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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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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Perioperative nutritional support: a randomised clinical trial
M.F. von Meyenfeldt,W.J.H.J. Meijerink,M.M.J. Rouflart,M.T.H.J. Builmaassen,Peter B. Soeters +4 more
TL;DR: It is concluded that pre-operative nutritional support, in patients with severe depletion, results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients.
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Enhanced Recovery after Surgery (ERAS) Programs for Patients Having Colorectal Surgery: A Meta-analysis of Randomized Trials
Cagla Eskicioglu,Shawn S. Forbes,Shawn S. Forbes,Mary-Anne Aarts,Mary-Anne Aarts,Allan Okrainec,Allan Okrainec,Robin S. McLeod,Robin S. McLeod +8 more
TL;DR: There is some evidence to suggest that enhanced recovery after surgery programs are better than traditional perioperative care, but evidence from a larger, better quality randomized controlled trial is necessary.
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Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery
J. C. M. Santos,Jesiane Stefânia da Silva Batista,M. T. Sirimarco,A. S. Guimarães,Carlos Emílio Levy +4 more
TL;DR: Mechanical bowel preparation is unnecessary and may be harmful in terms of preventing wound infection and anastomotic dehiscence in patients undergoing elective colorectal surgery.
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Effect of Preoperative Nutritional Deficiency on Mortality After Radical Cystectomy for Bladder Cancer
Justin R. Gregg,Michael S. Cookson,Sharon Phillips,Shady Salem,Sam S. Chang,Peter E. Clark,Rodney Davis,C.J. Stimson,Monty Aghazadeh,Joseph A. Smith,Daniel A. Barocas +10 more
TL;DR: Nutritional deficiency, as measured by preoperative weight loss, body mass index and serum albumin, is a strong predictor of 90-day mortality and poor overall survival in patients undergoing radical cystectomy for bladder cancer.
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Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics
Monika Svanfeldt,Anders Thorell,Jonatan Hausel,Mattias Soop,Olav Rooyackers,Jonas Nygren,Olle Ljungqvist +6 more
TL;DR: Preoperative oral carbohydrate (CHO) reduces postoperative insulin resistance and the effect of CHO on postoperative whole‐body protein turnover was studied.