ERAS Program Research Articles

Enhanced Recovery after Pelvic Organ Prolapse Surgery.

The objective of this study was to review on the influence of enhanced rehabilitation in pelvic organ prolapse surgery outcomes, specifically focusing on length of hospital stay, hospital costs, pain, morbidity, and patient satisfaction. Following the PRISMA model and using PubMed as a source, eight articles pertaining to prolapse surgery and two articles concerning vaginal hysterectomies were selected, all published between 2014 and 2021. These studies revealed no significant difference in terms of operating time, intra- and post-operative complications, intra-operative blood loss and post-operative pain scores before and after the introduction of the ERAS program. Only one study noted a difference in readmission rates. There was, however, a noticeable decrease in intra-operative and post-operative intravenous intakes, opioid administration, length of stay, and overall hospital costs with the adoption of ERAS. Additionally, with ERAS, patients were able to mobilize more rapidly, and overall patient satisfaction significantly improved.

302. IMPACT OF ERAS BENCHMARK ACHIEVEMENTS AND HYBRID ROBOTIC ASSISTED ESOPHAGECTOMY ON RECOVERY AND READMISSION IN AN ERAS CENTER OVER TIME

Abstract Background Early recovery after surgery (ERAS) guidelines have provided an effective recovery approach for esophagectomy. Adherence to ERAS benchmarks leads to improvements in accelerated recovery over time. We evaluated differences in ERAS clinical benchmark achievements in patients undergoing hybrid robotic assisted esophagectomy (hRAMIE) and the impact on length of hospital stay (LOS). We also examined the overall performance of our ERAS program and impact of operative technique on recovery and readmissions over time. Methods A single-center prospective database of esophageal cancer patients was retrospectively analyzed between January 2020 and December 2022. All consecutive patients underwent hRAMIE within a standardized ERAS pathway. Impact of individual ERAS benchmark achievements on postoperative outcomes were evaluated according to LOS groups: accelerated (≤6 days, AR), targeted (7–8 days, TR), and delayed recovery (≥9 days, DR). Ability to achieve AR and readmission rates were compared with previous esophagectomy patient cohorts and institutional published data. Data were tested for normality with Shapiro–Wilk testing. Continuous variables were compared via ANOVA or Kruskal-Wallis testing. Categorical variables were compared via Fisher testing. Results Sixty-four patients underwent hRAMIE with a median LOS 5.5 days. AR, TR, and DR was achieved by 75.0%, 18.8%, and 6.3% patients, respectively. AR outperformed the other groups in ICU stay (p = 0.0046), transition to PO medications (p < 0.0001), and chest tube removal (p = 0.0002). Complications (48.4%) were more frequent among the TR and DR groups (p = 0.0051). 30-day readmission rate of 9.4% did not differ among the recovery groups (AR 6.2%, TR 25.0%, DR 0%, p = 0.114). 90-day mortality was 4.7% and disproportionately impacted the DR group (p = 0.0203). AR increased overtime without impacting readmission rate compared to previous cohorts in our ERAS center (Figure 1). Conclusion Within a common ERAS pathway at a single center, adherence to recovery benchmarks in patients undergoing hRAMIE multiplies the impact of ERAS and evolving operative technique on accelerated recovery across time. Improvements in AR can be achieved without affecting readmission rates. Routine audit of achievements of ERAS benchmarks is necessary to maintain post-esophagectomy outcomes in a time of changing health care resources.

291. TREATMENT OUTCOMES ACCORDING TO PATHOLOGICAL RESPONSE AFTER NEOADJUVANT CHEMORADIATION AND SURGEY IN OESOPHAGEAL CANCER

