Adherence to early mobilisation: Key for successful enhanced recovery after liver resection

Yip, Vincent; Dunne, Declan; Samuels, Stanley I.; Tan, Chih Ying; Lacasia, C.; Tang, Joseph; Burston, C.; Malik, Hassan; Poston, Graeme J.; Fenwick, Stephen

doi:10.1016/j.ejso.2016.07.015

Cited by 43 publications

(32 citation statements)

References 32 publications

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“…Early mobilization can improve postoperative cardiopulmonary function and thereby reduce the risk of pulmonary complications and DVT. 4,42 In our protocol, in-bed limb exercises were started 6 hours after patients were awakened from anesthesia, and ambulation was started within 24 hours after surgery. Patients were instructed and monitored by a physical therapist.…”

Section: Postoperative Management In the Eras Protocolmentioning

confidence: 99%

Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

Wang¹,

Liu²,

Zhao³

et al. 2019

Journal of Neurosurgery

115

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OBJECTIVEAlthough enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China.METHODSA multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints.RESULTSThe median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1–3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51–15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1–2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29–1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56–6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001).CONCLUSIONSThis multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn)

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Section: Postoperative Management In the Eras Protocolmentioning

confidence: 99%

Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

Wang¹,

Liu²,

Zhao³

et al. 2019

Journal of Neurosurgery

115

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“…The search did not reveal any relevant RCTs which had compared post-operative physiotherapy interventions following gynaecologic, gastrointestinal, gastrectomy, pancreatic, bariatric, colorectal, colon, liver, head or neck or breast surgery within ERAS ® cohorts. The search strategy generated studies within these cohorts of patients however the outcomes of the studies focused on early mobilisation [26], prehabilitation [27], intraoperative techniques [28], the feasibility of ERAS ® within elderly cohorts [29] and the outcomes between conventional care and ERAS ® pathways [30,31].…”

Section: Resultsmentioning

confidence: 99%

What is the role of post-operative physiotherapy in general surgical Enhanced Recovery after Surgery pathways?

Burgess

Immins

Wainwright

2018

European Journal of Physiotherapy

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Enhanced Recovery after Surgery (ERAS ®) has improved outcomes following elective surgery. This narrative review aimed to assess current evidence for post-operative physiotherapy interventions in general surgical procedures which adopt ERAS ® principles. Materials and Methods A systematic review of the literature between 2000 and 2017 was conducted. Randomised controlled trials (RCTs) that compared physiotherapy interventions for patients after the following elective ERAS ® procedures were included: gynaecologic, gastrectomy, gastrointestinal, pancreatic, bariatric, head and neck, breast, cystectomy, colorectal, colonic and liver. Results One study (two publications) was found to compare post-operative physiotherapy interventions in radical cystectomy patients on an ERAS ® pathway. The addition of a progressive exercise-based intervention improved aspects of health-related quality of life (dyspnea (p <0.05), constipation (p <0.02) and abdominal flatulence (p≤0.05)). Enhanced mobilisation was achieved, but no differences were observed in length of stay or severity of complications. Conclusions It is essential that the paucity of research to assess post-operative physiotherapy interventions within ERAS ® cohorts is highlighted. The results of our literature search highlight that there is a role for post-operative physiotherapy in ERAS ® pathways. However, without well-conducted RCTs to evaluate procedure-specific interventions, the optimal type, timing, and dose will not be found and the potential for improving patient functional recovery will be limited.

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“…Up to 85% of patients undergoing liver resection may be ambulatory by postoperative day 3 [7] . In a study by Yip et al [77] , sitting out of bed by POD 1 (P < 0.03), walking by POD 3 (P = 0.03) and removal of urinary catheter by POD 3 (P < 0.01) were independently associated with successful completion of an ERAS protocol aiming at hospital discharge within 6 days after surgery. Delay in removal of urinary catheter is enough to prolong hospital stay.…”

Section: Postoperative Mobilization and Urinary Catheter Removalmentioning

confidence: 94%

Enhanced recovery after surgery in liver surgery

Kumar¹,

Jha²,

Negi³

2018

MIS

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Enhanced recovery after surgery (ERAS) or fast-track surgery protocols, have been implemented across surgical fields with positive impact on outcomes. These protocols represent a standardized and evidence-based multimodal perioperative strategy founded on a series of measures aiming to attenuate the physical and psychological stress responses to surgical insults, and to potentiate the postoperative rehabilitation of patients. The successful adoption of ERAS protocols in various specialties enabled its gradual acceptance in the complex field of liver surgery. Even though many elements have been adapted especially from colorectal surgery, a few elements of ERAS protocol are unique to liver surgery. The goals of enhanced recovery can be achieved with efforts beginning at the first interaction on outpatient basis. Core elements of this multidisciplinary effort include pre-operative counseling, shortened preoperative fasting, no pre-anesthetic medication, targeted antimicrobial prophylaxis and early withdrawal, preventing and treating of postoperative nausea and vomiting, minimally invasive approaches, avoidance of postoperative nasogastric decompression, preventing hypothermia, optimal perioperative fluid management, selective use of abdominal drains, early urinary catheter removal, optimal pain control, early oral feeding and mobilization. The available evidence from recent randomized controlled studies and meta-analyses comparing ERAS programs with traditional care in liver surgery suggests that length of hospital stay is shortened without increasing morbidity, mortality or readmission rates.

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Adherence to early mobilisation: Key for successful enhanced recovery after liver resection

Cited by 43 publications

References 32 publications

Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

What is the role of post-operative physiotherapy in general surgical Enhanced Recovery after Surgery pathways?

Enhanced recovery after surgery in liver surgery

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