Journal ArticleDOI
Multimodal strategies to improve surgical outcome.
Henrik Kehlet,Douglas W. Wilmore +1 more
TLDR
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.Abstract:
Objective: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. Background: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of minimal invasive surgical access have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated. Methods: We searched Medline for the period of 1980 to the present using the key terms fast track surgery, accelerated care programs, postoperative complications and preoperative patient preparation; and we examined and discussed the articles that were identified to include in this review. This information was supplemented with our own research on the mediators of the stress response in surgical patients, the use of epidural anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. Results: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. Conclusions: 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. Developments and improvements of multimodal interventions within the context of "fast track" surgery programs represents the major challenge for the medical professionals working to achieve a "pain and risk free" perioperative course.read more
Citations
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Journal ArticleDOI
Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS®) society recommendations
Ulf Gustafsson,Michael J. Scott,Michael J. Scott,W. Schwenk,Nicolas Demartines,Didier Roulin,Nader K. Francis,Clare McNaught,John MacFie,A. S. Liberman,Mattias Soop,Andrew G. Hill,Robin H. Kennedy,Dileep N. Lobo,Kenneth C. H. Fearon,Olle Ljungqvist,Olle Ljungqvist +16 more
TL;DR: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolicism (ESPEN) present a comprehensive evidence-based consensus review of peri operative care for colonic surgery.
Journal ArticleDOI
Evidence-based surgical care and the evolution of fast-track surgery.
Henrik Kehlet,Douglas W. Wilmore +1 more
TL;DR: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted.
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.
Journal ArticleDOI
Anaesthesia, surgery, and challenges in postoperative recovery
Henrik Kehlet,Jørgen B. Dahl +1 more
TL;DR: The anaesthetist has an important role in facilitating early postoperative recovery by provision of minimally-invasive anaesthesia and pain relief, and by collaborating with surgeons, surgical nurses, and physiotherapists to reduce risk and pain.
Journal ArticleDOI
Enhanced recovery after surgery : a consensus review of clinical care for patients undergoing colonic resection
Kenneth C. H. Fearon,Olle Ljungqvist,M.F. von Meyenfeldt,Arthur Revhaug,Cornelis H. C. Dejong,Kristoffer Lassen,Jonas Nygren,Jonatan Hausel,Mattias Soop,Jens Rikardt Andersen,Henrik Kehlet +10 more
TL;DR: In this article, clinical care of patients undergoing colonic surgery differs between hospitals and countries, and there is considerable variation in rates of recovery and length of colon cancer surgery in different countries.
References
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