scholarly journals Prevalence and Consequences of Preoperative Weight Loss in Gynecologic Surgery

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 1094 ◽  
Author(s):  
Basile Pache ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Amaniel Kefleyesus ◽  
Patrice Mathevet ◽  
...  
Keyword(s):  
Weight Loss ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Preoperative Weight Loss ◽  
Nutritional Screening ◽  
Preoperative Weight ◽  
Eras Protocol ◽  
Extensive Surgery

Preoperative malnutrition and weight loss negatively impact postoperative outcomes in various surgical fields. However, for gynecologic surgery, evidence is still scarce, especially if surgery is performed within enhanced recovery after surgery (ERAS) pathways. This study aimed to assess the prevalence and impact of preoperative weight loss in patients undergoing major gynecologic procedures within a standardized ERAS pathway between October 2013 and January 2017. Out of 339 consecutive patients, 33 (10%) presented significant unintentional preoperative weight loss of more than 5% during the 6 months preceding surgery. These patients were less compliant to the ERAS protocol (>70% of all items: 70% vs. 94%, p < 0.001) presented more postoperative overall complications (15/33 (45%) vs. 69/306 (22.5%), p = 0.009), and had an increased length of hospital stay (5 ± 4 days vs. 3 ± 2 days, p = 0.011). While patients experiencing weight loss underwent more extensive surgical procedures, after multivariate analysis, weight loss ≥5% was retained as an independent risk factor for postoperative complications (OR 2.44; 95% CI 1.00–5.95), and after considering several surrogates for extensive surgery including significant blood loss (OR 2.23; 95% CI 1.15–4.31) as confounders. The results of this study suggest that systematic nutritional screening in ERAS pathways should be implemented.

scholarly journals Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol

2019 ◽  
Vol 29 (4) ◽  
pp. 1134-1141 ◽  
Author(s):  
Tomasz Stefura ◽  
Jakub Droś ◽  
Artur Kacprzyk ◽  
Mateusz Wierdak ◽  
Monika Proczko-Stepaniak ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Weight Loss ◽  
Preoperative Weight

scholarly journals Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Amr Nady Abdelrazik ◽  
Ahmad Sameer Sanad
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Control Groups ◽  
Analog Scale ◽  
Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

2019 ◽  
Vol 29 (4) ◽  
pp. 810-815 ◽  
Author(s):  
Basile Pache ◽  
Jonas Jurt ◽  
Fabian Grass ◽  
Martin Hübner ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Length Of Hospital Stay ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Prolonged Length ◽  
Academic Center ◽  
The Impact

IntroductionEnhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.MethodsRetrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.ResultsA total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).ConclusionsCompliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

scholarly journals Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

2019 ◽  
Vol 29 (8) ◽  
pp. 1235-1243 ◽  
Author(s):  
Ester Miralpeix ◽  
Gemma Mancebo ◽  
Sonia Gayete ◽  
Marta Corcoy ◽  
Josep-Maria Solé-Sedeño
Keyword(s):  
Functional Capacity ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Oncology ◽  
Psychological Support ◽  
Gynecologic Surgery ◽  
Nutritional Counseling ◽  
Oncology Patients ◽  
Operative Recovery ◽  
Eras Protocol

Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

The contribution of specific enhanced recovery after surgery (ERAS) protocol elements to reduced length of hospital stay after ventral hernia repair

2019 ◽  
Vol 34 (10) ◽  
pp. 4638-4644 ◽  
Author(s):  
Walker Ueland ◽  
Seth Walsh-Blackmore ◽  
Michael Nisiewicz ◽  
Daniel L. Davenport ◽  
Margaret A. Plymale ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hospital Stay ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Eras Protocol

scholarly journals Enhanced Recovery After Surgery can Improve Patient Outcomes and Reduce Hospital Cost of Gastrectomy for Cancer in the West: A Propensity-Score-Based Analysis

2021 ◽  
Author(s):  
Jacopo Weindelmayer ◽  
Valentina Mengardo ◽  
Angela Gasparini ◽  
Michele Sacco ◽  
Lorena Torroni ◽  
...  
Keyword(s):  
Propensity Score ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Neoadjuvant Treatment ◽  
Multivariable Analysis ◽  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
The West ◽  
Median Reduction ◽  
Eras Protocol

Abstract Background Data on ERAS for gastrectomy are scarce, and the majority of the studies come from Eastern countries. Patients in the West are older and suffer from more advanced tumors that impair their clinical condition and often require neoadjuvant treatment. This retrospective study assessed the feasibility and safety of an Enhanced Recovery After Surgery (ERAS) protocol for gastrectomy in a Western center. Methods We conducted a single-center study of 351 patients operated for gastric cancer: 103, operated from January 2015 to December 2016, followed the standard pathway, while 248, operated from January 2017 to December 2019, followed the ERAS program. The primary outcomes considered were length of hospital stay (LOS) and direct costs. Secondary outcomes were 90-day morbidity and mortality, readmission rate, and compliance with ERAS items. A propensity score (PS) was built on confounding variables. Results Compliance with ERAS items after the program was ≥ 70%. Univariable analysis evidenced a 2-day median reduction in LOS and a median cost reduction of €826 per patient in the ERAS group. PS-based multivariable analysis confirmed a significant, 2-day decrease in median LOS and a €1097 saving after ERAS introduction. Ninety-day mortality decreased slightly in ERAS group, while complications and readmissions did not change significantly. When complications were included in the multivariable analysis, ERAS retained its significance, although the effects on LOS and cost were blunted to a median reduction of 1 day and €775, respectively. Conclusions ERAS for gastrectomy improved patients’ recovery and reduced hospital costs without changes in morbidity, mortality, or readmission.

Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery

2019 ◽  
Vol 29 (9) ◽  
pp. 1417-1424 ◽  
Author(s):  
Maria D Iniesta ◽  
Javier Lasala ◽  
Gabriel Mena ◽  
Andrea Rodriguez-Restrepo ◽  
Gloria Salvo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Surgery ◽  
Complication Rates ◽  
Operative Outcomes ◽  
Tertiary Center ◽  
Operative Complications ◽  
Eras Protocol ◽  
Post Operative Complications

ObjectiveThe aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and re-operations) in gynecologic surgery at a tertiary center.MethodsWe included 584 patients who had open gynecologic surgery between November 1, 2014 and December 31, 2016. Patients were categorized into subgroups according to their date of surgery from the time of the ERAS protocol implementation. Patients were categorized by their per cent compliance into two groups:<80% versus ≥80%. We analyzed compliance with the elements of the protocol over time and its relation with post-operative outcomes, length of stay, post-operative complications, readmission, and re-operations rates. We modeled the probability of having a post-operative complication within 30 days of surgery as a function of overall compliance.ResultsOverall compliance was 72.3%. Patients with compliance ≥80% had significantly less complications (P<0.001) and shorter length of stay (P<0.001). Readmission and re-operation rates were not impacted by compliance (P=0.182, P=0.078, respectively). Avoidance of salt water overload, early mobilization, early oral nutrition, and early removal of Foley catheter were significantly associated with less post-operative complications within 30 days.ConclusionsCompliance with an ERAS pathway exceeding 80% was associated with lower complication rates and shorter length of stay without impacting on re-operations or readmissions.

scholarly journals P.233 Implementation of an Enhanced Recovery After Surgery (ERAS) Protocol for Scheduled Spine Surgery

2021 ◽  
Vol 48 (s3) ◽  
pp. S87-S88
Author(s):  
J Smith-Forrester ◽  
R Greene ◽  
S Christie
Keyword(s):  
Spine Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Current System ◽  
Length Of Hospital Stay ◽  
Care Program ◽  
Cost Of Care ◽  
Operative Care ◽  
Eras Protocol ◽  
Future Work

Background: Enhanced Recovery After Surgery (ERAS) Protocols improve post-surgical outcomes through decreased length of hospital stay, reduced readmission rates, decreased post-operative pain, and greater patient satisfaction. ERAS also has significant benefits to the healthcare system through reduced cost of post-operative care. While ERAS protocols are well established in many surgical fields, a complete guideline for spine surgery is lacking. Early ERAS studies in spine surgery suggest up to a 50% reduction in length of stay (LOS) and decreased cost of care. Methods: Primary literature review followed by multidisciplinary critical appraisal for optimization and redesign of our current system of care for scheduled spine surgery (SSS), including patient experience and team logistics from initial consultation through post-operative care and follow up. Results: An evidence-based guideline, optimizing pre-, intra-, and post-operative phases of care was developed. Specific focus catered to pre-operative education and patient barriers to discharge. Further improvements in pre-admission patient goal setting, introduction of a patient care “passport”, post-operative reduction in narcotic administration, and increased same day post-operative mobilization were means to reduce LOS. Conclusions: A spine ERAS pathway was developed, allowing our care program to better facilitate patient recovery after SSS. Future work will aim to determine economic impact of the pathway.

scholarly journals Is It Possible to Maintain High Compliance with the Enhanced Recovery after Surgery (ERAS) Protocol?—A Cohort Study of 400 Consecutive Colorectal Cancer Patients

2018 ◽  
Vol 7 (11) ◽  
pp. 412 ◽  
Author(s):  
Magdalena Pisarska ◽  
Natalia Gajewska ◽  
Piotr Małczak ◽  
Michał Wysocki ◽  
Piotr Major ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Short Term ◽  
Entire Study ◽  
High Compliance ◽  
Eras Protocol ◽  
Mean Compliance

The aim of our study was to evaluate the implementation and degree of adherence to the Enhanced Recovery after Surgery (ERAS) protocol in a group of 400 patients operated laparoscopically for colorectal cancer, and to assess its impact on the short-term results. The prospective study included patients with histologically confirmed colorectal cancer undergoing elective laparoscopic resection from years 2012 to 2017. For the purpose of further analysis, patients were divided into four groups: 100 consecutive patients were in each group. There were no statistically significant differences between groups in demographic parameters. The mean compliance with the ERAS protocol in the entire study group was 84.8%. Median adherence differed between the groups 76.9% vs. 92.3% vs. 84.6% vs. 84.6%, respectively (p < 0.0001). There were statistically significant differences between groups in the tolerance of oral diet (54% vs. 83% vs. 83% vs. 64%) and mobilization (74% vs. 92% vs. 91% vs. 94%) on the first postoperative day. In subsequent groups, time to first flatus decreased (2.5 vs. 2.1 vs. 2.0 vs. 1.7 days, p = 0.0001). There were no statistical differences in the postoperative morbidity rate between groups (p = 0.4649). The median length of hospital stay in groups was 5 vs. 4 vs. 4 vs. 4 days, respectively (p = 0.0025). Maintaining high compliance with the ERAS protocol is possible, despite the slight decrease that occurs within a few years after its implementation. This decrease in compliance does not affect short-term results, which are comparable to those shortly after overcoming the learning curve.

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