Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center

Patel, Sephalie Y.; Getting, Rosemarie E. Garcia; Alford, Brandon; Hussein, Karim; Schaible, Braydon; Boulware, David; Lee, Jae K.; Gilbert, Scott M.; Pow‐Sang, Julio M.; Sexton, Wade J.; Spiess, Philippe E.; Poch, Michael

doi:10.1007/s00268-018-4665-z

Cited by 16 publications

(12 citation statements)

References 24 publications

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“…The positive effect of a multidisciplinary concept in comparison to an exclusively surgical concept was shown by Patel et al [24]. They were able to show that especially by adding optimized fluid management and epidural anesthesia, transfusion rate and nausea could be reduced.…”

Section: Discussionmentioning

confidence: 93%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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Purpose Different enhanced recovery after surgery (ERAS) protocols (EP) for radical cystectomy (RC) have been published. Protocols highly differ in number of included items and specific measures. Materials and methods A systematic review and meta-analysis on EPs in RC were performed using the databases MedLine, Cochrane Library, Web of science, and Google Scholar. The specific ERAS measures of the protocols were extracted, analyzed, and compared. Pooling of available outcome data was performed for length of stay, complications, readmission rate, and time to defecation. Results The search yielded a total of 860 studies of which 25 studies were included in qualitative and 22 in quantitative analysis. Oral bowel preparation (BP) was omitted in 24/25 (96%) EPs, optimized fluid management was administered in 22/25 (88%) EPs and early mobilization (postoperative day 1) in 21/25 (84%). Gum chewing (n = 12, 46%), metoclopramide (n = 11, 44%), and alvimopan (n = 6, 24%) were the most common measures to prevent postoperative ileus. Our meta-analysis revealed a significant benefit in favor of EPs for the outcome parameters length of stay [mean difference (MD) − 3.46 d, 95% confidence interval (CI) − 4.94 to − 1.98, p < 0.01], complications [Odds ratio (OR) = 0.76, 95% CI 0.61-0.94, p = 0.01] and time to defecation (MD − 1.37 d, 95% CI − 2.06 to − 0.69, p < 0.01). Readmission rate did not show a significant difference (OR = 0.73, 95% CI 0.52-1.03, p = 0.07). Conclusion Current EPs focus on omitting oral BP, early mobilization, and optimized fluid management while they differ in methods preventing postoperative ileus. Our meta-analysis revealed a benefit in introducing these protocols into clinical practice.

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Section: Discussionmentioning

confidence: 93%

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

et al. 2020

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“…Development of standardized pain management and ERAS protocols may help optimize patient-reported outcomes and reduce health care costs [1,23]. The majority of reported ERAS programs for pain management dependent multidisciplinary cooperation, which include the efforts of neurosurgeons, anesthetists, residents, operating room nurses, neurophysiologist, dieticians and the support from family members of the patient [1,[24][25][26]. However, these studies vary widely in their methodology and targeted patient populations.…”

Section: Discussionmentioning

confidence: 99%

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

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“…In a recent study, authors investigated the effect of including anesthesia ERAS components to an existing surgical ERAS program for RC. They found a decrease in intraoperative transfusions and PONV . Implementing non‐opioid pain medications with regional anesthesia can decrease LOS, time to regular diet and decrease narcotic use .…”

Section: Intraoperative Componentsmentioning

confidence: 98%

“…They found a decrease in intraoperative transfusions and PONV. 22 Implementing non-opioid pain medications with regional anesthesia can decrease LOS, time to regular diet and decrease narcotic use. 23…”

Section: Anesthetic Protocolsmentioning

confidence: 99%

Enhanced recovery after surgery review and urology applications in 2020

Pessôa¹,

Ürkmez

Kukreja

et al. 2020

BJUI Compass

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Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.

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Improved Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol for Radical Cystectomy with Addition of a Multidisciplinary Care Process in a US Comprehensive Cancer Care Center

Abstract: This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.

Cited by 16 publications

References 24 publications

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Enhanced recovery after surgery review and urology applications in 2020

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