ERAS Program Research Articles

Dynamics of leptin, insulin resistance, parathyroid hormone, 25(OH)D in the implementation of the eras-protocol in patients of surgical profile

The aim: to increase the effectiveness of treatment of patients of surgical profile with overweight by developing algorithms for perioperative intensive care for the successful implementation of the ERAS protocol.Material and methods. The basis of this study is the analysis of the results of a comprehensive clinical and instrumental dynamic examination of 122 patients with surgical herniological profile for a period of 1 day to 1 month from the date of surgery. The study included patients with ventral hernias of the anterior abdominal wall, which were determined by the SWR classification. The conditions for admission to the study under the conditions of inclusion were a fence 10 days before surgery to determine the analysis of vitamin D concentration. 3 groups of patients were identified (control, with addition to the protocol of treatment of cholecalciferol, with addition to the protocol of treatment of cholecalciferol and a solution of D-fructose-1,6-diphosphate sodium salt of hydrate). Determined the type of fat distribution, index of visceral obesity, triglycerides, high-density lipoprotein, leptin, fasting glucose, endogenous insulin, calculated the index of HOMA. Parametric statistics methods were used to process the obtained data.Results. In the vast majority of overweight patients (90 %) the abdominal type of fat distribution with the presence of visceral index obesity was determined. At the time of screening, the concentration of leptin in the blood of all studied patients exceeded the upper limit of normal by almost 4 times. The absence of a probable connection between the level of 25 (OH) D and leptin was determined, which confirms the presence of obesity due to reduced muscle mass and impaired energy metabolism, the presence of a relationship between the level of 25 (OH) D, HOMA, concentration of parathyroid hormone in the blood.Conclusions. Implementation of a planned surgical profile in overweight patients at the screening stage 10 days before surgery to determine the level of 25 (OH) D in the blood is a key point in deciding the possibility of conducting the perioperative period according to the ERAS program. Additional purpose to its classical protocol of cholecalciferol and solution of D-fructose-1,6-diphosphate sodium salt of hydrate increases the quality of motor activity of patients after surgery, increases their adaptive potential by restoring lost muscle function. The optimized classical algorithm of the ERAS-program significantly (p <0.05) improved the quality of life in the long term (30 days after surgery), such as physical functioning, general health, viability scale, mental health (SF-36 scale) and decreased body mass index

The Role of the Jogo Tonggo Program in the Empowerment of the New Normal Era Community in Central Java Province

Community empowerment is very important for the community, especially the government itself because these activities have a positive impact on the surrounding environment. Community empowerment is also one way for people to work together to make the program that has been issued a success. This study provides an overview of the implementation of community empowerment in the ‘Jogo Tonggo’ program initiated by the Central Java Provincial Government to fight the Covid-19 pandemic and looks at the impacts and strategies of the Central Java Provincial Government in reducing the number of people exposed to Covid-19. This study used a qualitative approach with a literature study method in the form of a review of the Jogo Tonggo new normal era program based on references and data in the field. The results showed that this program was also responded positively by the people of Central Java so that even in the new normal, the government did not hesitate to implement the program to reduce the level of people exposed to Covid-19.

DYNAMICS OF PHOSPHATE LEVEL AND ADAPTATION POTENTIAL IN THE IMPLEMENTATION OF THE ERAS-PROTOCOL IN OVERWEIGHT PATIENTS WITH A SURGICAL PROFILE

The results of the treatment of overweight patients under the ERAS program are presented. When comparing different variants of the intensive care protocol, it is best to add colecalciferol and D-fructose-1,6-diphosphate sodium salt hydrate.An increase in the amount of secretory active adipose tissue in the body is accompanied by a decrease in the bioavailability of vitamin D, a decrease in the level of 25 (OH) D in the blood increases the level of parathyroid hormone. The introduction of a planned surgical profile in overweight patients at the screening stage 10 days before surgery to determine the level of 25 (OH) D in the blood is a key point in deciding the possibility of a perioperative period under the ERAS program. Additional use to its classic protocol of colecalciferol (positive effect on long-term effects and is significant in the prediction process) and sodium D-fructose-1,6-diphosphate hydrate solution (directly affects the effect of rapid recovery after elective surgery) improves the quality of motor activity of patients after operations, increases their adaptive capacity by restoring lost muscle function. The optimized classical algorithm of the ERAS program significantly (p <0.05) improved the quality of life in the long run (30 days after surgery), such as physical functioning, general health, viability scale, mental health (SF-36 scale) and reduced body mass index.