Abstract Background Neoadjuvant chemoradiation followed by surgery is now standard of care for resectable oesophageal cancer. The aim of this study was to analyse various parameters of treatment outcome with respect to pathologic complete responders (pCR) and pathological partial responders. Methods Consecutive 136 patients with operable oesophageal cancer, who received neoadjuvant chemoradiation followed by oesophageal surgery between march 2013 to january 2023 were included. Data was extracted from electronically and physically maintained patient clinical records. Data was collected in mircosoft excel and analysed using Epi Info Version 7.2. Chi square test and student t test were used to test the difference between proportions and means respectively. All tests were 2 tailed and significance level was 0.05. Various demographic, clinical and treatment outcome parameters were analysed according to pathological complete responders (pCR) and pathological partial responders. Results Out of 136 patients, 112(82.3%) had squamous histology. Among 136 patients, 75(55%)had pCR. Postoperative complications were seen in 30(49.18%) of pCR group as compared to 24(32%) in partial responders (p = 0.04). Pulmonary 16(53%) vs 8(33%), cardiac 5(16%) vs 3(12%) and vocal cord palsy 6(20%) vs 8(32%) complications were seen in pCR vs partial responders respectively. 9(14.75%) of pCR group had recurrences as compared to 32(45.33%) in partial responders (p = 0.003). pCR group had distant recurrences in neck 4(66.6%) (p = 0.01) and liver 4(66%) as compared to 2(14.3%) and 4(28.5%) respectively in partial responders. Conclusion High pCR is seen due to more number of patients with squamous histology. pCR has more postoperative pulmonary and cardiac complications which may indicate inherent radiosensitivity and tissue fragility which mandates strict ERAS program and affirms deferred surgery and wait and watch policy for complete clinical responders. Recurrences in pCR are less but are seen mostly in distant sites indicating aggressive surveillance protocol.

Enhanced recovery after microdiscectomy: reductions in opioid use, length of stay and cost

BackgroundEnhanced recovery after surgery (ERAS) protocols are widely used worldwide. Recently, studies of the ERAS program in spinal surgery subspecialties have been reported. The aim of this study was to evaluate the impacts of ERAS in minimally invasive microdiscectomy (MD) surgery.MethodsThis was a retrospective cohort study of patients undergoing MD at a single center. From March 2018 to March 2021, 286 patients were in the ERAS group. A total of 140 patients from March 2017 to February 2018 were in the conventional group. The outcomes included length of stay (LOS), the postoperative numeric rating scale (NRS), complications, 30-day readmission rate, 30-day reoperation rate and cost. Moreover, perioperative factors were also evaluated.ResultsCompared with the conventional group, the LOS and cost were reduced in the ERAS group. There were no significant differences in the NRS, complication rate, 30-day readmission or reoperation rates between the groups. Furthermore, postoperative drainage volume, and postoperative opioid use were lower in the ERAS group.ConclusionsThe ERAS protocol for MD surgery reduces LOS, cost and opioid use and accelerates patient recovery.

Rol de los cuidados perioperatorios guiados por protocolo para mejorar la recuperación tras la cirugía de cáncer de cabeza y cuello: experiencia institucional

BackgroundEnhanced recovery after surgery (ERAS) improve recovery after surgery. This study aimed to determine whether ERAS leads to a decrease in stay in the hospital and improves global and functional recovery after head and neck neoplasms surgery. MethodsWe performed a prospective case and historical control study after the ERAS application. The hospital database selected 50 confirmed eligible patients in control non-ERAS group. Prospectively 54 patients were included in the ERAS group. The primary outcome was time to readiness for discharge (TRD); secondary outcomes were the length of stay (LOS), readmission rate of up to 30 days and Quality of recovery score QoR-15. Data were compared with appropriate parametric and nonparametric tests. ResultsBaseline demographic data of patients were comparable between the two groups. Patients in ERAS group had significantly shorter TRD compared to the non-ERAS group 8 (6-10) versus 11 (8-16); P=.002. LOS was also significantly shorter in the ERAS group compared to the non-ERAS group (8 [7-11] versus 12 [9-17]; P=.002). Readmission at 30-days was no different, with six patients in each group. QoR-15 score was statistically better in ERAS group (94.88±12.50) compared to non-ERAS group (85.44±12.68; P<.001). ConclusionImplementing the ERAS programme decreased TRD and LOS and improved patient-reported recovery outcome QoR-15 in head and neck neoplasms surgery.

FTP3.8 Are we doing enough to get patients moving after colorectal cancer surgery?

