Enhanced recovery after surgery on multiple clinical outcomes

Zhang, Xingxia; Yang, Jie; Chen, Xinrong; Li, Du; Li, Ka; Zhou, Yong

doi:10.1097/md.0000000000020983

Cited by 47 publications

(34 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our study showed the importance in adopting the ERAS protocols to improve perioperative outcomes of RC patients compared to a traditional approach and that the multimodal nature of ERAS is better than individually focusing on a single element within it. A recent umbrella review of 23 meta-analyses across multiple surgical specialties including urology (3) by Zhang et al 34 showed strong evidence that ERAS pathways can reduce LOS and cost without increasing morbidity and readmission. Despite these positive results, we need to exercise caution in interpreting these findings, there are limitations that cannot be ignored.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis

Peerbocus¹,

Wang²

2021

RRU

View full text Add to dashboard Cite

Introduction Enhanced recovery after surgery (ERAS) protocols aim to optimize patient recovery after major surgery. Our study was to examine the evidence of the effectiveness of interventions designed to improve patient outcomes after radical cystectomy. Design Systematic review and meta-analysis. Data Sources PubMed, Medline, Embase, Cochrane from January 2005 to January 2021 without language restrictions. Eligibility Criteria Randomized and non-randomized controlled studies implementing ERAS measuring its interventions on rates of postoperative complications, 30-day readmission, length of stay (LOS) and bowel function after radical cystectomy. Data Extraction and Synthesis Two members of the investigating team independently selected studies and evaluated bias using the Cochrane collaboration tool. Meta-analysis of all comparative studies used inversed-weighted, fixed- effects models and random effects models to pool results. Publication bias was graphically assessed using contour-enhanced funnel plots and the Egger’s test of funnel plot symmetry. Results Fifteen studies were included in our meta-analysis; we observed that ERAS decreased the time for the first bowel movement (standardized mean difference [SMD]: –1.30, 95% CI −1.90 to −0.70, P<0.00001) and shortened the length of stay (LOS) ([SMD]: –0.49, 95% CI −0.77 to −0.20, (P < 0.00001)); however, 30-day readmission (risk ratio [RR]: 0.97,95% [CI] 0.73 to 1.28, P=0.52) and the overall postoperative complication rate (risk ratio [RR]: 0.98,95% confidence interval [CI]: 0.88 to 1.09, P= 0.41) showed no significant difference.

show abstract

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis

Peerbocus¹,

Wang²

2021

RRU

View full text Add to dashboard Cite

show abstract

“…ERAS protocols are complex, requiring organised care from a multidisciplinary team to ensure strong patient outcomes and provide an elevated level of care. Enhanced recovery pathways reduce length of stay (LOS) by an average of 2.35 days and total cost by an average of $639.06 in comparison with conventional perioperative procedures, according to a 2020 meta-analysis of ERAS across multiple surgeries and surgical specialties [1]. Despite concerns, ERAS does not increase morbidity, mortality or readmission rates [2], having even been shown to decrease 30-day mortality rates following orthopedic surgery [1].…”

Section: Introductionmentioning

confidence: 99%

“…Enhanced recovery pathways reduce length of stay (LOS) by an average of 2.35 days and total cost by an average of $639.06 in comparison with conventional perioperative procedures, according to a 2020 meta-analysis of ERAS across multiple surgeries and surgical specialties [1]. Despite concerns, ERAS does not increase morbidity, mortality or readmission rates [2], having even been shown to decrease 30-day mortality rates following orthopedic surgery [1]. Since its beginnings as 'fast-track' surgery in 1997 [3], ERAS has been researched across a broad range of surgical subspecialties, from orthopedics to transplant surgery [4].…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery

Golder

Papalois

2021

JCM

View full text Add to dashboard Cite

Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.

show abstract

“…Innovations to address these include specific therapeutic interventions, such as fluid management 5 , and broader interventions through models or systems of care which combine high quality elements, such as enhanced recovery after surgery (ERAS) 6 , and prehabilitation programmes 7 . Systems changes perhaps provide a greater opportunity for measurable improvements 8 .…”

Section: Introductionmentioning

confidence: 99%

“…However, detailed high-quality cost-effectiveness analysis is relatively limited in systems or models of care in postoperative care. For example, in a recent ERAS umbrella systematic review 6 , only 13 of over 200 studies even mentioned cost as an outcome. Those studies that do address cost and effectiveness frequently including simple estimates, or formal but simple cost-effectiveness calculations [13][14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a New Model of Postoperative Care: A Preliminary Cost-effectiveness Analysis Using Markov Modelling

Ludbrook¹

2020

Preprint

View full text Add to dashboard Cite

Background: Re-design of systems or models of care to manage perioperative care has the potential to generate higher value care (improved outcomes; ideally lower cost). However, this needs high quality measurement of cost-effectiveness to allow stakeholders to select those which provide most value, and to plan future interventions. Data on cost-effective analysis in this area are sparse, and trials often apply relatively simple analytic techniques.Methods: This analysis utilised recently published data from a small feasibility trial of a new model of medium-acuity postoperative care for moderate-risk patients undergoing surgery (Advanced Recovery Room Care; ARRC). The trial 1 data were used to develop a Markov cost-effectiveness model of patient transition (model transition probabilities) between locations of care (model states), each with different effects and cost. Cost was taken from the perspective of hospitals. The effect chosen was patient postoperative days at home after surgery (DAH), an effect reflecting quality of in-hospital care, acknowledged financially by healthcare fundholders, and relevant to consumers. A model cycle time of 4 hours run out to 30 days after surgery reflected clinically relevant timelines and costs.Results: This model showed the potential differences before and after introduction of ARRC in ICU use, re-admissions, and DAH, in particular, which reflected the findings from the ARRC trial. Incremental cost effectiveness ratio (ICER) of introduction of ARRC was minus $601 for every increased day at home. Sensitivity analysis revealed 805 of 1000 simulations found a negative ICER.Conclusions: These data suggest that the ARRC model may have positive cost-effectiveness, something to be examined in a future prospective clinical trial. Such cost-effectiveness modelling may have utility in examination of other innovations in perioperative care.Trial registration: The ARRC trial on which this analysis is based was prospectively registered: ANZCTRN 12617001173381

show abstract

Enhanced recovery after surgery on multiple clinical outcomes

Abstract: Supplemental Digital Content is available in the text

Cited by 47 publications

References 85 publications

Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis

Enhanced Recovery After Surgery and Radical Cystectomy: A Systematic Review and Meta-Analysis

Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery

Evaluation of a New Model of Postoperative Care: A Preliminary Cost-effectiveness Analysis Using Markov Modelling

Contact Info

Product

Resources

About