Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties

Smith, Thomas W.; Wang, Xuanji; Singer, Marc; Godellas, Constantine V.; Vaince, Faaiza

doi:10.1016/j.amjsurg.2019.11.009

Cited by 156 publications

(139 citation statements)

References 25 publications

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“…Исходя из анализа имеющихся работ касательно ценности элементов, входящих в ПУР [6], имеющегося опыта клиники и нашего понимания принципов ERAS, в применяемый в центре ПУР включены следующие ключевые элементы: предоперационное консультирование, отказ от подготовки кишечника, сбалансированная инфузионная терапия, раннее восстановление энтерального питания, ранняя мобилизация и отказ, или раннее удаление назогастрального зонда и мочевого катетера. В нашем исследовании вышеупомянутые ключевые элементы были реализованы на 100% у всех пациентов основной группы.…”

Section: Discussionunclassified

“…Наиболее прогрессивным способом оптимизации до-и раннего послеоперационного периодов в настоящее время считается концепция ускоренного послеоперационного восстановления (Fast Track Surgery, Enhanced Recovery After Surgery, ERAS) [5,6].…”

Section: оригинальное исследованиеunclassified

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Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Кошель

Петрович²,

Drozodv

et al. 2020

VECS

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Introduction. The number of patients with cystic formations of the pancreas has increased significantly recently. Some of the patients need open or minimally invasive surgery. The implementation of ERAS (Enhanced recovery after surgery) protocols has been proved to be effective in orthopedics, bariatric and colorectal surgery. However, safety and feasibility of implementation of accelerated rehabilitation protocols in patients with cystic formations of the pancreas who underwent resection and resection-drainage interventions have not been sufficiently studied.The aim of the study was to assess the effectiveness and safety of implementation of the developed accelerated rehabilitation protocol in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions.Material and methods. This research is a retrospective-prospective, single-center study. The study included 110 patients with cystic formations of the pancreas of various etiologies. All patients were divided into two groups: the control group consisted of 55 patients, their perioperative management was carried out according to standard protocols, and the experimental group consisted of 55 patients, their perioperative management was carried out according to the accelerated rehabilitation protocol developed in the clinic. All patients included in the study were exposed to surgery: resection and resection-draining interventions in various modifications were performed.Results. Patients in the studied groups were comparable by gender, age, body mass index, ASA score, preoperative albumin level. No statistically significant differences were found in the duration of the operation, intraoperative blood loss, or the frequency of blood transfusions. The overall complication rate was significantly lower in the experimental group compared with the control group (38,2% versus 58,2%, p = 0,03). Postoperative recovery of the gastrointestinal function was also faster in the experimental group. Thus, in the experimental group, the average time to the gas discharge was 2,1 0,8 days; in the control group - 3,1 1,1 days (p = 0,01); the average time to the first stool was 3,2 1,9 and 4,2 1,2 days, respectively (p 0,001). The total duration of the postoperative hospital bed per day was significantly lower in the experimental group compared with the control group (11,8 7,7 vs 16,2 13,2 days, respectively, p = 0,02).Conclusions. The study demonstrated safety and effectiveness of implementation of accelerated rehabilitation protocols in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions. Implementation of the protocols allows reducing the duration of the postoperative hospital bed per day, incidence rate of complications, and also accelerating the gastrointestinal function recovery.

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Section: Discussionunclassified

Section: оригинальное исследованиеunclassified

Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Кошель

Петрович²,

Drozodv

et al. 2020

VECS

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“…These pathways include optimizing preoperative medical care; standardizing intraoperative fluid and ventilation management and employing epidural or regional anesthesia (ie, numbing medicine around the nerves of the spine and periphery, respectively) in conjunction with, or in addition to, general anesthesia; and postoperatively prescribing multimodal pain medications and encouraging early ambulation and removal of lines and drains. 7,9,10,11 The evidence-based medical interventions applied during ERAS pathways are aimed at improving normal recovery after an operation and at preventing common problems such as pain, nausea, urinary tract infections, pneumonia, delirium, and delay in return of bowel function. The solution to many of these problems is early mobilization facilitated by nonsedating pain control.…”

Section: Need For Better Pain Managementmentioning

confidence: 99%

Should Surgeons or Anesthesiologists Manage Perioperative Pain Protocols?

Doerr

Chidgey

2020

AMA Journal of Ethics

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“…However, a step-by-step approach to implementing and maintaining compliance with anesthesia bundles in large anesthesia practices has not been thoroughly described. [12][13][14][15] As part of a quality improvement project, in March of 2018, an Enhanced Recovery After Surgery pathway for laparoscopic, vaginal, and open hysterectomy patients called "ERAS Hysterectomy" was implemented at the Massachusetts General Hospital. This pathway was designed by surgeons and anesthesiologists and utilized the Consolidated Framework For Implementation Research (CFIR) framework to implement evidence-based clinical care.…”

Section: Introductionmentioning

confidence: 99%

Implementing ERAS: how we achieved success within an anesthesia department

et al. 2021

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Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p < 0.001) was achieved during the intervention period. Compliance with the pathway was sustained in the post-intervention period despite no additional actions. Conclusions Implementing the anesthesia bundle of an ERAS pathway in a large anesthesia group with diverse providers successfully occurred using implementation science-based approach of intense interventions, and these results were maintained after the intervention ceased.

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Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties

Cited by 156 publications

References 25 publications

Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Should Surgeons or Anesthesiologists Manage Perioperative Pain Protocols?

Implementing ERAS: how we achieved success within an anesthesia department

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