Abstract Background Enhanced recovery after surgery (ERAS) is a widely implemented, multi-disciplinary pathway designed to reduce perioperative stress, maintain postoperative physiological function and accelerate recovery after surgery. Postoperative movement, as advocated by ERAS, reduces postoperative muscle wasting and the risk of complications such as chest infections and ileus and should be encouraged in all colorectal cancer patients. Methods Nine adult patients undergoing elective colorectal cancer resection had their physical activity assessed using an ActivPAL™ accelerometer applied to the anterior right thigh from the first postoperative day for 7 days or until discharge (if sooner). Time in bed and step count was collected. Results Patient age ranged from 54-87 years (median = 71). Mode of access included laparoscopy (n=7), robotic (n=1) and open (n=1), and no patients required intensive care postoperatively. The median length of hospital stay was 6 days (interquartile range (IQR): 3 days) and patients wore the accelerometer for a median time of 6 days (IQR: 2 days). The median step count on postoperative days 1, 3 and 5 was 128 (IQR: 236), 506 (IQR: 532) and 438 (IQR: 1256) steps/day, respectively. The median time spent in bed was 10 (IQR: 2.2), 10 (IQR: 8.5) and 9 (3.4) hours, respectively. Conclusions Even in those patients engaged in an ERAS programme, time spent performing physical activity is variable and does not appear to increase during the postoperative inpatient period. Step count targets may be a useful goal setting, patient-led directive to improve the consistency of postoperative mobilisation.

İlahiyat Alanında Yurt Dışında Lisans ve Lisansüstü Eğitim: Ürdün Örneği

During the 20th century, several Muslim countries made attempts to create modern educational institutions, switch to the university system, and adapt the traditional Islamic Studies to the new system. Various countries have implemented similar initiatives by taking different approaches. The majority of Muslims have prioritized the transmission of Islamic scientific knowledge to succeeding generations and the tackling of social issues. Examining Islamic studies and theological education systems which carried out in other countries gives us an opportunity to discover different answers to the same dilemmas. Jordan is one of the countries where Islamic theological education has been given at the universities founded in the last century. In this paper, after a brief information about switching the university system at the Arap world, we introduced the long-established Universities in Jordan and Faculties of Sharia (al-Sharee’a) and Islamic Studies which are similar to the Faculties of Theology/Islamic Sciences in Turkey. We gave detailed information about the goals of these faculties, their missions, and curricula; and made a comparison with similar educational institutions in our country in terms of their programs and curricula. Unlike the Faculties of Theology/Islamic Sciences in our country, the aforementioned faculties in Jordan carry out multi-program education. These faculties have Usūlu al-Dīn departments that offer standard Islamic sciences education in the center, but the programs of the faculties are not limited to this. In addition to the Usūl al-Dīn program, there are other programs conducted jointly with other faculties. These include the Fiqh and Qadā' (Fiqh and Judiciary) program in partnership with the Faculties of Law, the Islamic Banking program in partnership with the Faculties of Economics, and the al-Dirasāt al-Islamiyya fi'l-Asri al-Mu'āsir (Islamic Studies in the Contemporary Era) program, which offers education in a foreign language. The fact that the program of Islamic Economics and Finance, Islamic Insurance, and similar programs, which have recently started to provide education at the graduate level in Turkey, have been carried out in Jordan for more than ten years at both undergraduate and graduate levels is important in terms of sharing experiences. Moreover, the Fiqh and Qadâ' program, whose graduates can work in the Sharia courts, stands out in the context of the relationship between Islamic sciences and society. In addition, the departments of Usūlu'd-Din and Dawah, which are among the programs carried out in the faculties of Sharia, have similarities and differences with the programs of the Faculties of Theology / Islamic Sciences and Religious Higher Specialization and Training Centers in our country. In this context, it has been determined that Theology/Islamic Sciences education in Jordan is deficient in terms of Religious Sciences (Sociology of Religion, Psychology of Religion, Philosophy of Religion, etc.), and this situation has been examined in our study as an issue that deserves criticism. This study, it is aimed to inform those concerned about the developments in other countries with Muslim societies in order to break down some prejudices, then to create the right interaction and to benefit from it.

Failure of enhanced recovery after surgery in liver surgery: a systematic review and meta analysis.

