Enhanced Recovery After Surgery (ERAS ® ) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study

Abstract

According to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS(programme. Surgery and nursing staff should carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS interventions in accordance with a patient's clinical condition and preferred personal timing.

Systematic Review of Preoperative Patient Readiness

“…Addressing information needs or providing information was the common theme across 24 (89%) of the 28 studies 8,11,20,21,23‐38,40‐42 . We identified that two topics tied as the second‐leading issues; 8 (29%) of the 28 studies included a common focus of addressing pain concerns when providing preoperative care, 17,22,25,27,28,35,36,41 and 8 (29%) of the 28 studies addressed preoperative fear and anxiety 17,19,25,28,35,37‐39 . The next most frequent issues addressed were the need for support (8 [29%] of the 28 studies), 8,17,22,26,28,32,38,39 patient satisfaction with the surgical experience (8 [29%] of the 28 studies), 20,23,29,31,34,35,37,38 and the need to make a decision (4 [14%] of the 28 studies) 19,26,30,34 …”

“…Galli et al 27 discussed the importance of establishing rapport between health care professionals and a patient preparing for surgery as an initial step in establishing trust. Based on this rapport, health care professionals can establish trust and build relationships that allow patients to have confidence that the health care team members will work to achieve positive outcomes 8,22,27,28,32,39 . The studies we reviewed also provided an important reminder that as part of establishing trust, health care professionals should always ensure privacy when communicating sensitive information 41 .…”

“…In the context of perioperative practice, physiologic responses are “[t]he physical, biochemical, and functional responses to the intended therapeutic effects of an operative or other invasive procedure.” 48 (p56) We determined that health care professionals address readiness related to the patient’s physiological responses when they discuss the patient’s pain and pain management plan 17,22,25,27,28,35,36,41 and possible physiologic changes in terms of appearance or wound healing as part of procedural concerns 18…”

“…Several of the study results point to the need for health care professionals to assess the physical status of the patient preparing for surgery, which includes ensuring the completion of necessary diagnostic studies (eg, laboratory tests, imaging examinations, biopsy procedures) 21,22,33,39 and performing physical examinations to identify skin breaks and determine the patient’s overall health status 23,36 . Other issues addressed the area of physical preparation , including promoting hygiene, 36 bowel preparation, 11,27,28 and the administration of needed medications 36 . Personnel in many perioperative environments work with patients to help them physically prepare for an upcoming surgical procedure, 21,31 which includes ensuring nutritional modifications such as NPO status, 11 dietary provisions, 23,28 and glycemic control 27 .…”

A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy

“…Nevertheless, hospital duration and postoperative complications Clavien-Dindo stage I-II can be reduced by ERAS [41]. Accordingly, low-risk patients may benefit from the ERAS protocol [42]. Furthermore, our predictive models and nomograms allow for the opportunity to calculate the individual risk for the development of CR-POPF.…”