ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

Chorath, Kevin; Luu, Neil N.; Go, Beatrice; Moreira, Alvaro; Rajasekaran, Karthik

doi:10.1177/01945998211019671

Cited by 14 publications

(11 citation statements)

References 66 publications

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“…Although recent interest in ERAS has led to a surge in studies demonstrating their efficacy in various adult surgical populations, [19][20][21] their use in pediatric patients is significantly more limited. The present study sought to synthesize the impact of ERAS protocol implementation across various centers following primary palatoplasty in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

Shin¹,

Wagner²,

Prasad³

et al. 2022

Journal of Craniofacial Surgery

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Objective: Perform a systematic review assessing the efficacy of enhanced recovery after surgery (ERAS) protocols for cleft palate repair. Primary outcomes included hospital length of stay, readmission rates, and postoperative narcotic use. Secondary outcomes included complications, time to initial postoperative oral intake, and pain scores. Data Sources: Cohort and randomized studies of ERAS protocols pertaining to cleft palate repair were identified by systematic review of Medline, Scopus, Embase, and grey literature. Review Methods: Data extracted included patient demographics, clinical care protocols, complication rates, postoperative narcotic use, time to initial postoperative oral intake, hospital length of stay, family satisfaction, and 30-day readmission. Meta-analysis was used to compare outcomes between patients enrolled in ERAS protocols versus those in conventional care pathways. Results: Eight hundred sixty-five articles were screened, and 5 studies met full inclusion criteria. A total of 425 patients were included. Patients in ERAS protocols saw a mean reduction of – 23.96 hours in length of stay compared to controls (95% confidence interval [CI]: – 26.4, – 20.6). Patients in ERAS protocols also had decreased total morphine consumption (mean difference [MD]: – 3.88 mg; CI: – 4.31, – 3.45), and decreased time to first initial feed compared to controls (MD: – 3.88 hours; CI: – 4.3, – 3.5). There was no difference in readmission rates or complication rates between ERAS and control groups. Conclusions: ERAS protocols have seen limited use in pediatric patients. The present study sought to assess the impact of ERAS protocols following primary palatoplasty. Our results indicate decreased hospital length of stay, postoperative opioid consumption, and time to feeding, without increasing readmission rates or complication rates.

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Section: Discussionmentioning

confidence: 99%

Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

Shin¹,

Wagner²,

Prasad³

et al. 2022

Journal of Craniofacial Surgery

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“…There is a growing body of evidence supporting the safety and efficacy of the enhanced recovery after surgery concept for various procedures. The most recent meta-analysis showing beneficial effects are in thyroid surgery [8 ▪ ], aortic aneurysm surgery [9 ▪ ] and pediatric surgery [10 ▪ ] all supporting its benefits in shortening hospital stay and improving patients’ satisfaction.…”

Section: Enhanced Recovery After Surgery Pathwaysmentioning

confidence: 99%

Ambulatory anesthesia and discharge: an update around guidelines and trends

Rohi

Olofsson

Jakobsson

2022

Current Opinion in Anaesthesiology

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Purpose of reviewProvide an oversight of recent changes in same-day discharge (SDD) of patient following surgery/anesthesia.Recent findingsEnhanced recovery after surgery pathways in combination with less invasive surgical techniques have dramatically changed perioperative care. Preparing and optimizing patients preoperatively, minimizing surgical trauma, using fast-acting anesthetics as well as multimodal opioid-sparing analgesia regime and liberal prophylaxis against postoperative nausea and vomiting are basic cornerstones. The scope being to maintain physiology and minimize the impact on homeostasis and subsequently hasten and improve recovery.SummaryThe increasing adoption of enhanced protocols, including the entire perioperative care bundle, in combination with increased use of minimally invasive surgical techniques have shortened hospital stay. More intermediate procedures are today transferred to ambulatory pathways; SDD or overnight stay only. The traditional scores for assessing discharge eligibility are however still valid. Stable vital signs, awake and oriented, able to ambulate with acceptable pain, and postoperative nausea and vomiting are always needed. Drinking and voiding must be acknowledged but mandatory. Escort and someone at home the first night following surgery are strongly recommended. Explicit information around postoperative care and how to contact healthcare in case of need, as well as a follow-up call day after surgery, are likewise of importance. Mobile apps and remote monitoring are techniques increasingly used to improve postoperative follow-up.

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“…In addition to ERAS protocols for head and neck cancer surgery, there is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. A recently published systematic review and meta‐analysis showed that ERAS protocols for thyroid and parathyroid surgery significantly reduced hospital LOS and costs without increasing complications or readmission rates 17 . In light of the benefits seen in patients with head and neck cancer and those undergoing thyroid and parathyroid surgery, we were interested in investigating the role of ERAS protocols for other patient populations in otolaryngology.…”

Section: Introductionmentioning

confidence: 99%

“…A recently published systematic review and meta-analysis showed that ERAS protocols for thyroid and parathyroid surgery significantly reduced hospital LOS and costs without increasing complications or readmission rates. 17 In light of the benefits seen in patients with head and neck cancer and those undergoing thyroid and parathyroid surgery, we were interested in investigating the role of ERAS protocols for other patient populations in otolaryngology. Our objective therefore was to collate, critically appraise, and analyze the published literature regarding the use and efficacy of ERAS protocols for outpatient operations in otolaryngology.…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature

Chorath

Hobday

Suresh

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Objective: Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based pathways designed to reduce complications, promote recovery, and improve outcomes following surgery. These protocols have been successfully applied for the management of head and neck cancer, but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology. Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods: A systematic literature review was conducted using MEDLINE, EMBASE, SCOPUS, and gray literature. We identified studies that evaluated ERAS protocols among patients undergoing otologic, laryngeal, nasal/sinus, pediatric, and general otolaryngology operations. We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results: A total of eight studies fulfilled the inclusion criteria and were included in the analysis. Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy, functional endoscopic sinus surgery, tympanoplasty and mastoidectomy, and septoplasty. A reduction in postoperative length of stay and hospital costs was reported in two and three studies, respectively.Comparative studies between ERAS and control groups showed persistent improvement in pre-and postoperative anxiety and pain levels, without an increase in postoperative complications and readmission rates.Conclusions: A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology. These clinical pathways appear promising for these procedures as they may reduce length of stay, decrease costs, and improve pain and anxiety postoperatively.

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ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta‐analysis

Cited by 14 publications

References 66 publications

Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

Enhanced Recovery After Surgery for Pediatric Cleft Repair: A Systematic Review and Meta-Analysis

Ambulatory anesthesia and discharge: an update around guidelines and trends

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology: Review of literature

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