This study aimed to conduct a systematic review of the literature to identify and summarize the existing evidence regarding ERAS failure and related risk factors after hepatic surgery. The objective was to provide physicians with a better understanding of these factors so that they can take appropriate action to minimize ERAS failure and improve patient outcomes. A literature search of the PubMed MEDLINE, OVID, EMBASE, Cochrane Library, and Web of Science was performed. The search strategy involved terms related to ERAS, failure, and hepatectomy. A meta-analysis was conducted on four studies encompassing a total of 1,535 patients, resulting in the identification of 20 risk factors associated with ERAS failure after hepatic surgery. Four of these risk factors were selected for pooling, including major resection, ASA classification of ≥3, advanced age, and male gender. Major resection and ASA ≥ 3 were identified as statistically significant factors of ERAS failure. The comprehensive literature review results indicated that the frequently identified risk factors for ERAS failure after hepatic surgery are linked to operative and anesthesia factors, including substantial resection and an American Society of Anesthesiologists score of 3 or higher. These insights will assist healthcare practitioners in taking prompt remedial measures. Nevertheless, there is a requirement for future high-quality randomized controlled trials with standardized evaluation frameworks for ERAS programs.

Application of a protocol for enhanced recovery after radical cystectomy: a before-and-after cohort study.

Radical cystectomy with urinary diversion is a major urological surgery burdened both by a high rate of short- and long-term complications and by a high emotional and psychological impact. Post-operative recovery is extremely important and the application of ERAS protocols can facilitate the return to functional autonomy. The aim of the present study was to verify the efficacy of our ERAS programme on outcomes of recovery after surgery of patients undergoing radical cystectomy with various urinary diversions. This is a before-after study comparing the historical group (n. 77) of radical cystectomies following a peri-operative standard of care with the prospective observational group (n. 83) following our ERAS programme. Recovery after surgery outcomes evaluated were length of stay, re-admission rate at 30-90/days and post-operative complications. Patients treated following the ERAS protocol presented less intra-operative blood loss (p < 0.001) and less intra-operative fluid infusions (p < 0.001). Time of first flatus was shorter in the ERAS group, though no difference was found in timing of nasogastric tube removal and defecation. Removal of drainage was done significantly earlier in the ERAS group. The median length of stay decreased from 12 to 9days (p = 0.003) with a significant reduction also in re-admission rates at 30 and long-term complications at 90days from surgery. The application of an opioid-free ERAS protocol to patients undergoing open radical cystectomy was associated, as compared with prior traditional care, with significant reductions of recovery time and length of stay, number of total in-hospital complications, in particular functional ileus and re-admissions by 30 and 90days after surgery.

Safety and feasibility of implementation of ERAS in CRS and HIPEC: Enhancing recovery or complications.

e18745 Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.

Mid-term Results of an ERAS Program of Bariatric Surgery in a Tertiary Referral Center.

To identify preoperative risk factors for discharge failure beyond postoperative day two (POD-2) in bariatric surgery ERAS program in a tertiary referral center. all consecutive patients who underwent laparoscopic bariatric treated in accordance with ERAS protocol between January 2017 and December 2019 were included. Two groups were identified, failure of early discharge (> POD-2) (ERAS-F) and success of early discharge (≤ POD-2) (ERAS-S). Overall postoperative morbidity, unplanned readmission rates were analyzed at POD-30 and POD-90, respectively. Multivariate logistic regression was performed to determine the independent risk factors for LOS > 2days (ERAS-F). A total of 697 consecutive patients were included, 148 (21.2%) in ERAS-F group and 549 (78.8%) in ERAS-S group. All postoperative complications at POD 90, whether medical or surgical were significantly more frequent in ERAS-F group than in ERAS-S group. Neither readmission nor unplanned consultations rates at POD 90 were significantly different between both groups. History of psychiatric disorder (p = 0.01), insulin-dependent diabetes (p < 0.0001), use of anticoagulants medicine (p < 0.00001), distance to the referral center > 100km (p = 0.006), gallbladder lithiasis (p = 0.02), and planned additional procedures (p = 0.01) were independent risk factors for delayed discharge beyond POD-2. One in five patients with bariatric surgery failed to discharge earlier despite the ERAS program. Knowledge of these preoperative risk factors would allow us to identify patients who need more recovery time and a tailored approach to the ERAS protocol.

Treatment of patients with metastatic epidural spinal cord compression using an enhanced recovery after surgery program.

