A systematic review of enhanced recovery after surgery for vascular operations

McGinigle, Katharine L.; Eldrup-Jørgensen, Jens; McCall, Rebecca; Freeman, Nikki L. B.; Pascarella, Luigi; Farber, Mark A.; Marston, William A.; Crowner, Jason

doi:10.1016/j.jvs.2019.01.050

Cited by 52 publications

(38 citation statements)

References 44 publications

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“…40,41 The effectiveness of other quality improvement interventions such as enhanced recovery programmes and peri-operative care teams in reducing complications after PAD surgery warrants further exploration. 42,43 CONCLUSION Multiple peri-operative complications following surgery for lower limb PAD were strongly associated with two year amputation or death after discharge, after adjustment for patient age, comorbidities, and procedure type. Multiple complications carried a compounding risk.…”

Section: Discussionmentioning

confidence: 95%

Multiple Peri-Operative Complications are Associated with Reduced Long Term Amputation Free Survival Following Revascularisation for Lower Limb Peripheral Artery Disease: A Population Based Linked Data Study

Aitken

Randall

Noguchi

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis large, population based linked data study demonstrates that the accumulation of multiple peri-operative complications, including stroke, acute renal failure, delirium, and cardiac events, are associated with a progressive increase in the combined outcome of amputation and death after open or endovascular surgery for peripheral artery disease. While the association between peri-operative complications and short term adverse events is well recognised, this study found increased risks up to two years after surgery. Furthermore, patients with multiple complications had almost double the long term risk compared with those with one complication.Objective: To determine, in a population based linked data study, the relationship between peri-operative multiple complications and longer term outcomes, specifically the combined outcome of two year amputation or death, after lower limb revascularisation for peripheral artery disease (PAD). Methods: State wide health administrative data and death records were probabilistically linked for all patients who had lower limb artery surgery between 2010 and 2012 in New South Wales, Australia. Multivariable Cox regression modelled the impact of medical and surgical complications on the combined outcome of amputation or death two years after discharge. Results: Open surgery was performed on 3004 patients (26.7%), and endovascular on 8263 (73.3%). Of the 10 971 patients discharged alive, 3747 (34.1%) experienced at least one complication, and 2113 (19.3%) had multiple complications. Older patients, those with high comorbidity scores, or those with chronic limb threatening ischaemia were at increased risk of multiple complications. After adjusting for procedure type, patients with multiple complications experienced more than three times the hazard ratio (HR) of amputation or death two years after the procedure than those without complications (adjusted HR 3.4, 95% confidence interval 3.1e3.7), and increasing complications progressively multiplied the risk. In particular, non-surgical complications such as stroke, acute renal failure, delirium, and cardiac events were associated with the highest rates of two year amputation or death. Conclusion: Multiple complications after surgery for lower limb PAD carried a compounding risk of reduced long term amputation free survival. Patients experiencing at least one complication form a high risk group that requires increased attention to prevent the potential development of further complications.

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Section: Discussionmentioning

confidence: 95%

Multiple Peri-Operative Complications are Associated with Reduced Long Term Amputation Free Survival Following Revascularisation for Lower Limb Peripheral Artery Disease: A Population Based Linked Data Study

Aitken

Randall

Noguchi

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…The authors explain that the advantages of LIA over peripheral nerve blocks and neuraxial blocks include the absence of motor blockade, thus enabling early mobilization, the preservation of hemodynamic stability and the absence of influence on urine retention [266]. In vascular surgery, a recent systematic review suggested that use of ERAS protocols is currently limited because of low quality evidence regarding feasibility and effectiveness [267]. One RCT comparing thoracic epidural analgesia vs. CWI analgesia after abdominal aortic surgery showed that CWI resulted in comparable, good pain control but required higher doses of LA [268].…”

Section: Wound Infiltration In Enhanced Recovery After Surgery Protocolsmentioning

confidence: 99%

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

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“…All of the 55 articles investigated the impact of ERAS/FTS on clinical outcomes compared with conventional care mode involved in colorectal surgery (n = 13), [ 3 , 31 – 42 ] liver surgery (n = 7), [ 43 – 49 ] gastric surgery (n = 7), [ 22 , 50 – 55 ] orthopedic surgery (n = 3), [ 56 – 58 ] bariatric surgery (n = 3), [ 59 – 61 ] urology surgery (n = 3), [ 62 – 64 ] breast surgery (n = 3), [ 65 – 67 ] esophageal surgery (n = 3), [ 68 – 70 ] pancreatic surgery (n = 3) [ 71 – 73 ] and other surgeries (n = 10) [ 4 , 74 – 82 ] including gynecologic surgery, [ 74 ] abdominal aortic aneurysm repair surgery, [ 76 ] lung surgery [ 77 ] and vascular operations. [ 79 ] The most clinical results were measured in the meta-analyses are length of hospital stay (LOS)/post-operative hospital stay (PLOS) (n = 47), cost (n = 16), mortality (n = 30), morbidity (n = 54), readmission (n = 42), reoperation (n = 8) and other secondary outcomes. All the meta-analyses reported the ERAS/FTS pathways were used in observational groups and 37 of 55 specifically pointed out the number of protocols in the pathways and the range of ERAS elements applied in the articles was from 2 to 22.…”

Section: Resultsmentioning

confidence: 99%

“…The data indicated that ERAS pathways can significantly reduce LOS and PLOS compared with traditional care. And the reduction of LOS were 3.75 days (−5.13 to −2.36) in cystectomy; [ 64 ] 3.55 days (−4.42 to −2.69) in esophageal cancer surgery; [ 69 ] 3.5 days (−5.8 to −1.4) in vascular operations; [ 79 ] 3.17 days (−3.99 to −2.35) in liver surgery; [ 49 ] 3.05 days (−4.87 to −1.23) in abdominal gynecologic surgery, [ 74 ] and 1.58 days (−1.99 to −1.18) in breast reconstruction. [ 66 ] There are also some articles shown the reduction of PLOS, in pancreatic surgery, it was shorter 4.45 days (−5.99 to −2.91) [ 72 ] than traditional groups, 4.17 days (−5.72 to −2.61) in pancreaticoduodenectomy [ 73 ] and 2.72 days (−3.86 to −1.57) in hepatectomy.…”

Section: Resultsmentioning

confidence: 99%