How can lean thinking improve ERAS program in bariatric surgery?

Enhanced recovery after bariatric surgery protocol (ERABS) decreased length of hospital stay (LOS) without influencing clinical outcomes. ERABS improved logistics aspects in operating room (OR) with OR time savings. Lean management was used to reorganize OR logistics and to improve its efficiency. This study analyzed clinical and OR logistic aspects in ERABS protocols. Retrospective analysis of prospectively maintained database of obese patients undergoing bariatric surgery from 2017 to 2019 was performed. Since September 2018, patients were treated with ERABS protocol (ERABS group). All patients treated with a standard protocol between January 2017 and September 2018 (control group) were compared to ERABS group. Preoperative (anthropometric data, surgical and medical history) and intraoperative (type of procedure) were analyzed in two groups. LOS was the primary outcomes parameter analyzed; complications, readmissions and reoperations within 30 days were the secondary outcomes. Logistic endpoints were evaluated in time saving and efficiency: surgical time, team work time and total anesthesia time. 471 patients underwent bariatric surgery: 239 patients (control group) compared to 232 patients (ERABS group). ERABS presented more previous surgical history rate (p = 0.04) compared to control group with difference of type of procedure performed (p < 0.001). Roux-en-Y gastric bypass was mainly procedure in both groups (61.1% in control group compared to 52.6% in ERABS groups). Mean LOS was shorter in ERABS (3.16days) compared to control group (4.81days) with no difference in clinical outcomes rate. All logistics endpoints showed a time savings in ERABS group compared to control group (surgical procedure, total anesthesia and team work time, p < 0.001). In multivariate analysis, LOS was associated to ERAS status (IRR 0.722; p < 0.0001), team work time (IRR 1.002; p = 0.002), surgical procedure time (IRR 1.002; p < 0.0001). ERAS status was not associated with complication neither readmission, but surgical procedure time was a factor associated with complication (IRR 1.011; p = 0.0008). This study confirmed that ERABS protocol is safe and a feasible alternative with improved LOS. OR reorganization and logistic efficiency achieved using lean management helped reduce all OR times and these are likely related to the improvement in LOS and complication.

Enhanced recovery for obese patients undergoing gynecologic cancer surgery

ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort...

Essential elements of anaesthesia practice in ERAS programs.

Enhanced recovery pathways vary amongst institutions but include key components for anesthesiologists, such as haemodynamic optimization, use of short-acting drugs (and monitoring), postoperative nausea and vomiting (PONV) prophylaxis, protective ventilation, and opioid-sparing multimodal analgesia. After critical appraisal of the literature, studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies. For each item of the perioperative treatment pathway, available English literature was examined and reviewed. Patients should be permitted to drink clear fluids up to 2h before anaesthesia and surgery. Oral carbohydrate loading should be used routinely. All patients may have an individualized plan for fluid and haemodynamic management that matches the monitoring needs with patient and surgical risk. Minimizing the side effects of anaesthetics and analgesics using short-acting drugs with careful perioperative monitoring should be encouraged. Protective ventilation with alveolar recruitment maneuvers is required. Preventive use of a combination with 2-3 antiemetics in addition to propofol-based total intravenous anaesthesia (TIVA) is most likely to reduce PONV. While the ideal analgesia regimen remains to be determined, it is clear that a multimodal opioid-sparing analgesic strategy has significant benefits. Careful evaluation of single patient and planning of the anesthetic care are mandatory to join the ERAS philosophy. Optimal fluid management, use of short-acting drugs, prevention of PONV, protective ventilation, and multimodal analgesia are the cornerstones of the anaesthesia management within ERAS protocols.

