Usefulness of an enhanced recovery after surgery protocol for perioperative management following open repair of an abdominal aortic aneurysm

Tatsuishi, Wataru; Kohri, Takayuki; Kodera, Kojiro; Asano, Ryuta; Kataoka, Go; Kubota, Sayaka; Nakano, Kiyoharu

doi:10.1007/s00595-012-0252-3

Cited by 34 publications

(31 citation statements)

References 16 publications

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“…18 The time to restart oral consumption and the postoperative LOS were significantly shorter in the ERAS group than in the conventionally managed group, and the in-hospital medical costs for the ERAS group decreased by 8% compared with those for the conventionally managed group.…”

Section: Vascular Surgerymentioning

confidence: 85%

“…In this review, studies investigating the cost as either a primary or secondary outcome have been conducted in Europe, [7][8][9][10][11][12] Asia, [13][14][15][16][17][18] North America, 2,19 USA, 20 and Australasia. 1,21 Six of the 17 studies were systematic reviews.…”

Section: Resultsmentioning

confidence: 99%

“…8,9,13,18,20,21 Thus, no study achieved the minimum score to be considered ''high quality''. Three studies in gynecology scored 11 of a possible 19.…”

Section: Resultsmentioning

confidence: 99%

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Health economics in Enhanced Recovery After Surgery programs

Stowers

Lemanu

Hill

2014

Can J Anesth/J Can Anesth

132

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Purpose The Enhanced Recovery After Surgery (ERAS) program aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. Nevertheless, few studies have evaluated the cost-effectiveness of ERAS programs. The aim of this systematic review, therefore, is to evaluate the claims that ERAS is cost-effective and to characterize how these costs were reported and evaluated. Source The electronic databases, MEDLINE Ò and EMBASE TM , were searched from inception to April 2014. Principal findings Seventeen studies met the inclusion criteria and were included for review. Enhanced Recovery After Surgery protocols in various abdominal surgeries have been investigated, including colorectal, bariatric, gynecological, gastric, pancreatic, esophageal, and vascular surgery. All studies reported cost savings associated with hastening recovery and reducing morbidity and complications. All studies included in this review focused primarily on in-hospital costs, with some attempting to account for readmission costs and follow-up services. In all but two studies, the breakdown of cost data for the individual studies was poorly detailed. Conclusions In conclusion, ERAS protocols appear to be both clinically efficacious and cost effective across a variety of surgical specialties in the short term. Nevertheless, studies reporting out-of-hospital cost data are lacking. Further research is required to determine how best to evaluate both medium-and long-term costs relating to ERAS pathways while taking quality of life data into account. RésuméObjectif Le programme de Récupération rapide après la chirurgie (RRAC) vise à combiner et coordonner des interventions de soins périopératoires basées sur des données probantes qui soutiennent la standardisation et l'optimisation des soins chirurgicaux. En association avec ses avantages cliniques, il a été suggéré que la RRAC réduisait les coûts grâce à une convalescence raccourcie et une moindre morbidité. Néanmoins, peu d'études ont évalué le rapport efficacité-coût des programmes de RRAC. Le but de cette synthèse systématique est donc d'évaluer l'argument de rentabilité de la RRAC et de préciser dans quelle mesure ces coûts ont été rapportés et évalués. Sources Une recherche a été menée dans les bases de données électroniques MEDLINE Ò et EMBASE TM depuis les origines du concept jusqu'en avril 2014. Constatations principales Dix-sept études répondaient aux critères d'inclusion et ont été analysées. Les protocoles de Récupération rapide après la chirurgie concernant différentes interventions chirurgicales abdominales (colorectales, bariatriques, gynécologiques, gastriques, pancréatiques, oesophagiennes et vasculaires) ont été étudiés. Toutes les études rapportaient des économies associées à l'accélération de la récupération et à la réduction de la morbidité et des complications. Tout...

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Section: Vascular Surgerymentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

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Health economics in Enhanced Recovery After Surgery programs

Stowers

Lemanu

Hill

2014

Can J Anesth/J Can Anesth

132

View full text Add to dashboard Cite

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“…In the current environment, ERAS pathways may provide the added benefit of decreasing health care expenditures 1,3 while improving quality of care and patient satisfaction. Benefits of ERAS protocols have been published, predominantly in colorectal surgery, 4e6 but also in vascular, 7 hepatobiliary, 8,9 bariatric, 10 esophageal, 11 orthopedic, 12,13 and gynecologic surgery. 14 To our knowledge, outcomes of implementing ERAS pathways in patients undergoing plastic and reconstructive surgery have not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery in microvascular breast reconstruction

Batdorf

Lemaine

Lovely

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

184

217

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“…Enhanced recovery after surgery (ERAS) perioperative protocols are multimodal and multidisciplinary perioperative care pathways that establish evidence-based best practices throughout the patients' entire care episode including preoperative, intraoperative, and postoperative phase of care. 11,18,25,37,38 The ERAS perioperative protocols, as well as the Fast-track postoperative protocols, combine various anesthesia techniques, minimally invasive techniques, optimal pain and nausea control, and rapid postoperative rehabilitation including enteral hydration, nutrition, and ambulation. 11,18,25 Ultimately, all measures aim to achieve a rapid, uncomplicated recovery with minimal stay in the ICU or, if possible, direct transfer to the floor on the same day of surgery if patients satisfy preestablished criteria.…”

Section: Avenues For Future Improvementmentioning

confidence: 99%

Value-based neurosurgery: the example of microvascular decompression surgery

McLaughlin¹,

Buxey²,

Chaw³

et al. 2014

JNS

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Object Value of care is emerging as a promising framework to restructure health care, emphasizing the importance of reporting multiple outcomes that encompass the entire care episode instead of isolated outcomes specific to care points during a patient's care. The authors assessed the impact of coordinated implementation of processes across the episode of surgical care on value of neurosurgical care, using microvascular decompression (MVD) as an example. Methods This study is a retrospective review of consecutive cases involving patients with either trigeminal neuralgia or hemifacial spasm undergoing first-time MVD. Patients were divided into 2 groups: Group 1 included patients who underwent surgery between February 2008 and November 2009 and Group 2 included those who underwent surgery between January 2011 and October 2012. The authors collected data on outcome measures spanning the entire surgical episode of care according to the Outcome Measures Hierarchy. Results Forty-nine patients were included: 20 patients in Group 1 and 29 patients in Group 2. Thirty-one patients underwent MVD for trigeminal neuralgia and 18 for hemifacial spasm. A zero mortality rate and high degree of symptom resolution were achieved in both groups. Group 2 benefited from a reduction in the average total operating room time, a decrease in the mean and median postoperative length of hospital stay, a decrease in the mean length of stay on the floor, and a reduction in the rates of complications and readmissions. Conclusions Comprehensive implementation of improvement processes throughout the continuum of care resulted in improved global outcome and greater value of delivered care. Enhanced-recovery perioperative protocols and diagnosis-specific clinical pathways are two avenues built around global care delivery that can help achieve an “optimal episode of surgical care” in every case.

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Usefulness of an enhanced recovery after surgery protocol for perioperative management following open repair of an abdominal aortic aneurysm

Abstract: Use of the ERAS protocol for the perioperative management of open AAA surgery shortened the time before recommencing oral consumption, the postoperative hospital stay, and reduced the medical costs compared to the conventional approach.

Cited by 34 publications

References 16 publications

Health economics in Enhanced Recovery After Surgery programs

Health economics in Enhanced Recovery After Surgery programs

Enhanced recovery after surgery in microvascular breast reconstruction

Value-based neurosurgery: the example of microvascular decompression surgery

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