scholarly journals Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

2016 ◽  
Vol 2016 ◽  
pp. 1-9
Author(s):  
Timothy L. Fitzgerald ◽  
Catalina Mosquera ◽  
Nicholas J. Koutlas ◽  
Nasreen A. Vohra ◽  
Kimberly V. Edwards ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
High Volume ◽  
Surgical Oncology ◽  
Readmission Rates ◽  
Before And After ◽  
The Difference ◽  
Oncology Unit ◽  
Eras Protocol ◽  
The Cost ◽  
Surgical Unit

Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations. Interdisciplinary educational seminars were conducted for all health professionals. However, one test surgeon adopted the protocol. 394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included. The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant. For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS. An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality.

A Single Surgeons Experience with Enhanced Recovery after Surgery: An Army of One

2016 ◽  
Vol 82 (7) ◽  
pp. 594-601 ◽  
Author(s):  
Catalina Mosquera ◽  
Nicholas J. Koutlas ◽  
Timothy L. Fitzgerald
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Univariate Analysis ◽  
Intestinal Resection ◽  
High Volume ◽  
Before And After ◽  
Individual Surgeon ◽  
The Mean ◽  
Eras Protocol ◽  
Surgical Oncologist

The benefits of enhanced recovery after surgery (ERAS) have been demonstrated for multiple surgical procedures in high-volume programs. However, resources required for its implementation may be daunting to individual surgeons. Patients undergoing elective abdominal procedures from June 2013 to April 2015 by a surgical oncologist before and after the implementation of an ERAS protocol were reviewed. A total of 179 patients were included. The mean age of the patients was 63 years, and a majority of them were females (53.6%), white (61.5%), had a Charlson score of 0 to 2 (45.8%), and a Clavien complication grade of 0 to I (60.1%). The univariate analysis revealed that the ERAS protocol was associated with shorter length of stay (LOS) (6.2 vs 9.6 days), lower cost ($21,674 vs $30,380), and lower mortality (0 vs 3.3%); P < 0.05. Differences were noted in LOS and costs for all procedures, the differences were the greatest for hepatic resection (3.8 vs 8.4 days and $16,770 vs $28,589), intestinal resection/stoma closure (4.8 vs 7.6 days and $18,391 vs $22,239), and other abdominal procedures (5.0 vs 10.8 and $17,713 vs $30,900); P < 0.05. The differences were less for patients undergoing procedures for which postoperative pathways were already in place such as pancreatic (9 vs 10.8 days and $30,524 vs $34,291) and colorectal (5.3 vs 6.5 days and $20,733 vs $25,150) surgeries. P > 0.05. An ERAS program can be instituted by an individual surgeon with the benefits of decreased LOS, cost, and mortality.

scholarly journals Evaluation of an enhanced recovery protocol on patients having radical cystectomy for bladder cancer

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Bonnie Liu ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Effective Means ◽  
Control Group ◽  
Complication Rates ◽  
Readmission Rates ◽  
Significant Difference ◽  
And Gender ◽  
Eras Protocol

Introduction: Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care protocols that are designed to shorten recovery time and reduce complication rates.1,2 An ERAS protocol was implemented in the Saskatoon Health region for radical cystectomy patients in 2013. This study evaluates the safety and efficacy of the protocol for patients having radical cystectomy for bladder cancer. Methods: Length of stay (LOS), early in-hospital complication rates, 30-day readmission rates, age, and gender were collected for patients seen for bladder cancer requiring radical cystectomy in Saskatoon between January 2007 and December 2016. Of these patients, 176 were pre-ERAS implementation (control group) and 84 were post-ERAS implementation (experimental group). The data from each variable was compared between the groups using a Z-test. Results: There was no significant difference in age or gender of patients between the groups. Average LOS pre-ERAS was 14.25±14.57 days, which is significantly longer than the post-ERAS average of 10.91±8.56 days (p=0.043). There was no significant difference in 30-day readmission rate (19.87% pre-ERAS vs. 19.05% post-ERAS; p=0.873) or complication rate (51.7% pre-ERAS vs. 46.4% post-ERAS; p=0.425). Conclusions: The implementation of an ERAS protocol for radical cystectomy reduces LOS, with no effect on early complication rates or 30-day readmission rates. This indicates that the protocol is safe for patients when compared to previous practices and is an effective means of reducing LOS.

scholarly journals A WeChat-Based Mobile Platform for Perioperative Health Education for Gastrointestinal Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ying Li ◽  
Xiao-hui Cheng ◽  
Wen-ting Xu ◽  
Li-ping Tan ◽  
Xiao-jun Gou
Keyword(s):  
Health Education ◽  
Enhanced Recovery ◽  
Gastrointestinal Surgery ◽  
Perioperative Period ◽  
Mobile Platform ◽  
Successful Recovery ◽  
Before And After ◽  
Patient Health ◽  
Access Information ◽  
Eras Protocol

Appropriately instructing and guiding patients before and after surgery is essential for their successful recovery. In recent years, however, the development of the enhanced recovery after surgery (ERAS) protocol has restricted the opportunity for healthcare professionals to spend time with their patients before and after surgery because of efficiency-driven, shortened hospital stay. Here, we embedded health education information of the perioperative period for gastrointestinal surgery on a WeChat-based mobile platform and evaluated the platform through medical staff evaluation, patient volunteer evaluation, and quantitative grading rubric. Clinicians and nurses believed that the mobile platform was attractively designed and easy to navigate, valuable, and adequate for patient health education. The content of health education was embedded into the WeChat-based mobile platform, thereby allowing patients and caregivers to access information at their own pace and enable repeat reading.

