ERAS—Anticipated outcomes and realistic goals

Abstract

Enhanced recovery programs emphasize implementation of perioperative measures to reduce stress and restore baseline function. Complications and length of stay are greatly improved as a result, but the field is moving toward more patient centric and longer term outcomes that better reflect functional recovery. Programs demonstrating value in these domains will undoubtedly see corollary gains in traditional metrics. Thus, greater focus on patient well-being and treatment success is key to successful implementation of enhanced recovery.

Clinical trends and effects on quality metrics for surgical gastroesophageal cancer care

“…Efforts to develop enhanced postoperative recovery pathways can serve as example for such aspects of perioperative care, although their benefits over standard practice will still remain debatable unless impacted outcomes are measured and found to be benefited (15,33). Adherence to standardized practice pathways is thus not proposed to be used as surrogate for quality care, but rather measurement of relevant outcomes for patient-centered care should drive this process (34). An example for selection of relevant metrics and establishing benchmarks is the National Quality Forum colon cancer project (35); a similar forum, supported or endorsed by specialty professional societies and other stakeholders could be created for GC care.…”

Enhanced Recovery After Surgery

“…26,30 While these guidelines are evidence-based, there is little understanding of the impact that each component has on the improvement in outcomes. 6 Similarly, without uniformity in the definition of ERAS compliance across a specialty, studies cannot be directly compared. The ERAS Compliance Group has shown that higher compliance with ERAS protocols is associated with more substantial benefits in colorectal surgery.…”

“…79 This quality metric represents the number of patients who initiate postoperative adjuvant treatment of any kind divided by the number of patients intended to receive adjuvant therapy. 6,79 Successful tumor resection is a critical piece of oncologic care, but with high rates of multi-disciplinary management of cancer, adjuvant therapies are often recommended. 79,80 RIOT is an important outcome that can be used to validate the degree of successful recovery.…”

“…1–4 Central to the concept of ERAS is reduction of the typical physiological neuroendocrine stress response to surgery (Figure 1). 5,6 By targeting specific aspects of the preoperative, intraoperative, and postoperative care, ERAS protocols create a cohesive pathway that effectively returns patients to normal homeostasis. The major goal of the ERAS initiative is to rapidly and safely return a patient to his or her baseline function after the stress of a surgical operation.…”

Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study

“…But in genrenal population and with other mode of administration, the effect of topical ropivacaine anesthesia was not clear. The purpose of this study was to investigate whether topical ropivacaine anesthesia can increase the tolerance to the endotracheal tube to facilitate early and rapid recovery of surgical patients (enhanced recovery after surgery, ERAS) [ 14 ] post-thyroidectomy.…”