Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial

Takagi, Kosei; Yoshida, Ryuichi; Yagi, T.; Umeda, Yuzo; Nobuoka, Daisuke; Kubo, Takashi; Hinotsu, Shiro; Matsusaki, Takashi; Morimatsu, Hiroshi; Eguchi, Jun; Wada, Jun; Senda, Masuo; Fujiwara, Toshiyoshi

doi:10.1016/j.clnu.2018.01.002

Cited by 63 publications

(36 citation statements)

References 33 publications

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“…Previous studies about the efficacy of ERAS mostly originated from colorectal surgery, which was performed by the investigators who had initially developed the concept of ERAS [234]. More recently, several randomized trials and their systemic reviews have demonstrated the clinical benefits of ERAS in other abdominal procedures, including gastrectomy [56]. However, despite the clinical benefits of ERAS, its implementation in real practice has been relatively slow for several reasons, such as lack of convincing data, low level of awareness about ERAS, or limitations in institutional experience and systems [78].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

Jeong

Kim

2019

J Gastric Cancer

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Purpose Despite its clinical benefits, enhanced recovery after surgery (ERAS) is less widely implemented for gastric cancer surgery. This nationwide survey investigated the current status of the implementation of ERAS in perioperative care for gastric cancer surgery in South Korea. Materials and Methods This survey enrolled 89 gastric surgeons from 52 institutions in South Korea. The questionnaire consisted of 24 questions about the implementation of the ERAS protocols in the management of gastric cancer surgery. The survey was carried out using an electronic form sent via email. Results Of the 89 gastric surgeons, 58 (65.2%) answered that they have knowledge of the concept and details of ERAS, 45 (50.6%) of whom were currently applying ERAS for their patients. Of the ERAS protocols, preoperative education (91.0%), avoidance of preoperative fasting (68.5%), maintenance of intraoperative normothermia (79.8%), thromboprophylaxis (96.5%), early active ambulation (64.4%), and early removal of urinary catheter (68.5%) were relatively well adopted in perioperative care. However, other practices, such as avoidance of preoperative bowel preparation (41.6%), provision of preoperative carbohydrate-rich drink (10.1%), avoidance of routine abdominal drainage (31.4%), epidural anesthesia (15.9%), single-dose prophylactic antibiotics (19.3%), postoperative high oxygen therapy (36.8%), early postoperative diet (14.6%), restricted intravenous fluid administration (53.9%), and application of discharge criteria (57.3%) were not very well adopted for patients. Conclusions Perioperative management of gastric cancer surgery is largely heterogeneous among gastric surgeons in South Korea. Standard perioperative care based on scientific evidence needs to be established to improve the quality of surgical care and patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

Jeong

Kim

2019

J Gastric Cancer

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“…(2) It is very difficult to compare the incidence rates between different treatment centers according to the confirmed case, as the study reported the complication classification scheme (Clavien classification), and a suggestion for grading the complications based on the treatment intervention was to use a compound endpoint, which would reduce the required sample size study and improve objectivity and comparability. (3) Only two studies were randomized controlled trials (48, 49); therefore, data contained in these studies cannot be effectively analyzed.…”

Section: Discussionmentioning

confidence: 99%

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

Cao

Huang

et al. 2019

Front. Oncol.

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Purpose: To assess the impact of enhanced recovery after surgery (ERAS) protocols in pancreaticoduodenectomy. Methods: Four databases were searched for studies describing ERAS program in patients undergoing pancreatic surgery published up to May 01, 2018. Primary outcomes were mortality, readmission, reoperation and postoperative complications. Secondary outcomes were the length of stay and cost. Results: A total of 19 studies met inclusion and exclusion criteria and included 3,387 patients. Meta-analysis showed a decrease in pancreatic fistula (OR = 0.79, 95% CI: 0.67 to 0.95; I 2 = 0%), infection (OR = 0.63, 95% CI: 0.50 to 0.78; I 2 = 0%), especially incision infection (OR = 0.62, 95% CI: 0.42 to 0.91; I 2 = 0%), and pulmonary infection (OR = 0.28, 95% CI: 0.12 to 0.66; I 2 = 0%). Length-of-stay (MD: −3.89 days, 95% CI: −4.98 to −2.81; I 2 = 78%) and cost were also significantly reduced. There was no significant increase in mortality, readmission, reoperation, or delayed gastric emptying. Conclusion: This analysis revealed that using ERAS protocols in pancreatic resections may help decrease the incidence of pancreatic fistula and infections. Furthermore, ERAS also reduces length of stay and cost of care. This study provides evidence for the benefit of ERAS protocols.

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“…Over time, TEA has become an integral part of anesthesia-based Acute Pain Services (APS) and Enhanced Recovery After Surgery (ERAS) especially abdominal surgery [129][130][131]. Opioid sparing adequate analgesia is a cornerstone to APS/ERAS, and TEA serves as an adjunct in fast-track recovery, as it minimizes opioid-related sedation, and allows for more effective mobilization [132].…”

Section: Neuraxial Analgesiamentioning

confidence: 99%

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Gabriel

Swisher

Sztain

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: There are various important implications associated with poorly controlled postoperative pain in the adult surgical patientthis includes cardiopulmonary complications, opioid-related side effects, unplanned hospital admissions, prolonged hospital stay, and the subsequent development of chronic pain or opioid addiction. With the ongoing national opioid crisis, it is imperative that perioperative providers implement pathways for surgical patients that reduce opioid requirements and painrelated complications. Areas covered: In this review, the authors discuss the components of a multimodal opioid-sparing analgesia pathway as it pertains to the perioperative environment. Medications reviewed include gabapentinoids, acetaminophen, non-steroidal anti-inflammatory drugs, ketamine, intravenous lidocaine, dexmedetomidine, and glucocorticoids. The use of peripheral nerve blocks and neuraxial analgesia are also discussed. Expert opinion: In appropriate cases, regional anesthetic interventions are extremely useful for postoperative analgesia, including peripheral nerve blocks and neuraxial analgesia and while newer postoperative analgesics have been postulated, the literature on such is presently controversial. Coordinated approaches to pain management are recommended to reduce the need for opioids and to improve patient satisfaction post-surgery.

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Effect of an enhanced recovery after surgery protocol in patients undergoing pancreaticoduodenectomy: A randomized controlled trial

Abstract: UMIN000014068.

Cited by 63 publications

References 33 publications

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

Implementation of Enhanced Recovery after Surgery (ERAS) Program in Perioperative Management of Gastric Cancer Surgery: a Nationwide Survey in Korea

Impact of Enhanced Recovery After Surgery on Postoperative Recovery for Pancreaticoduodenectomy: Pooled Analysis of Observational Study

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

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