Advantages of, and Adaptations to, Enhanced Recovery Protocols for Perioperative Care during the COVID-19 Pandemic

Abstract

This review formulates the rationale for using enhanced recovery protocols (ERPs) to standardize and optimize perioperative care during this high-risk time to minimize poor outcomes owing to provider, patient, and system vulnerabilities. Data Sources: n/a Methods of Study Selection: A literature review using key Medical Subject Headings terms was performed-according to methods described by the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines-on studies that described enhanced recovery and coronavirus disease (COVID-19). Tabulation, Integration, and Results: Modifications to our existing ERPs related to the COVID-19 pandemic should include new accommodations for patient education, preoperative COVID-19 testing, prehabilitation, and intraoperative infection as well as thromboembolism risk reduction. Conclusion: ERPs are evidence-based, best practice guidelines applied across the perioperative continuum to mitigate surgical stress, decrease complications, and accelerate recovery. These benefits are part of the high-value−care equation needed to solve the clinical, operational, and financial challenges of the current COVID-19 pandemic. The factors driving outcomes on ERPs, such as the provision of minimally invasive surgery, warrant careful consideration. Tracking patient outcomes and improving care in response to outcomes data are key to the success of clinical care protocols such as ERPs. Numerous emerging clinical registries and reporting systems have been activated to provide outcomes data on the impact of COVID-19. This will inform and change surgical practice as well as provide opportunity to learn if the advantages that surgeons, patients, and the healthcare system might gain from using ERPs during a pandemic are meaningful.

Enhanced recovery after gynecologic surgery: review of the literature

“…Thus, patients, health-care workers, and other patients can be protected by avoiding unnecessary exposures. Bedside preoperative COVID-19 screening should be integrated into the ERAS program so that we can reduce the risk of horizontal viral transmission and reduce the perioperative complications from unrecognized SARS-CoV-2 infection [53]. ERAS Society's guidelines for peri-operative care in gynecological surgery [54], published in 2016, provide recommendations for pre-and intra-operative care and postoperative care, and the recommendations in these two guidelines are based on colorectal surgery guidelines.…”

How Efficient Are Isolation Protocols? Outcome of Isolation Protocol in Surgery during COVID-19 Pandemic: A Single Institute Experience

“…A systemic metaanalysis has proved RT-PCR as the gold standard test for COVID-19 [14,15] to acquire reliable results [16,17], and is included in the routine panel of investigations [18,19]. Most of the academic centres are using RT-PCR for screening [20] and is recommended before surgeries [21].…”

Where Enhanced Recovery after Surgery (ERAS) Protocols Meet the Three Major Current Pandemics: COVID-19, Obesity and Malignancy

“…A variety of unknown and difficult-to-solve problems have arisen, especially in daily surgical clinical practice. After an interval of about 6–8 months of almost total cancellation of all elective surgeries, the surgical community was called upon to take effective measures in preventing in-hospital SARS-CoV-2 spread so as to resume elective surgical procedures with the greatest safety for the patient [ 12 ]. Patients with oncological diseases have faced significant delays in their cancer diagnoses and treatments during the COVID-19 pandemic era.…”

“…ERAS protocols have been proposed as valuable tools in the surgical management of patients with malignancy during the SARS-CoV-2 era [ 16 ]. These protocols maintain homeostasis during the perioperative period, aiming to minimize the prevalence and severity of complications after complex gynecologic oncology surgeries even during the COVID-19 pandemic [ 12 ]. More specifically, strategies for the reduction in the length of hospital stays and readmissions are among the preventative measures of transmission of SARS-CoV-2 [ 43 ].…”