Purpose: The aims of this study were to introduce a new medical, pathway based on the concept of "enhanced recovery after surgery" (ERAS) for patients with metastatic epidural spinal cord compression (MESCC), and to test whether the ERAS program could improve clinical metrics among such patients. Methods: Data from patients with MESCC (n = 98), collected between December 2016 and December 2019 (Non-ERAS cohort), and from 86 patients with metastatic epidural spinal cord compression collected between January 2020 and December 2022 (ERAS cohort), were retrospectively analyzed. Patients were treated by decompressive surgery combined with transpedicular screw implantation and internal fixation. Patient baseline clinical characteristics were collected and compared between the two cohorts. Surgical outcomes analyzed included operation time; intraoperative blood loss; postoperative length of hospital stay; time to ambulation, regular diet, urinary catheter removal, and radiation therapy; perioperative complications; anxiety; depression; and satisfaction with treatment. Results: No significant differences in clinical characteristics were found between the non-ERAS and enhanced recovery after surgery cohorts (all p > 0.050), indicating that the two cohorts were comparable. Regarding surgical outcomes, the enhanced recovery after surgery cohort had significantly less intraoperative blood loss (p < 0.001); shorter length of postoperative hospital stay (p < 0.001); shorter time to ambulation (p < 0.001), regular diet (p < 0.001), urinary catheter removal (p < 0.001), radiation administration (p < 0.001), and systemic internal therapy (p < 0.001); lower perioperative complication rate (p = 0.024); less postoperative anxiety (p = 0.041); and higher score for satisfaction with treatment (p < 0.001); whereas operation time (p = 0.524) and postoperative depression (p = 0.415) were similar between the two cohorts. Compliance analysis demonstrated that ERAS interventions were successfully conducted in the vast majority of patients. Conclusion: The enhanced recovery after surgery intervention is beneficial to patients with metastatic epidural spinal cord compression, according to data on intraoperative blood loss; length of hospital stay; time to ambulation, regular diet, urinary catheter removal, radiation exposure, and systemic internal therapy; perioperative complication; alleviation of anxiety; and improvement of satisfaction. However, clinical trials to investigate the effect of enhanced recovery after surgery are needed in the future.

Effect of rectus sheath anaesthesia versus thoracic epidural analgesia on postoperative recovery quality after elective open abdominal surgery in a French regional hospital: the study protocol of a randomised controlled QoR-RECT-CATH trial

IntroductionEnhanced recovery after surgery (ERAS) protocols increase patient well-being while significantly reducing mortality, costs and length-of-stay after surgery. A key component is multimodal analgesia that prevents postoperative pain and facilitates...

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group.

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.

A qualitative exploration of the strategies used by patients and nurses when navigating a standardised care programme.

The main aim of this paper is to explore and discuss the interesting juxtaposition of patient involvement within a standardised Enhanced Recovery After Surgery care programme (ERAS). We address our aim by examining the work and strategies of nursing staff caring for patients during postoperative recovery from surgery, exploring how these two potentially competing priorities might effectively co-exist within a hospital ward. This was a qualitative exploratory study, with data generated through 42 semi-structured interviews with patients and nurses who had taken part in an ERAS programme in one of three hospital wards in the United Kingdom, adopting a reflexive thematic approach to data analysis. We shine a light on the work undertaken by patients and nurses during the navigation of postoperative recovery, identifying strategies of collaboration and negotiation during this journey. Furthermore, we also identify and consider patients engaged in peer-peer support during postoperative recovery. This paper adds to the existing literature and current ways of thinking in relation to the quest for standardised, clinically effective care balanced with the aspirations for individualised, patient-centred care. This paper also helps inform thinking about the use of care pathways in relation to service delivery, considering how best to initiate and deploy best practice aimed at safe and effective postoperative recovery.

ERAS Programs for Head and Neck Surgery

ERAS Programs for Head and Neck Surgery

Enhanced recovery after cesarean section (ERAC): Where are we in Austria?