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

2018 ◽  
Vol 28 (3) ◽  
pp. 581-585 ◽  
Author(s):  
Alberto A. Mendivil ◽  
Justin R. Busch ◽  
David C. Richards ◽  
Heather Vittori ◽  
Bram H. Goldstein
Keyword(s):  
Enhanced Recovery ◽  
Gynecologic Oncology ◽  
Hospital Costs ◽  
Hospital Setting ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Readmission Rates ◽  
Historical Cohort ◽  
Eras Protocol ◽  
The Impact

ObjectivesThe purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion.MethodsWe retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates.ResultsThere were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282).ConclusionsThe results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

Effect of Enhanced Recovery After Surgery Protocol Implementation on Cost and Outcomes by Type of Colectomy Performed

2020 ◽  
Vol 86 (9) ◽  
pp. 1078-1082
Author(s):  
Miles Landry ◽  
Rachel Lewis ◽  
Andrew Antill ◽  
R. Eric Heidel ◽  
Jessica Taylor ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cost Of Care ◽  
Longitudinal Impact ◽  
Anatomic Site ◽  
Elective Colorectal Surgery ◽  
Before And After ◽  
Eras Protocol ◽  
The Impact ◽  
Over Time

Background Enhanced recovery after surgery (ERAS) protocols are widely utilized for elective colorectal surgery to improve outcomes and decrease costs, but few studies have evaluated the impact of ERAS protocols on cost with respect to anatomic site of resection. This study evaluated the impact of ERAS protocol on elective colon resections by site and longitudinal impact over time. Methods A single-center retrospective cohort study of 598 consecutive patients undergoing elective colorectal resection before and after implementation of ERAS protocol from 2013 to 2017 was performed. The primary outcomes were length of stay (LOS) and cost. Comparative and multivariate inferential statistics were used to assess additional outcomes. Results A total of 598 patients (100 pre-ERAS vs 498 post-ERAS) were evaluated with an overall median LOS of 4 days for right and left colectomies and 3 days for transverse colectomies. When comparing type of resection before and after ERAS protocol introduction, an increased LOS for left hemicolectomies from 3.09 to 4.03 days ( P = .047) was noted, with all other comparisons failing to reach statistical significance. Over time, an initial decrease in LOS for MIS approach after protocol introduction was observed; however, this effect diminished in the ensuing years and had no significant effect overall. Total cost of care was significantly increased post-ERAS for all cohorts except transverse colectomies. No further statistically significant differences were found. Conclusion After an initial improvement in outcomes, continued utilization of ERAS protocols demonstrated no improvement in LOS compared to pre-ERAS data and increased cost overall for patients regardless of site of resection.

scholarly journals Enhanced Recovery After Surgery (ERAS) Protocol for Gastrectomy: A Tailored Program Developed at a Gastric Cancer Unit

2020 ◽  
Vol 2 (1) ◽  
pp. 12-17
Author(s):  
Jacopo Desiderio ◽  
Stefano Trastulli ◽  
Antonio Di Cintio ◽  
Rita Commissari ◽  
Andrea Colasanti ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Care Management ◽  
Enhanced Recovery ◽  
Patient Adherence ◽  
Enhanced Recovery After Surgery ◽  
Surgical Oncology ◽  
Evidence Based ◽  
Care Environment ◽  
Comprehensive Management ◽  
Eras Protocol

Background Planning for and managing patients who follow multidisciplinary paths allow institutions to provide better care administration; greater collaboration among medical staff, patients, and their relatives; better patients education; reduced possible complications related to surgery and hospital stay; and increased patient adherence to the proposed treatments due to better information. The ERAS Society’s guidelines align in this direction, and many institutions are now looking to apply the suggestions contained in its items. This effort is especially important in surgical oncology. In this work, we report the experience of our center in developing tailored guidelines for patients undergoing gastrectomy based on evidence from the literature and adapted to address the availability of personnel and equipment in our institute. Methods A permanent institutional working group was established at St. Mary’s Hospital. Evidence‐based comprehensive research was conducted to find optimal perioperative care management for patients undergoing gastrectomy. Evidence and recommendations were thoroughly evaluated and considered together with the items from the ERAS Society’s guidelines. Results A complete patient pathway has been established from the first outpatient visit to discharge. All ERAS items were considered and adapted to our hospital’s care environment. Education, nutrition, anesthesiologist care, surgical approach, and ward organization are the main points of strength highlighted in the present work. Conclusion This proposed institutional evidence‐based protocol show comprehensive management for patients with gastric cancer eligible for enhanced surgical pathways.

