Newly implemented enhanced recovery pathway positively impacts hospital length of stay

Martin, Thomas; Lorenz, Talya; Ferraro, Jane; Chagin, Kevin; Lampman, Richard M.; Emery, Karen; Zurkan, Joan E.; Boyd, Jami L.; Montgomery, Karin; Lang, Rachel E.; Vandewarker, James F.; Cleary, Robert K.

doi:10.1007/s00464-015-4714-8

Cited by 53 publications

(30 citation statements)

References 63 publications

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“…The two groups are well‐balanced with no difference in age, sex, or morbidities … Our development of a multidisciplinary, evidence‐based ERAS program at a major tertiary medical centre performing abdominal colorectal surgery was associated with shortened LOS in the univariate analysis. However, despite the preoperative optimization of the patients, according to several articles, our findings did not show a reduction of 30‐days readmission rates, nor the rate of reinterventions or Clavien Dindo complications (Table ).…”

Section: Discussioncontrasting

confidence: 63%

C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

Olivares

Martínez

Torralba

et al. 2018

Journal of Surgical Oncology

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Section: Discussioncontrasting

confidence: 63%

C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

Olivares

Martínez

Torralba

et al. 2018

Journal of Surgical Oncology

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“…The programme did not reduce the rate of reinventions nor Clavien–Dindo complications. The results are consistent with findings from other medical centres . LOS and readmissions have often been used as a benchmark of the success of a surgical protocol.…”

Section: Discussionsupporting

confidence: 90%

C‐reactive protein as a marker of the systemic inflammatory response to surgery reduction within an enhanced recovery after surgery protocol in elective colorectal surgery of the elderly: A prospective cohort study

et al. 2018

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Aim The main aim of the present study was to evaluate the systemic inflammatory response (SIR) to surgery using C‐reactive protein (CRP) in patients <70 and ≥70 years of age, operated on by elective colorectal surgery with an enhanced recovery after surgery (ERAS) protocol, and to compare them with a historical cohort with standard care (pre‐ERAS group). The secondary objectives were to analyse the length of stay (LOS) in hospital, 30‐day readmission rates and complications in both age groups. Patients and Methods There was a total of 133 patients <70 years (69 in the pre‐ERAS group and 64 in the ERAS group) and 123 patients ≥70 years (66 in the pre‐ERAS group and 57 in the ERAS group). We compared the CRP values on postoperative days (POD) 1, 2 and 3 between the pre‐ERAS/ERAS group, laparoscopic/open surgery and the presence/absence of Clavien–Dindo complications. Multivariable linear regression was used to assess whether ERAS had a decreasing effect on the SIR on POD 1, 2 and 3. Results The groups were well balanced. The ERAS protocol decreased the SIR to surgery in patients ≥70 years. This could explain our good results, where there was a decrease in LOS in hospital in that group without an increase in 30‐day readmission rates or perioperative complications. ERAS protocol did not decrease the SIR at any point in the evolution of patients <70 years. The application of an ERAS protocol in patients≥70 years, laparoscopic surgery and not having complications reduced the SIR. Conclusion ERAS could be implemented without reservations in elderly patients undergoing elective colorectal surgeries and decreases the SIR to surgery and LOS in hospital more for younger patients than elderly patients.

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“…It has evolved over the years into a multidisciplinary team approach involving surgeons, anaesthesiologists, critical care physicians, physiotherapists, nutritionists and nurses in the perioperative care of the patient and integrating evidencebased protocols into clinical practice. This multimodal approach has been shown to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery [5]. Subsequently, the ERAS society was established in 2010 and guidelines have been published for colorectal, bariatric surgery, gastrectomy, liver surgery and gynaecologic oncology.…”

Section: Introductionmentioning

confidence: 99%

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

et al. 2020

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Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra-and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

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Newly implemented enhanced recovery pathway positively impacts hospital length of stay

Cited by 53 publications

References 63 publications

C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

C‐reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study

C‐reactive protein as a marker of the systemic inflammatory response to surgery reduction within an enhanced recovery after surgery protocol in elective colorectal surgery of the elderly: A prospective cohort study

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

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