Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy

Fujikuni, Nobuaki; Tanabe, Kazuaki; Tokumoto, Noriaki; Suzuki, Takahisa; Hattori, Minoru; Misumi, Toshihiro; Ohdan, Hideki

doi:10.4240/wjgs.v8.i5.382

Cited by 31 publications

(20 citation statements)

References 21 publications

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“…After initial evaluation, 597 studies were removed for being duplicates, 2204 for being irrelevant (as determined by reading the abstracts), and 67 studies were excluded for reasons determined by reading the full text (Additional file 2). 16 studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in the final meta-analysis. Figure 1 shows the work flow for the selection of studies.…”

Section: Literature Identificationmentioning

confidence: 99%

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

et al. 2020

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Background: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods: Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results: A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection (RR = 0.50, 95%CI: 0.33 to 0.75), postoperative length of stay (MD =-2.53, 95%CI: − 3.42 to − 1.65), time until first postoperative flatus (MD =-0.64, 95%CI: − 0.84 to − 0.45) and time until first postoperative defecation (MD =-1.10, 95%CI: − 1.74 to − 0.47) in patients who received ERAS, compared to conventional care. However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P = 0.10), surgical site infection (P = 0.42), postoperative anastomotic leakage (P = 0.45), readmissions (P = 0.31) and ileus (P = 0.25). Conclusions: ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

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Section: Literature Identificationmentioning

confidence: 99%

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…After initial evaluation, 597 studies were removed for being duplicates, 2,204 for being irrelevant (as determined by reading the abstracts), and 67 studies were excluded for reasons determined by reading the full text (Additional File 2). 16 studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] were included in the final meta-analysis. Fig.…”

Section: Literature Identificationmentioning

confidence: 99%

The Application of Enhanced Recovery after Surgery for Upper Gastrointestinal Surgery: Meta-Analysis

Huang

Zhu

Luo

et al. 2019

Preprint

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Background: Although enhanced recovery after surgery (ERAS) has made great progress in the field of surgery, the guidelines point to the lack of high-quality evidence in upper gastrointestinal surgery. Methods : Randomized controlled trials in four electronic databases that involved ERAS protocols for upper gastrointestinal surgery were searched through December 12, 2018. The primary endpoints were lung infection, urinary tract infection, surgical site infection, postoperative anastomotic leakage and ileus. The secondary endpoints were postoperative length of stay, the time from end of surgery to first flatus and defecation, and readmission rates. Subgroup analysis was performed based on the type of surgery. Results : A total of 17 studies were included. The results of the meta-analysis indicate that there was a decrease in rates of lung infection ( RR =0.50, 95%CI: 0.33 to 0.75 ), postoperative length of stay ( MD =-2.53, 95%CI: -3.42 to -1.65 ) , time until first postoperative flatus ( MD =-0.64, 95%CI: -0.84 to -0.45 ) and time until first postoperative defecation ( MD =-1.10, 95%CI: -1.74 to -0.47 ) in patients who received ERAS, compared to conventional care . However, other outcomes were not significant difference. There was no significant difference between ERAS and conventional care in rates of urinary tract infection (P=0.10), surgical site infection (P=0.42), postoperative anastomotic leakage (P=0.45), readmissions (P=0.31) and ileus (P =0.25). Conclusions : ERAS protocols can reduce the risk of postoperative lung infection and accelerating patient recovery time. Nevertheless, we should also consider further research ERAS should be performed undergoing gastrectomy and esophagectomy.

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“…Good nutritional status could reduce the occurrence of complications such as wound infections and may help wound healing (22). Research examining shortening preoperative fasting and postoperative eating time of elderly patients with lumbar surgery is markedly lacking, despite studies indicating that it is safe and effective (1,18,23). Our studies showed that elderly patients oral carbohydrate drink 2 hours before the induction anesthesia and after surgery drinking water starting 2-4 hours early feeding started 6 hours is safe and without increasing complications.…”

Section: Discussionmentioning

confidence: 72%

“…Shorting fasting and feeding time is one of important preoperative elements in our ERAS program. Because of perioperative starvation induces stress hormones release of the in ammatory cytokine and the accumulation of lipid products in skeletal muscles, traditional preoperative fasting for at least 8 h and oral feeding on postoperative 1 day may cause insulin resistance and metabolic stress (17,18). Insulin resistance and metabolic stress could increase the rate of postoperative complications (19).…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

Wang

Kong

et al. 2020

Preprint

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Background: Degenerative disorders of the lumbar spine decrease the mobility and quality of life of elderly patients. Lumbar fusion surgery is the primary method of treating degenerative lumbar spine disorders; however, the surgical stress response associated with major surgery has been linked to pathophysiological changes in the elderly, resulting in undesirable postoperative morbidity, complications, pain, fatigue, and extended convalescence. In the present study, we aimed to determine whether enhanced recovery after surgery significantly improved satisfaction and outcomes in elderly patients (>65 years old) with short-level lumbar fusion. Methods: A total of 192 patients were included, 96 in the enhanced recovery after surgery group and 96 case-matched patients in the non- enhanced recovery after surgery group. Data including demographic, comorbidity and surgical information were collected from electronic medical records. enhanced recovery after surgery interventions were categorised as preoperative, intraoperative and postoperative. We also evaluated primary outcome, surgical complication, length of stay, postoperative pain scores and 30-day readmission rates. Results: There were no statistically significant intergroup differences in regards to demographics, comorbidities、American Society of Anaesthesiologists grade、or the number of fusion levels. There were also no differences between mean surgery time of intraoperative blood loss between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. In addition, the mean preoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs and Oswestry Disability Index score were not significantly different between the two groups. Overall, enhanced recovery after surgery pathway compliance was 92.1%. There were no significant differences in the number of complications or the mortality rates between the enhanced recovery after surgery and non- enhanced recovery after surgery groups. Furthermore, the mean postoperative Japanese Orthopaedic Association score、Visual Analogue Score for the back and legs, Oswestry Disability Index score and readmission rates score revealed no significant differences between the groups at 30-day- follow-up point. However, we observed a statistically significant decrease in length of stay in the enhanced recovery after surgery group (12.30±3.03 of enhanced recovery after surgery group versus 15.50±1.88 in non- enhanced recovery after surgery group, p=0). Multivariable linear regression showed that comorbidities (p=0.023) and implementation of enhanced recovery after surgery program (p=0.002) were correlated with prolonged length of stay. Multivariable logistic regression showed that no characteristics were associated with complications. Conclusions: This report describes the first enhanced recovery after surgery protocol used in elderly patients after short-level lumbar fusion surgery. Our enhanced recovery after surgery program is safe and could help decreases length of stay in elderly patients with short-level lumbar fusion.

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Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy

Abstract: Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

Cited by 31 publications

References 21 publications

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

The application of enhanced recovery after surgery for upper gastrointestinal surgery: Meta-analysis

The Application of Enhanced Recovery after Surgery for Upper Gastrointestinal Surgery: Meta-Analysis

Enhanced recovery after surgery (ERAS) program for elderly patients with short-level lumbar fusion

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