Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery

Kehlet, Henrik; Wilmore, Douglas W.

doi:10.1097/sla.0b013e31817f2c1a

Cited by 1,466 publications

(1,069 citation statements)

References 176 publications

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“…The fast-track methodology requires a procedure-specific pain regimen to allow early mobilization, and thereby reduce the length of convalescence and morbidity (Kehlet and Wilmore 2008). In the present study, the patients had low postoperative pain scores irrespective of which study group they belonged to, both at rest and during mobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Implementation of accelerated clinical pathways based on the fast-track principles reduces morbidity and enhances recovery for patients undergoing THA (Kehlet and Wilmore 2008). One of the key prerequisites is optimized pain relief, allowing early postoperative mobilization (Kehlet and Wilmore 2008).…”

mentioning

confidence: 99%

“…One of the key prerequisites is optimized pain relief, allowing early postoperative mobilization (Kehlet and Wilmore 2008). This requires that the pain treatment should be safe and effective, both at rest and during activity (Srikandarajah and Gilron 2011).…”

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confidence: 99%

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Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

et al. 2015

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Background and purpose — The local infiltration analgesia (LIA) technique has been widely used to reduce opioid requirements and to improve postoperative mobilization following total hip arthroplasty (THA). However, the evidence for the efficacy of LIA in THA is not yet clear. We determined whether single-shot LIA in addition to a multimodal analgesic regimen would reduce acute postoperative pain and opioid requirements after THA.Patients and methods — 116 patients undergoing primary THA under spinal anesthesia were included in this randomized, double-blind, placebo-controlled trial. All patients received oral opioid-sparing multimodal analgesia: etoricoxib, acetaminophen, and glucocorticoid. The patients were randomized to receive either 150 mL ropivacaine (2 mg/mL) and 0.5 mL epinephrine (1 mg/mL) or 150 mL 0.9% saline. Rescue analgesic consisted of morphine and oxycodone as needed. The primary endpoint was pain during mobilization in the recovery unit. Secondary endpoints were pain during mobilization on the day after surgery and total postoperative opioid requirements on the first postoperative day.Results — The levels of pain during mobilization—both in the recovery unit and on the day after surgery—and consumption of opioids on the first postoperative day were similar in the 2 groups.Interpretation — LIA did not provide any extra analgesic effect after THA over and above that from the multimodal analgesic regimen used in this study.

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Section: Discussionmentioning

confidence: 99%

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Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

et al. 2015

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“…To this end, the concept of “fast‐track surgery” was introduced in the 1990s by Henrik Kehlet. It was demonstrated that by applying evidence‐based perioperative principles to open colonic surgery, the post‐operative length of hospital stay could be reduced to 2–3 days 1, 2. Realising that the surgical journey involves many professional competencies, a more integrated, multiprofessional, multidisciplinary approach was needed, whereby a decision taken early in the course of the treatment plan would impact on later developments and influence the choices available for recovery further down the line.…”

Section: Figurementioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

Scott

Baldini

Fearon

et al. 2015

Acta Anaesthesiol Scand

320

178

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BackgroundThe present article has been written to convey concepts of anaesthetic care within the context of an Enhanced Recovery After Surgery (ERAS) programme, thus aligning the practice of anaesthesia with the care delivered by the surgical team before, during and after surgery.MethodsThe physiological principles supporting the implementation of the ERAS programmes in patients undergoing major abdominal procedures are reviewed using an updated literature search and discussed by a multidisciplinary group composed of anaesthesiologists and surgeons with the aim to improve perioperative care.ResultsThe pathophysiology of some key perioperative elements disturbing the homoeostatic mechanisms such as insulin resistance, ileus and pain is here discussed.ConclusionsEvidence‐based strategies aimed at controlling the disruption of homoeostasis need to be evaluated in the context of ERAS programmes. Anaesthesiologists could, therefore, play a crucial role in facilitating the recovery process.

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“…Objective outcomes such as radiographs may be important, but these might not really matter if the patient’s perception of the outcome is negative. In fast-track surgery (Kehlet and Wilmore 2008, Husted et al 2010b, 2012, Kehlet 2013), with the increased focus on reduced length of stay (LOS) it is even more important to look at the results of treatment and care from the patient’s point of view. Approximately 18,000 patients in Denmark underwent THR and TKR in 2012 (Danish Hip Arthroplasty Register 2013, Danish Knee Arthroplasty Register 2013), making these amongst the more common surgical procedures.…”

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confidence: 99%

High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

et al. 2015

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Background and purpose — Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding length of stay (LOS) and patient satisfaction.Patients and methods — In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient satisfaction was measured using a numerical rating scale (NRS; 0–10).Results — For THR, the median satisfaction score was 9–10 and for TKR it was 8.5–10 in all parameters. Older THR patients had higher overall satisfaction. No association was found between overall satisfaction following THR or TKR and sex comorbidity, or LOS. THR patients had shorter mean LOS than TKR patients, even though the median LOS was 2 days for both groups. THR patients were more satisfied than TKR patients in the first weeks after discharge.Interpretation — Patient satisfaction is high following fast-track THR and TKR, with scores ranging from 8.5 to 10 on the NRS. A qualitative investigation of the first weeks after discharge is required to learn more about how to improve the experience of recovery.

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Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery

Cited by 1,466 publications

References 176 publications

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

Perioperative local infiltration anesthesia with ropivacaine has no effect on postoperative pain after total hip arthroplasty

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

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