‘Enhanced recovery after surgery’: tijd voor de standaard in chirurgie?

Abstract

Enhanced recovery after surgery: towards a new standard in surgery? In a changing healthcare landscape and the hospital of the future, a crucial question remains how to maintain a good quality of care for patients in a healthcare system under pressure. Enhanced recovery after surgery (ERAS) may provide the answer to this question and focuses on a multimodal, multidisciplinary patient-centered care pathway. The pathophysiological core of ERAS consists of reducing the surgical stress response and the associated inflammation to limit the degree of organ dysfunction and to enhance recovery. ERAS programs include (but are not limited to) evidence-based guidelines regarding a reduced fasting time and allowing the intake of carbohydrate-rich drinks up to 2 hours prior to surgery, minimally invasive surgery, multimodal opioid-sparing analgesia, normovolemia, normothermia, the avoidance or early removal of drains, and the early restart of nutrition and mobilization. With an increased compliance to ERAS elements, the outcome becomes better. Ample evidence exists that ERAS programs lead to a reduced length of stay, less complications, less readmissions, less reoperations and a reduced mortality. Additionally, ERAS programs are cost-saving. The implementation of ERAS care pathways requires a policy focused on ‘change’ management, teamwork, leadership, vision, communication and a continuous audit of the entire care process.