ObjectiveEnhanced recovery after surgery (ERAS) recommendations for cesarean section (ERAC), likely the most common reason for laparotomy in women, were issued in 2018–19. We examined how current perioperative management at cesarean section in Austrian hospitals aligns with ERAS recommendations. Study designWe surveyed the 21 largest public obstetric units in Austria for alignment with 20 of the 31 strong ERAS recommendations regarding perioperative maternal care at cesarean section. We also looked at how the German-language clinical guideline for cesarean section (AWMF Guideline Sectio caesarea) aligns with ERAS recommendations. ResultsThe 21 obstetric units cared for about 51% of all births in Austria in 2019. Cesarean section rates ranged from 17.7% to 50.4%. All 21 units implemented the five strong recommendations regarding patient information and counselling, regional anesthesia, euvolemia and multimodal analgesia. The least implemented strong recommendation was the one for the use of pneumatic compression stockings to prevent thromboembolic disease (0/21 units). Overall, all 21 units implemented ≥11 and 13 (62%) implemented ≥15 (≥75%) of the 20 strong recommendations; no unit implemented all 20 strong recommendations. There were no differences in the implementation of strong recommendations according to hospital volume. ConclusionsEven in the absence of formal adoption of ERAS program for cesarean section many perioperative ERAS recommendations are already implemented in Austria. The least implemented recommendations were the use of pneumatic compression stockings (0 of 21 units) and immediate catheter removal (4 of 21 units). Only 10 of the 20 ERAS recommendations we looked at are included in the current German-language clinical guideline for cesarean section.

Developing a Robotic Surgical Platform Is Beneficial to the Implementation of the ERAS Program for Colorectal Surgery: An Outcome and Learning Curve Analysis

Robotic surgery and ERAS protocol care are both prominent developments and have each become global trends. However, the effects and learning curves of combining robotic surgery and ERAS care in colorectal resection have not yet been well validated. This study aimed to present our real-world experience and establish the learning curves necessary for the implementation of an ERAS program in minimally-invasive surgery for colorectal resection, while also evaluating the impact that the development of the robotic technique has on ERAS outcomes. A total of 155 patients who received elective, minimally-invasive surgery, including laparoscopic and robotic surgery for colorectal resection, with ERAS care during the period June 2019 to September 2021 were included in this retrospective analysis. Patients were divided chronologically into five groups (31 cases per quintile). Patient demographics, tumor characteristics, perioperative data, ERAS compliance, and surgical outcomes were all compared among the quintiles. Learning curves were evaluated based on ERAS compliance and optimal recovery, which are composed of an absence of major complications, postoperative length of stay (LOS) of no more than five days, and no readmission within 30 days. A multivariable logistic regression model was used to assess factors associated with postoperative LOS. There were no statistically significant differences seen overall or between the quintile groups in regards to demographic and tumor characteristic parameters. A total of 79 patients (51%) received robotic surgery, with the ratio of robotic groups rising chronologically from zero in the first quintile to 90.3% in the fifth quintile (p < 0.001). The median compliance rate of total ERAS protocol was 83.3% overall, 72.2% in the first quintile and 83.3% in the 2nd-5th quintiles (p < 0.001). A total of 85 patients underwent optimal recovery after surgery, four patients in the first quintile, 11 patients in the second quintile, and 21, 24, 25 patients in the 3rd-5th quintiles respectively (p < 0.001). There were significant improvements from early to later groups upon postoperative LOS (p < 0.001). In addition, the surgical outcomes including first oral intake within 24 hours after surgery, time to first stool and early termination of intravenous fluid administration showed significant improvement among the quintiles. A multivariable logistic regression model demonstrated that robotic surgery was superior to laparoscopic surgery upon postoperative LOS (odds ratio = 5.029, 95% confidence interval [CI] = 1.321 to 19.142; p = 0.018). Our experience demonstrated that an effective implementation of the ERAS program in minimally-invasive colorectal surgery requires 31 patients to accomplish the higher compliance and requires more cases to reach the maturation phase for optimal recovery. We believe that developing a robotic platform would have no impact on the learning curve of ERAS implementation. Moreover, there is a beneficial effect on the postoperative length of surgery provided through the combination of ERAS care and robotic surgery for patients undergoing colorectal resection.

Nutrition Outcomes In Eras Program For Orthopedics

Nutrition Outcomes In Eras Program For Orthopedics

Prehabilitation in an ERAS program for endometrial cancer patients: impact on post-operative recovery

ObjectivesEnhanced recovery after surgery (ERAS) and prehabilitation programs are multidisciplinary care pathways that aim to reduce stress response and improve perioperative outcomes. However, literature is limited regarding the impact of...