Impact of standardized clinical pathways on esophagectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Francesco Puccetti ◽  
Bas P L Wijnhoven ◽  
MadhanKumar Kuppusamy ◽  
Michal Hubka ◽  
Donald E Low
Keyword(s):  
Enhanced Recovery ◽  
Clinical Pathways ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Quality Criteria ◽  
High Volume ◽  
Pulmonary Complications ◽  
Readmission Rates ◽  
Variable Approach ◽  
Cochrane Database

Summary Esophageal surgery is historically associated with adverse postoperative outcomes. Selected high-volume centers have previously reported the effect on clinical outcomes following the adoption of a standardized clinical pathway (SCP). This meta-analysis aims to evaluate the current literature to document the effect of SCP and enhanced recovery after surgery (ERAS) on esophagectomy outcomes. A literature search was conducted through the main search engines (PubMed, Embase, Medline, and Cochrane database) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All eligible comparative studies (randomized control trial, prospective, retrospective, and combined) were identified and assessed based on Methodological Index for Non-Randomized Studies and Jadad quality criteria. Data concerning overall morbidity, early mortality, and length of stay (LOS) were primarily collected and compared. Secondary outcomes included anastomotic leaks, pulmonary complications, and readmission rate. Twenty-six articles (including five randomized controlled trials and six prospective trials) were included in the analysis. Overall study quality was moderate and the included studies utilized a variable approach to SCP. No statistically significant differences were found between groups in terms of overall morbidity, postoperative mortality, anastomotic leak, and readmission rates. Significant improvements included pulmonary complications (odds ratios [OR] 0.66, 95% confidence interval [CI] 0.49–0.94) and hospital LOS (OR −3.68, 95% CI −4.49 to −2.87). Previous reports of SCP within esophagectomy programs have demonstrated clinical improvements in postoperative pulmonary complications and LOS. Given the high heterogeneity historically demonstrated within SCPs, further improvement in outcomes should be expected following the adoption of standardized ERAS guidelines.

Enhanced recovery after surgery protocols as a management strategy following major pancreatic surgery.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 396-396
Author(s):  
Lavanniya Kumar Palani Velu ◽  
Vishnuvardhan Chandrabalan ◽  
Ross Carter ◽  
Colin McKay ◽  
Nigel B Jamieson ◽  
...  
Keyword(s):  
Management Strategy ◽  
Pancreatic Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Wound Complications ◽  
Readmission Rates ◽  
Operative Morbidity ◽  
Positive Effects ◽  
Drain Removal ◽  
Eras Protocol

396 Background: Enhanced Recovery After Surgery (ERAS) protocols have been shown to have positive effects on lengths of stay (LOHS) and resource utilisation without a rise in readmission and post-operative morbidity rates in colorectal, hepatic and oesophago-gastric surgery. This study aimed to investigate the effects of an ERAS protocol on postoperative morbidity and readmission rates following pancreatic surgery in a tertiary referral centre. Methods: The perioperative care of patients undergoing pancreatic surgery was guided by a locally developed ERAS protocol incorporating pre-operative counselling and carbohydrate loading. Intra-thecal opiate and Patient Controlled Analgesia devices were utilised for postoperative analgesia. Supplemental intravenous fluid prescription was protocolised. Oral intake was restarted from post-operative day (PoD) 1 and escalated on an on-demand basis. Patients were mobilised from PoD 1 and escalated daily. Drain removal and step down care decisions were guided by serum markers and clinical progress. Results: 212 consecutive patients from 2010 to 2014 were included (conventional, N = 108, ERAS protocol, N = 104). 134 (63.2%) patients underwent pancreaticoduodenectomy, 41 (19.3%) patients underwent distal pancreatectomy, 11 (5.2%) patients underwent total pancreatectomy and the rest underwent palliative bypass or other procedures. There was a statistically significant reduction in the volume of supplemental intravenous fluids received with no significant renal impairment noted. Median LOHS was reduced to 10 days (Inter-quartile range [IQR] 7 – 19) from 16 days (IQR 12 – 26) (P < 0.001). Median critical care stay was reduced from 7 days (IQR 5 – 10) to 6 (IQR 4 -7) (P = 0.020). There was a statistically significant reduction in clinically significant wound complications (P = 0.019). There were no statistically significant increases in readmission rates, pancreas-specific or other generic post-operative morbidity rates. Conclusions: ERAS protocols are a viable peri-operative management strategy after major pancreatic surgery, and data suggests that LOHS can be reduced without an associated increase in readmission or post-operative morbidity rates.

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