The Development of Enhanced Recovery After Surgery Across Surgical Specialties

Senturk, James; Kristo, Gentian; Gold, Jason S.; Bleday, Ronald; Whang, Edward E.

doi:10.1089/lap.2017.0317

Cited by 64 publications

(47 citation statements)

References 60 publications

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“…There are limited randomized trials investigating ERAS protocols in gynecologic oncology and as these pathways become more widely implemented, the ability to design randomized trials without incorporating aspects of the care bundle in the control cohort is increasingly challenging. Additionally, there is a lack of evidence for individual components of the care bundle which require further investigation 33. In an effort to address the considerable variation in components of ERAS protocols across institutions and studies, a standardized protocol has been proposed and the ERAS Society has published guidelines for the postoperative care of gynecology and gynecologic oncology patients 34 35.…”

Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

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ObjectiveEnhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.MethodsA retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.ResultsOne hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.ConclusionsERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.

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Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

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“…Furthermore, ‘fast‐track’ and enhanced recovery after surgery approaches have been recently developed with the aim to further contain HS. Such approaches focus on the optimization of perioperative nutritional status, fluid balance, opioid‐sparing analgesia, pharmacologic and anti‐inflammatory measures, and early enteral feeding and ambulation . The development and validation of specific biomarkers predicting HS times may offer significant advantages in the early stratification of patients at risk of PHS.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory cell indexes as preoperative predictors of hospital stay in open elective thoracic surgery

Paliogiannis

Ginesu

Tanda

et al. 2018

ANZ Journal of Surgery

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“…A series of studies have focused on ERAS strategies for thoracic surgery in the past few years, indicating that ERAS can e ciently minimize the surgical trauma, reduce postoperative complications, improve quality of life before and after surgery, shorten hospital stay and nally decrease the nancial burden of patient [8][9][10][11]. However the results of ERAS research are still controversial [12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1,749 cases

Wang

Lai

et al. 2020

Preprint

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Background The study aimed to evaluate the outcomes following the implementation of enhanced recovery after surgery (ERAS) for patients undergoing lung cancer surgery.Method A retrospective cohort study involving 1,749 patients with lung cancer undergoing pulmonary resection was conducted. The patients were divided into two time period groups for analysis(routine pathway and ERAS pathway). Logistic regression analysis was performed to assess the risks of developing postoperative pulmonary complications.Results Among the 1,749 patients, 691 were stratified into the ERAS group, and 1,058 in to the routine group. The ERAS group presented with shorter postoperative in-hospital length of stay (LOS) (4.0 vs 6.0, P<0.001), total LOS (10.0 VS. 13.0 days, P<0.001), and lower total in-hospital costs (P<0.001), including material (P<0.001) and drug expenses (P<0.001). Furthermore, the ERAS group also presented with a lower occurrence of postoperative pulmonary complications (PPCs) than the routine group (15.2% vs. 19.5%, P=0.022). Likewise, a significantly lower occurrence of pneumonia (8.4% vs. 14.2%, P<0.001) and atelectasis (5.9% vs. 9.8%, P=0.004) was found in the ERAS group. Regarding the binary logistic regression, the ERAS intervention was the sole independent factor for the occurrence of PPCs (OR: 0.601, 95% CI: 0.434-0.824, P=0.002). In addition, age (OR: 1.032, 95% CI: 1.018-1.046), COPD (OR: 1.792, 95% CI: 1.196-2.686), and FEV1(OR: 0.205, 95% CI: 0.125-0.339) were also independent predictors of PPCs. Conclusion Implementation of an ERAS pathway shows improved postoperative outcomes, including shortened LOS, lower in-hospital costs, and reduced occurrence of PPCs, providing benefits to the postoperative recovery of patients with lung cancer undergoing surgical treatment.

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The Development of Enhanced Recovery After Surgery Across Surgical Specialties

Cited by 64 publications

References 60 publications

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Inflammatory cell indexes as preoperative predictors of hospital stay in open elective thoracic surgery

Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1,749 cases

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