Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

Oodit, Ravi; Biccard, Bruce; Panieri, Eugenio; Alvarez, Adrián; Sioson, Marianna R. S.; Maswime, Salome; Thomas, Viju; Kluyts, Hyla-Louise; Peden, Carol J.; Boer, H. de; Brindle, Mary; Francis, Nader; Nelson, Gregg; Gustafsson, Ulf; Ljungqvist, Olle

doi:10.1007/s00268-022-06587-w

Cited by 30 publications

(14 citation statements)

References 166 publications

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“…The potential impact of both the SSC and ERAS may be greatest in lower-resource settings, where uptake of both is typically lower . The recent publication of the first ERAS guideline for use in primary and secondary hospitals in low- and middle-income countries suggests a potential opportunity to introduce an ERAS SSC in such settings …”

Section: Discussionmentioning

confidence: 99%

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

et al. 2023

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ImportanceEnhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively.ObjectiveTo integrate the 2 tools to facilitate key perioperative decision-making.Evidence ReviewSnowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022.FindingsRound 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs.Conclusions and RelevanceThe SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.

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Section: Discussionmentioning

confidence: 99%

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

et al. 2023

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“…Open access the use of dexmedetomidine for patients undergoing general anaesthesia are inconsistent. [6][7][8][9][10] For instance, the Enhanced Recovery After Surgery recommendations support the use of dexmedetomidine for several types of surgery. [6][7][8][9][10] In contrast, the Australian and New Zealand Society of Anesthetists do not recommend its use during surgery because of potential harms, namely haemodynamic instability and oversedation.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol

Verret,

Le,

Lalu

et al. 2024

BMJ Open

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IntroductionDexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain.Methods and analysisWe will conduct a systematic review and meta-analysis following the recommendations of theCochrane Handbook for Systematic Reviews. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL approximately in October 2023. We will include randomised controlled trials evaluating the impact of systemic intraoperative dexmedetomidine on patient-centred outcomes. Patient-centred outcome definition will be based on the consensus definition established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC). Our primary outcome will be the quality of recovery after surgery. Our secondary outcomes will be patient well-being, function, health-related quality of life, life impact, multidimensional assessment of postoperative acute pain, chronic pain, persistent postoperative opioid use, opioid-related adverse events, hospital length of stay and adverse events. Two reviewers will independently screen and identify trials and extract data. We will evaluate the risk of bias of trials using the Cochrane Risk of Bias Tool (RoB 2.0). We will synthesise data using a random effects Bayesian model framework, estimating the probability of achieving a benefit and its clinical significance. We will assess statistical heterogeneity with the tau-squared and explore sources of heterogeneity with meta-regression. We have involved patient partners, clinicians, methodologists, and key partner organisations in the development of this protocol, and we plan to continue this collaboration throughout all phases of this systematic review.Ethics and disseminationOur systematic review does not require research ethics approval. It will help inform current clinical practice guidelines and guide development of future randomised controlled trials. The results will be disseminated in open-access peer-reviewed journals, presented at conferences and shared among collaborators and networks.PROSPERO registration numberCRD42023439896.

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“…Routine chest X-rays should be done only in patients above 55 years of age. The Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries propose that in addition to clinical cardiorespiratory assessment, patients should be screened for smoking, alcohol usage, hypertension, diabetes and anemia, and have a nutritional assessment, preoperative HIV testing in countries with high HIV/AIDS prevalence and delirium screening 42 . This review is not free of limitations.…”

Section: Environmental Labor Factorsmentioning

confidence: 99%

Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?

Ruiz

Olmedo²,

González³

et al. 2023

MRAJ

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In 2002, the American Heart Association guidelines established that routinary preoperative studies in low-risk patients (ASA I and II) are unnecessary. This fact has been supported by many other publications after that. However, the medical adherence to these recommendations in clinical practice is low. The aim of this review is to identify the reasons associated with a poor guideline’s adherence. Articles published between 2002 and 2022 reporting data on “preoperative test”, “routine preoperative test”, and “low-risk surgery” were identified through a computerized literature research using Pubmed, Scopus, Medigraphic and Cochrane databases and by selecting all of the articles related to adherence to clinical guidelines. The full text of relevant articles was reviewed by all authors. This review found that some of the causes of the limited adherence to clinical guidelines are: lack of awareness regarding current recommendations or lack of familiarity with them; physician attitudes about the guidelines (including outcome expectancy, lack of agreement, poor motivation to modify previous practice, question efficacy); and environmental labor factors of medical institutions, including lack of communication among the consultants involved in the perioperative care, and medicolegal concerns and fear of litigation. Hence, in order to propose effective alternatives to improve guidelines adherence, this review discuss some of the main reasons why in clinical practice there is still a poor compliance to surgical preoperative guidelines, even when more than 20 years have passed since the concept of routinary preoperative studies in low risk patients was eliminated by a myriad of clinical guidelines and medical associations.

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Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low–Middle‐Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

Cited by 30 publications

References 166 publications

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process

Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol

Routine Preoperative Tests in Low-Risk Surgery. What About Adherence to Clinical Guidelines?

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