Enhanced Recovery After Surgery for Low‐ and Middle‐Income Countries

McQueen, K. A. Kelly; Oodit, Ravi; Derbew, Miliard; Banguti, Paulin; Ljungqvist, Olle

doi:10.1007/s00268-018-4481-5

Cited by 27 publications

(22 citation statements)

References 12 publications

(14 reference statements)

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“…Firstly, tailoring of ERAS protocol to adapt a low-middle income country was proved to be successful in this study without adding more costs to the hospital expenses. Despite barriers [11] [12], ERAS during CS in developing countries should be focusing on basic elements first (eg, preoperative optimization, multimodal pain management, early postoperative mobilization) and making sure to prescribe effective low-cost available drugs [13]. In this study, with the cooperation with nursing staff, we succeeded to implement extensive preoperative assessment and constructed a detailed questionnaire in addition to proper patient health education that helped to improve patient acceptability of ERAS.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Cesarean Section (CS) versus Conventional Care in a Lower Middle-Income Country: A Randomized Controlled Trial

Darwish¹,

Mustafa²,

Youness³

et al. 2022

OJN

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Background: Enhanced recovery after surgery (ERAS) has been tested in a wide variety of surgeries with promising outcomes. However, there is a need for a standardized, evidence-informed approach to both the development of new ERAS ® Society guidelines, and the adaptation and revision of existing guidelines. Developing countries have limited resources and deserve every effort to improve economic status. Aim of the Study: to evaluate perinatal maternal outcomes of ERAS versus routine care protocols in women undergoing elective cesarean section (CS) in a lower middle-income country with limited resources ranked as a third most country performing CS worldwide using a multidisciplinary team (MDT) management. Design: A prospective randomized Controlled Trial. Setting: Outpatient department (OPD) and labor ward at the Woman's Health hospital, Assiut University, Egypt. Participants: Healthy pregnant women planned for elective CS (300 women) were randomly divided into a study group offered ERAS protocol and a control group offered regular care. Results: Repeat CS was the main indication of elective CS in both groups without significant difference (89 cases (59.3%) and 75 cases (50%) in both groups respectively). Other indications included cephalopelvic disproportion in 17 cases (11%) and 19 cases (12.6%), placenta previa in 28 (18.6%) and 34 (22.6%) cases, DM in 11 (7%) and 19 (12.6%) cases, and others in 5 (0.3%) and 3 (2%) cases in both groups respectively. The study group took much less time to eat and walk. It had significantly lower pain levels and postoperative problems, as well as much greater women's satisfaction and a shorter hospital stay (p = 0.001

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery after Cesarean Section (CS) versus Conventional Care in a Lower Middle-Income Country: A Randomized Controlled Trial

Darwish¹,

Mustafa²,

Youness³

et al. 2022

OJN

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“…10 There is limited LOS and complication data for colorectal surgery from low-and middle-income countries (LMICs), including South Africa (SA). [11][12][13][14] We introduced an ERAS programme for colorectal surgery into a private surgical group practice in Cape Town, SA, in April 2015. In this paper we report on an audit of the implementation of this ERAS programme and its outcomes.…”

Section: Introductionmentioning

confidence: 99%

Colorectal surgical outcomes following implementation of an enhanced recovery after surgery programme in Cape Town

Oodit

Constant

Maree³

et al. 2021

S. Afr. j. surg.

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BACKGROUND: Colorectal surgery is commonly performed for benign and malignant colorectal disease. The aim of this study was to describe length of stay (LOS), complications and its associated factors in patients undergoing elective colorectal surgery following implementation of an enhanced recovery after surgery (ERAS) programme in South Africa (SA METHODS: Socio-demographic, pre- intra- and postoperative clinical details and compliance to the ERAS guidelines were recorded in all patients undergoing colorectal surgery in a private practice in Cape Town, SA. Means and standard deviations or medians and interquartile range (IQR), as appropriate, were used to describe continuous variables and frequencies and percentages for categorical variables. Bivariate and multivariate analyses using linear regression of log transformed LOS and logistic regression for development of complications were performed RESULTS: Between 2015 and 2019, 457 patients had elective colorectal surgical procedures. The median LOS was 5 days (IQR 3-7). Pre- and intraoperative compliance was 92% and 86% respectively. In total, 203 (44%) patients developed 346 complications, of which 61% were minor. On bivariate analysis, increased intraoperative compliance was associated with a significant decrease in LOS (coefficient [ß] = 0.987, 95% confidence interval [CI] 0.984-0.991) and complications (odds ratio [OR] 0.457, 95/5 CI 0.266-0.787). For every additional 30 minutes of theatre time, irrespective of type of procedure, LOS increased by 8% and complications by 12%. On multivariate analysis, laparoscopic compared to open surgery was also associated with a shorter LOS (exp [ß] = 0.667, 95% CI 0.580-0.767 p < 0.001) and reduced complications (OR 0.457, 95% CI 0.266-0.787 CONCLUSION: Our results show that high compliance to the ERAS guidelines is possible in the private sector in SA and that a significant reduction in LOS can be achieved without placing the patient at a higher risk of complications Keywords: colorectal surgery, perioperative care, ERAS, LMIC, surgical checklist

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“…The implementation of these protocols in middle- and low-income countries would be beneficial and efforts should be made for their implementation. [ 7 ] This will be an opportunity to standardize care, improve outcomes, reduce complications and length of stay, and will be cost-effective in times to come. The focus of these protocols will be on on preoperative evaluation and optimization, use of cost-effective medications including antibiotics, regional blockade, multimodal pain management, and early mobilization postoperatively.…”

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confidence: 99%