,S. W. Polle,P. H. P. Fung Kon Jin,Cornelis H. C. Dejong,M.F. von Meyenfeldt,Dirk T. Ubbink,Dirk J. Gouma,Willem A. Bemelman +7 more
TL;DR: The aim of this review was to assess FT programmes for elective segmental colonic resections to accelerate recovery, reduce morbidity and shorten hospital stay.