ERAS (Enhanced Recovery after Surgery) in Colorectal Surgery

Sánchez-Jiménez, Raúl; Álvarez, Alberto Blanco; Trébol, Jacobo; Jiménez, Antonio Sánchez; Conde, Fernando Gutiérrez; Sáez, José Antonio Carmona

doi:10.5772/57136

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…Additionally, liquid and solid diet was tolerated significantly earlier in these patients as also documented in previous studies [13,20,23,37]. In the elective context, the intra-abdominal drain is not routinely placed in the ERAS setting [38]. Gonenc et al did not place any drain following laparoscopic Graham's patch repair [19], whereas early removal of the drain was encouraged in other studies [20,23].…”

Section: Discussionmentioning

confidence: 61%

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

Aggarwal,

Irrinki,

Kurdia

et al. 2023

World j. surg.

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Background Enhanced Recovery After Surgery (ERAS) is a multimodal approach with promising results in improving patient outcome. Only recently, is evidence emerging highlighting how similar principles of care can be applied to patients undergoing emergency abdominal surgery. Methods A randomized controlled trial was conducted from November 2021 to April 2022 at PGIMER Chandigarh, which is a leading tertiary care hospital in northern India. 60 patients with acute intestinal obstruction requiring emergency laparotomy were randomized and assigned to ERAS or Non-ERAS group. ERAS protocol with some modifications was applied. Primary endpoints were post-operative hospital stay. Secondary end points were morbidity, 30-day readmission and mortality rate. Data analysis was done using SPSS 22.0. Independent t test or Mann-Whitney test and Chi-square or Fisher-exact test were used for analysis. Results A significant 3-day reduction in hospital stay was observed in ERAS compared to non-ERAS group (median (interquartile range) 5.50 (4.75-8.25) vs 8.0 (6.0-11.0) p = 0.003) with no difference in 30-day readmission rate, mortality rate and complication rate (according to Clavien-Dindo classification). ERAS group was associated with early recovery of gastrointestinal functions including time to first passage of flatus (p \ 0.001), stools (p = 0.014), early ambulation (p \ 0.001), time to first fluid diet (p \ 0.001), solid diet (p = 0.001) and reduced nasogastric tube reinsertion rates (p = 0.01) despite its early removal. Conclusion ERAS with some modifications can be applied in patients with intestinal obstruction. Thus, we can expedite post-operative recovery and early regain of gastrointestinal function with decreased hospital stay, comparable morbidity and mortality. Further studies are needed to assess ERAS role in emergency gastrointestinal surgeries. Trial registration Ctri.gov Identifier: CTRI/2022/04/042156.

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Section: Discussionmentioning

confidence: 61%

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

Aggarwal,

Irrinki,

Kurdia

et al. 2023

World j. surg.

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“…Pain management is the key to achieving a successful surgical outcome following ERAS pathways. The use of multimodal analgesia by combining various analgesic agents for early recovery of patients has been practiced in ERAS pathways [ 2 , 10 ]. Gonenc et al used NSAIDs for pain management, and opioids were reserved for pain not responding to NSAIDs [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…These have now become the standard of care across specialties, reducing hospital stays and postoperative morbidity and mortality [ 9 ]. The ERAS programme has been widely implemented in elective surgical procedures; however, perioperative care in emergency surgeries continues to use the conventional protocol of management [ 10 ]. Recent evidence has demonstrated that many conventional care principles are baseless and harmful [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Tailored-Enhanced Recovery After Surgery Versus Conventional Care in Patients of Gastro-Duodenal Perforation: A Pilot Randomized Control Trial

Tandup,

Chauhan,

Chauhan

et al. 2023

Cureus

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Background: The enhanced recovery after surgery (ERAS) program established improved clinical outcomes in elective surgery; however, its role in emergencies is uncertain. This study was designed to assess the feasibility, safety, and efficacy of a tailored-ERAS (t-ERAS) protocol in patients undergoing modified Graham’s patch closure for gastro-duodenal perforation. Methods: A single-centre, prospective, parallel-arm, open-label, randomized controlled trial was conducted from February 2021 to December 2021. Patients with gastroduodenal perforation undergoing modified Graham's patch were randomly assigned to either conventional care or the t-ERAS pathway. Patients with refractory septic shock, psychiatric or neurological disorders, pregnancy, multiple perforations, sealed-off perforations, and perforation sizes greater than 1.5 cm were excluded. The primary outcome was to compare the length of hospitalization (LOH). Functional recovery parameters and morbidity were compared in secondary outcomes. Results: Twenty-five patients each were included in conventional care and the t-ERAS group. In the t-ERAS group, LOH was significantly shorter (6.3 SD2.15 days versus 9.56 SD4.33 days, p = 0.001). Patients in the t-ERAS group had significantly early functional recovery (days) with time to first bowel sound (1.8 SD0.41; p 0.002), first flatus (2.52 SD0.65; p = 0.026), first stool (3.04 SD0.68; p < 0.001), first liquid diet (2.24 SD0.60; p = 0.002), and duration of ileus (2.64 SD0.86; p = 0.038). There was no significant difference in morbidity such as post-operative nausea and vomiting, SSI, or pulmonary complications between the two groups. Conclusion: Tailored ERAS pathways are safe and effective in reducing the LOH and promoting early functional recovery in patients undergoing emergency closure of gastro-duodenal perforation.

