Enhanced recovery after surgery (ERAS) protocols: Time to change practice?

Abstract

Radical cystectomy with pelvic lymph node dissection remains the standard treatment for patients with muscle invasive bladder cancer. Despite improvements in surgical technique, anesthesia and perioperative care, radical cystectomy is still associated with greater morbidity and prolonged in-patient stay after surgery than other urological procedures. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization. Despite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow.The present article discusses particular aspects of ERAS protocols which represent fundamental shifts in surgical practice, including perioperative nutrition, management of postoperative ileus and the use of mechanical bowel preparation.

Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: A systematic review

“…It has been reported that they reduce the incidence of postoperative complications, resulting in reduced duration of hospital stay and improved short-term outcomes [40][41][42][43][44][45] by purportedly reducing the SIR after operation. Systematic reviews and meta-analyses of several randomized trials across multiple operative specialties indicate that ERAS programs reduce postoperative morbidity, decrease hospital stay, and accelerate recovery.…”

Effects of preoperative carbohydrates drinks on immediate postoperative outcome after day care laparoscopic cholecystectomy

“…Carbohydrate treatment causes decrease in postoperative protein catabolism, improved voluntary muscle strength and better lean body mass [14]. Preoperative carbohydrate treatment has been advocated as part of multimodal fast-track surgery because of its favorable effect in reducing postoperative insulin resistance, thus hastening patient's recovery [15].…”

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

“…The aim of enhanced recovery is to optimise multiple aspects of patient care to improve recovery thereby facilitating earlier discharge, without a reduction in patient satisfaction or the quality of care [9–13]. Much of the work establishing the benefits of enhanced recovery concerned patients undergoing Colorectal Surgery, with other specialties, such as Gynaecology, Urology and Orthopaedics, adopting the concept later [13, 14]. This widespread adoption is no doubt related to the mounting evidence that the implementation of enhanced recovery programmes result in benefits such as reduced morbidity, reduced length of stay and an earlier return to normal activities for patients [9, 13].…”