Enhanced recovery after surgery (ERAS) programs for esophagectomy

Abstract

A perioperative treatment protocol, enhanced recovery after surgery (ERAS) focuses on accelerating patient recovery. Previous studies confirmed that ERAS decreases surgical trauma and the stress response, which improved outcomes including reduced length of hospital stay (LOS) and decreased postoperative morbidity. While ERAS protocols have been successfully implemented in a variety of surgical disciplines (colorectal, bariatric, orthopedic, and gynecologic surgery), its use in esophageal surgery is still limited. This paper analyzes the feasibility and value of the ERAS protocol for esophageal surgery. Reviewing the literature found that implementation of ERAS resulted in decreased costs, length of stay and pulmonary specific complication reduction, but not overall morbidity. The evidence lacks randomized control trials. Further, the ERAS Society published recommendations for esophageal resection. This opportunity for unification of the protocol would make the studies more comparable and leads to stronger conclusions. Surgery specific items also require further confirmation. Nonetheless, the successful introduction of the ERAS protocol into a wide variety of surgical disciplines provides optimism for ERAS's effectiveness in esophageal surgery.

Early Respiratory Impairment and Pneumonia after Hybrid Laparoscopically Assisted Esophagectomy—A Comparison with the Open Approach

“…In the postoperative phase, patients were treated by principles of a “fast track” protocol with extubation as soon as possible, early enteral nutrition and mobilization at the earliest convenience [ 39 ]. Usually, patients were monitored at the ICU after abdomino-thoracic esophagectomy for at least until POD 1 and—if cardiac and respiratory functions were stable—discharged from the ICU.…”

“…In the postoperative phase, patients were treated by principles of a "fast track" protocol with extubation as soon as possible, early enteral nutrition and mobilization at the earliest convenience [39].…”

Results of an Enhanced Recovery after Surgery Protocol for Upper Gastrointestinal Surgery at a Super-Tertiary Referral Hospital in Thailand

“…If the results of that study showed patent anastomosis, low residual soft food intake was allowed. Patients could be discharged on postoperative day 8 if they met the discharge criteria (6,11).…”

“…ERAS is a multidisciplinary approach that aims to promote early postoperative recovery, reduced surgical stress response and organ dysfunction, decreased postoperative complications, reduced length of hospital stay and hospitalization cost, and improved long-term survival (3)(4)(5). ERAS has been successfully applied in many fields of surgery, including gastric and esophageal surgery (6)(7)(8). Although the safety and efficacy of the ERAS protocol in UGI surgery has been reported in numerous studies, implementation of the ERAS protocol is a challenge, and this has led to slow adoption of ERAS in some settings (9).…”

National opioid prescription patterns and patient usage after routine vasectomy

“…Specific to urologists, overprescription of post‐operative narcotics is common with 67% of patients having surplus opioids after urologic surgery (Bates, Laciak, Southwick, & Bishoff, 2011). Nevertheless, surgeons across many specialties ranging from general surgery, colorectal, thoracic, gynaecologic and urologic surgery have begun to make significant strides to standardise post‐operative pain management and reduce opioid prescriptions by developing opioid‐sparing enhanced recovery after surgery (ERAS) protocols (Hughes, Ventham, McNally, Harrison, & Wigmore, 2014; Ljungqvist, Scott, & Fearon, 2017; Rubinkiewicz, Witowski, Su, Major, & Pedziwiatr, 2019; Schwartz et al, 2019).…”