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“…Kanıta dayalı çalışmalar kapsamında geliştirilen hızlı iyileşme protokolleri cerrahi sonrası iyileşmenin hızlandırılmasını, mortalite ve morbiditenin azalmasını ve hastanede kalış süresinin kısaltılmasını amaçlamaktadır 1,[3][4][5] . Kanıt temelli uygulamalardan biri olan ve Cerrahi Sonrası Hızlandırılmış İyileşme (Enhanced Recovery After Surgery -ERAS) Derneği tarafından geliştirilen ERAS protokolü, "cerrahiye bağlı travmanın, cerrahi süreç boyunca bireylerde ortaya çıkardığı psikolojik sorunlar ve organ fonksiyon bozukluklarını engelleyerek bu süreci standardize etmek ve olası en iyi tedavi ve bakımı sağlayarak bireyi en kısa sürede taburcu etmek" olarak tanımlanmaktadır 6,7 .…”

Section: Introductionunclassified

“…Cerrahi hemşirelerinin, güncel ve kanıta dayalı bir yaklaşım olan ERAS protokolüne ilişkin gelişmeler hakkında bilgi sahibi olmaları, protokole uyum sağlamaları, yeni ve güncel yaklaşımları yakından takip ederek bilgilerini hasta bakımına yansıtmaları önemlidir [4][5][6][7][8][9][10][11]…”

Section: Introductionunclassified

Genel Cerrahi Hemşirelerinin Cerrahi Sonrası Hızlandırılmış İyileşme Protokolü Uygulamalarına İlişkin Değerlendirmeleri

Gür

Katran

ARPAG³

et al. 2023

İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi

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Amaç: Bu araştırmanın amacı; genel cerrahi kliniklerinde çalışan hemşirelerin Cerrahi Sonrası Hızlandırılmış İyileşme (Enhanced Recovery After Surgery-ERAS) protokolü uygulamalarına ilişkin değerlendirmelerini belirlemektir. Yöntem: Tanımlayıcı ve kesitsel tipteki bu araştırma, genel cerrahi kliniğinde çalışan 258 hemşire ile 20 Mayıs-20 Haziran 2021 tarihleri arasında gerçekleştirildi. Genel cerrahi kliniklerinde çalışan hemşirelerin sosyo-demografik, mesleki özellikleri ile ERAS protokolleri ve uygulamalarına ilişkin değerlendirmelerini içeren 37 sorudan oluşan veri toplama formu, çevrimiçi olarak hemşirelere iletildi. Veriler, SPSS 25.0 programıyla analiz edildi. Bulgular: Araştırmaya katılan hemşirelerin yaş ortalaması 28,81±7,63 yıl olup, %86’sı (n=222) kadın ve %38’i (n=98) lisans mezunudur. Hemşirelerin %38,8’nin (n=100) ERAS protokolleri hakkında bilgisi olmadığı, %58,9’unun (n=152) ise ERAS protokolüne yönelik herhangi bir eğitim almadığı ve %36,4’ünün (n=94) çalıştığı klinikte ERAS protokollerinin uygulanmadığı belirlendi. Lisansüstü eğitim düzeyine sahip olan (p<0,01) ve ERAS protokollerine ilişkin bilgi sahibi olan hemşirelerin (p<0,001) protokolün ameliyat öncesi, sonrası ve bileşenlerin toplamının uygulanmasına yönelik sorulara doğru yanıt verme oranlarının istatistiksel olarak anlamlı ve yüksek olduğu belirlendi. Çalıştığı hastanedeki hasta-hemşire oranı 1-5 arasında olan (p<0,05) ve ERAS protokollerine ilişkin eğitim alan (p<0,01) hemşirelerin ise ameliyat sonrası bileşenlerin uygulanmasına yönelik sorulara doğru yanıt verme oranlarının istatistiksel olarak anlamlı ve yüksek olduğu bulundu. Sonuç: Lisansüstü eğitim düzeyine sahip ve ERAS protokollerine ilişkin bilgisi olan hemşirelerin ameliyat öncesi ve sonrası uygulamalara ilişkin sorulara doğru yanıt verme oranının yüksek olduğu belirlendi. Çalıştığı hastanede en fazla 5 hastaya bakan ve ERAS protokollerine ilişkin eğitim almış olan hemşirelerin ise ameliyat sonrası uygulamalara yönelik sorulara doğru yanıt verme oranının yüksek olduğu bulundu. Cerrahi hemşirelerinin bilgi düzeyini artırmaya yönelik hemşirelik eğitiminde ve mezuniyet sonrası hizmet içi eğitim programlarında ERAS protokollerine yer verilmesi, cerrahi hemşirelerinin ERAS protokolüne yönelik güncel gelişmeler ile kanıta dayalı rehberleri takip etmeleri ve cerrahi hastasının bakımında disiplinler arası ERAS protokolü uygulamalarının temel alınarak hasta bakımına aktarılması önerilmektedir.

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ERAS (Enhanced Recovery after Surgery) in Colorectal Surgery

Cited by 12 publications

References 28 publications

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

Modified Enhanced Recovery After Surgery (ERAS) Protocol Versus Non‐ERAS Protocol in Patients Undergoing Emergency Laparotomy for Acute Intestinal Obstruction: A Randomized Controlled Trial

Impact of Tailored-Enhanced Recovery After Surgery Versus Conventional Care in Patients of Gastro-Duodenal Perforation: A Pilot Randomized Control Trial

Genel Cerrahi Hemşirelerinin Cerrahi Sonrası Hızlandırılmış İyileşme Protokolü Uygulamalarına İlişkin Değerlendirmeleri

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