Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

Pędziwiatr, Michał; Mavrikis, Judene; Witowski, Jan; Adamos, Alexandros; Major, Piotr; Nowakowski, Michał; Budzyński, Andrzej

doi:10.1007/s12032-018-1153-0

Cited by 239 publications

(204 citation statements)

References 73 publications

(87 reference statements)

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“…Current evidence and multiple publications support the role of ERAS protocols in decreasing the length of stay in both routine and complex surgeries, including HPB surgery. 6 It is concluded that perioperative complications rates are not affected, some medical complications can be decreased, and length of stay is usually reduced without a negative impact on readmission and reoperation rates. There is no HPB-specific research addressing questions of compliance and its impact on the success of ERAS protocols.…”

Section: Discussionmentioning

confidence: 99%

“…There is significant variability in reported outcomes, and the validity of conclusions is usually based on low‐quality evidence . What is clear is that compliance with and audit of the established protocol appears to be an important element in the implementation of a successful ERAS program . We decided to study the relationship between compliance with established HPB ERAS protocol and perioperative outcomes at our institution.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

2019

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Background and Aim Enhanced recovery after surgery (ERAS) protocols are reported to improve postoperative outcomes in patients undergoing a routine protocol and postoperative outcomes in patients undergoing hepatic and pancreatic resections at our institution. Methods A total of 99 consecutive patients at a single institution managed with a similar ERAS protocol were divided into the “early” (50 patients) and “late” (49 patients) cohorts. Both cohorts were statistically identical in demographics and range of surgical procedures performed. Postoperative complications, readmission, reoperation rates, and length of stay were analyzed. Categorical variables were statistically compared using Fisher's exact test and continuous variables using t‐test and Mann–Whitney U‐test when appropriate. Results There were 32 hepatectomies/18 pancreatectomies in the “early” cohort and 22 hepatectomies/29 pancreatectomies in the “late” cohort. The overall complication rate was 38.8%, with a 30‐day readmission rate and reoperation rate of 16.1 and 5%, respectively. There was one mortality (1%). Group‐specific overall complication rate (40 vs 38.7%, P = 0.8), readmission rate (20 vs 12.2%, P = 0.4), reoperation rate (6 vs 4%, P = 1.0), and mortality (2 vs 0%, P = 1.0) were not statistically significant between both groups. Conclusions Despite similar rates of adherence to the established ERAS 24 protocol, there was no improvement in median length of stay (7 days) between the “early” and “late” groups. The only reason for noncompliance with the ERAS protocol was development of surgery‐related complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

2019

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“…It is for these reasons that since the first modern attempts to undertake abdominal surgery 50 years ago through to today, prevention and treatment of POI are widely discussed topics in equine medicine [20,21]. In human medicine, enhanced recovery after surgery (ERAS) programs exist, which include multiple pre-, intra-and postoperative interventions, aiming to reduce the occurrence of POI [22]. Currently, in equine medicine, no universally-accepted approach exists for the management of equine POI.…”

Section: Introductionmentioning

confidence: 99%

Current Strategies for Prevention and Treatment of Equine Postoperative Ileus: A Multimodal Approach

Kovač́¹,

Aliev²,

Pozyabin³

et al. 2020

Equine Science

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Equine paralytic (postoperative) ileus generally refers to an acute condition of impaired gastrointestinal motility. Paralytic ileus is most frequently seen following abdominal surgery on the small intestine in horses. Three main mechanisms are involved separately or simultaneously in its causation, namely neurogenicendocrinic, inflammatory-endotoxic and pharmacological mechanisms. Regardless of the cause, equine paralytic ileus can be fatal, if not properly diagnosed and treated. Over the past 22 years (1997-2019), we have diagnosed and treated more than 180 horses with postoperative ileus using differing methods. Based on our results and experience, and that of others, we have developed a multimodal strategy to reduce the incidence of postoperative ileus. This has resulted in effective treatment of ileus-diagnosed patients in 94% of cases, a significant improvement in survival rates over the last 20 years. In this review, we described pre-, intra-, and postoperative multiple supplementary preventative and treatment procedures that cure this condition. These methods are dependent on individual cases but include the control of endotoxemia and inflammation, as well as using the least traumatic surgical techniques, carrying out the pelvic flexure colotomy, improved anesthesia techniques, treating with continuous postoperative peritoneal lavage, the use of fluid, antibiotic and NSAIDs therapy, according to a scheme the use of different prokinetic agents (including metoclopramide, neostigmine methylsulfate and domperidone), nasogastric decompression, management to minimize the surgical and postoperative stress reaction and judicious timing of postoperative feeding of horses.An appreciation of the basic mechanisms that regulate gastrointestinal motility is a key component to understanding paralytic ileus. The musculature of the gastrointestinal tract in horses is made up of smooth muscle cells that are intimately associated, thus allowing them to conduct electrophysiological functions. There are three distinctive electrical potentials in the equine intestine: resting potential, slow-wave and spike potential that trigger contractions. Slow waves are rhythmic pacemaker currents initiated by the interstitial cells of Cajal (ICC). Normal gastrointestinal motility in horses results from very complex interactions among the enteric nervous system (ENS), autonomic and central nervous systems, ICC, gastrointestinal hormones, immune cells, glial cells and local factors that affect smooth-muscle activity [21,[23][24][25]. Extrinsically, the sympathetic nervous input through noradrenaline has an inhibitory effect on gastrointestinal motility, whereas parasympathetic input increases motility. The ENS is involved in all aspects of gastrointestinal function, not only motility, as well as by enteric processes such as immune responses, detecting nutrients, microvascular circulation, intestinal barrier function, and epithelial secretion of fluids and ions [10]. The neurons of the ENS are collected into two types of ganglia: myenteric (...

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“…Early recovery after surgery (ERAS) protocol is becoming gold standard in peri operative care with excellent results in colorectal, gastric and HPB surgeries. 1 ERAS is a evidence based peri-operative protocol which has shown significant improvements in perioperative outcomes. 2 Despite these overwhelming evidences .…”

Section: Introductionmentioning

confidence: 99%

Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

Vasavada

Patel

2020

Preprint

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Introduction: Aim of study to evaluate 90 days mortality and morbidity after ERAS protocol and also weather there is any difference in morbidity and mortality between Open and Laparoscopic surgeries. Material and Methods: All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. Results: We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality Conclusion: There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

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Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery

Cited by 239 publications

References 73 publications

Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

Postoperative complications are main reason for noncompliance with enhanced recovery after surgery program in patients undergoing hepatectomy and pancreatectomy

Current Strategies for Prevention and Treatment of Equine Postoperative Ileus: A Multimodal Approach

Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

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