Enhanced recovery after surgery: implementing a new standard of surgical care

Altman, Alon D.; Helpman, Limor; McGee, Jacob; Samouëlian, Vanessa; Auclair, Marie-Hélène; Brar, Harinder; Nelson, Gregg

doi:10.1503/cmaj.180635

Cited by 71 publications

(65 citation statements)

References 85 publications

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“…Enhanced Recovery After Surgery (ERAS) programs are becoming the standard practice in many surgical specialties [40]. ERAS is a multidisciplinary, evidence-based approach to improve perioperative outcomes and accelerate postoperative recovery [41]. Implementation of ERAS strategy in gynecological surgery has been shown to be associated an improvement in clinical outcomes, including shortened LOS [42].…”

Section: Variablesmentioning

confidence: 99%

Impact of perioperative red blood cell transfusion on postoperative recovery and long-term outcome in patients undergoing surgery for ovarian cancer: A propensity score-matched analysis

Zhang¹,

Wu²,

Xu³

et al. 2020

Gynecologic Oncology

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Section: Variablesmentioning

confidence: 99%

Impact of perioperative red blood cell transfusion on postoperative recovery and long-term outcome in patients undergoing surgery for ovarian cancer: A propensity score-matched analysis

Zhang¹,

Wu²,

Xu³

et al. 2020

Gynecologic Oncology

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“…During this process, patients are initially at risk of becoming weak, immobile, and catabolic and can subsequently experience impaired healing, immunosuppression, postsurgical complications [3,7,8]. ERAS methods differ from conventional approaches to perioperative care mainly in their emphasis on accelerating recovery by decreasing the physical and psychological responses of the body to surgical stress [3,5,6]. Specific goals of ERAS include minimizing primary surgical injury and blood loss through using minimally invasive techniques, implementing pharmacotherapy like tranexamic acid, individualizing fluid therapy to decrease risk of gut ileus, optimizing pain control with multimodal analgesia, and encouraging early postoperative mobilization to decrease risk of atelectasis, pneumonia, and deep vein thrombosis [3,7].…”

Section: Review Key Components Of Erasmentioning

confidence: 99%

“…ERAS guidelines make adjustments to each of the three phases of surgery [3,5,8]. Preoperatively, the focus is on properly preparing the patient for surgery without unnecessary disruptions to homeostasis.…”

Section: Review Key Components Of Erasmentioning

confidence: 99%

“…Prolonged recovery time creates issues with bed occupancy and unmanageable demands of nursing care [1]. Enhanced recovery after surgery (ERAS) was first introduced in 1997 as an evidence-based, multidisciplinary perioperative approach to caring for the surgical patient [4][5][6][7][8]. The main goal of ERAS is to accelerate recovery without increasing morbidity [7,9].…”

Section: Introductionmentioning

confidence: 99%

“…ERAS aims to reduce surgical stress on the body and to minimize disruption of anabolic homeostasis [3,4,6,8]. Implementation of ERAS guidelines has allowed institutions to decrease length of stay, rates of complications, and medical costs [4,5,11]. Of note, the integration of short-interval postoperative follow-up appointments and use of multimodal pain therapy into ERAS can help patients limit postoperative narcotic use [2].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

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Ambulatory surgery centers aid the healthcare system by not only providing a cost-effective option for delivery of care but also by helping to reduce overwhelming case volumes at inpatient facilities. While outpatient protocols have been designed for an increasing number of surgical procedures, the inpatient to outpatient transition of surgery remains limited by both procedure type and patient comorbidities. This limitation stems in part from the heavy emphasis on accelerated discharge following outpatient procedures, given that prolonged recovery time is associated with delayed turnover and increased nursing care demands. Since its inception, enhanced recovery after surgery (ERAS) has aimed to primarily reduce the disruption of physiologic homeostasis that occurs secondary to surgery. More recently, the aim of ERAS has evolved to help transition inpatient procedures to outpatient settings and may even be useful in more emergent cases. It should be noted, however, that outpatient surgery even in combination with ERAS is not the best option for all patients, and the use of ERAS protocols should be complemented with predictive assessments of patient risk. Beyond augmenting the efficiency of outpatient surgery, ERAS protocols, when used in eligible patients and especially when combined with regional anesthetic techniques, are effective in delivering opioid-sparing pain management while increasing overall outcomes and patient satisfaction rates.

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Implementation of back at work after surgery (BAAS): A feasibility study of an integrated pathway for improved return to work after knee arthroplasty

Strijbos

Sluis

Boymans

et al. 2022

Musculoskeletal Care

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Purpose: Optimizing return to work after knee arthroplasty is becoming more important because of the growing incidence of KA among workers and poor return to work outcomes. The purpose of this study is to investigate the feasibility of Back At work After Surgery (BAAS): an integrated clinical pathway for return to work after knee arthroplasty.Method: Working patients who received unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) between January 2021 and November 2021, younger than 65 years and motivated to return to work were eligible to participate. Feasibility was investigated on ve domains: reach, dose delivered, dose received, delity and patients' attitudes. These outcomes were obtained by a patientreported questionnaire and an interview with the occupational case manager and medical case manager.Results: Of the eligible 29 patients, eleven were willing to participate (response rate 38%; due to travel distance to and from the hospital). The dose delivered was between 91 and 100%, except information given about return to work from the orthopedic surgeon which was 18%. The dose received was 100%.For delity, case managers reported nine shortcomings for which ve solutions were mentioned. In terms of patients' attitude, all patients were satis ed and one patient mentioned an improvement.Conclusions: In terms of reach, participation was low: only 29%. The BAAS clinical pathway seems feasible based on dose delivered, dose received, delity and patient attitudes. The next step is to assess the effectiveness of the BAAS clinical pathway for return to work.

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Enhanced recovery after surgery: implementing a new standard of surgical care

Abstract: Contributors: All the authors were involved in initial conception of the paper, interpreted the evidence involved in the review, drafted and critically revised the manuscript, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

Cited by 71 publications

References 85 publications

Impact of perioperative red blood cell transfusion on postoperative recovery and long-term outcome in patients undergoing surgery for ovarian cancer: A propensity score-matched analysis

Impact of perioperative red blood cell transfusion on postoperative recovery and long-term outcome in patients undergoing surgery for ovarian cancer: A propensity score-matched analysis

Maximization of Non-Opioid Multimodal Analgesia in Ambulatory Surgery Centers

Implementation of back at work after surgery (BAAS): A feasibility study of an integrated pathway for improved return to work after knee arthroplasty

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