The Role of Enhanced Recovery Programmes in Elderly Patients Undergoing Thoracic Surgery

An ageing population and increasing use of imaging techniques have resulted in a greater number of elderly patients being diagnosed with localised, early stage non-small cell lung cancer (NSCLC). Several physiologic factors contribute to the challenge of thoracic surgery in elderly patients: age-related decline in pulmonary function, comorbid disease such as ischaemic heart disease, diabetes and osteoporosis; and advanced COPD in lifelong smokers. This article will discuss the potential advantages of enrolling elderly patients undergoing thoracic surgery on an enhanced recovery after surgery programme and the effect of such programmes on patient outcomes. Several interventions implemented in the pre-, intra- and post-op periods have been shown to reduce morbidity and mortality in elderly patients undergoing pulmonary resection. No single intervention has the capacity to reduce morbidity and mortality in the elderly undergoing pulmonary resection; however, a series of interventions implemented as an ERAS programme has the potential to improved outcomes in this patient population.

PROFAST: A randomised trial implementing enhanced recovery after surgery for highcomplexity advanced ovarian cancer surgery

BackgroundEnhanced recovery after surgery (ERAS) programs include multiple perioperative elements designed to achieve early recovery after surgery and a shorter length of stay (LOS) in hospital. The PROFAST trial aimed to expand the evidence base for implementing ERAS in advanced gynaecologic oncology surgery. MethodsThis prospective, interventional randomised clinical trial enrolled women undergoing surgery for either suspected or diagnosed advanced ovarian cancer, at a reference hospital in gynaecologic oncology in Barcelona (Spain) and who were treated after either an ERAS protocol or conventional management (CM) protocol. All enrolled women who underwent cytoreductive surgery were included in the primary analysis. The primary outcome was reduction in LOS, and secondary outcomes were incidence and type of intraoperative and postoperative complications, rate of readmission and mortality within a 30-d follow-up period. This trial is registered at ClinicalTrials.gov, number NCT02172638. FindingsFrom June 2014 to March 2018, 110 women were recruited, of which eleven were excluded. The ERAS group comprised 50 patients, and the CM group, 49 patients. Both groups were comparable with respect to baseline characteristics and complexity of the cytoreductive surgery, with an overall medium/high Aletti surgical complexity score of 7.4. Overall compliance to the ERAS protocol was 92%. As compared with the patients in the CM group, patients in the ERAS group had a decreased median of LOS of two days (7 versus 9 days; p = 0.0099) and a decreased rate of readmission (6% versus 20%, p = 0.0334). No further significant differences were detected with respect to incidence of intraoperative or postoperative complications, severe (Clavien–Dindo grade IIIB–IV) complications, Comprehensive Complication Index, reoperation during primary stay, or mortality. InterpretationPatients with advanced ovarian cancer in the ERAS program had a decreased LOS and decreased rate of readmission as compared with those in CM, with no increased morbidity or mortality. This study provides important evidence for the benefits of ERAS management even for gynaecologic surgeries of medium/high complexity and suggests that ERAS should be a standard practice for cytoreductive surgeries for peritoneal carcinomatosis.

The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study.

PurposePostoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy.Patients and MethodsThis prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery.ResultsCompared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL.ConclusionUltrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.

Impacto del grado de cumplimiento de un protocolo ERAS en la recuperación funcional después de cirugía colorrectal

IntroductionCompliance to ERAS protocols is a process quality measure that is associated to better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated to functional recovery. MethodsA prospective observational single-centre study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analysed the relationship between protocol compliance percentage and surgical stress (defined by C reactive protein [CRP] blood levels on postoperative 3rd day), and functional recovery (defined by the proportion of patients who meet the discharge criteria on the 5th PO day or before). Multivariate analysis was performed to asses independent factor associated to functional recovery. Results313 were included. For every additional percentage point of compliance to the protocol 3rd day C reactive protein plasmatic level decreases 1,46 mg/dL and increases 7% the probability to meet the discharge criteria (p < 0.001 both). Independent factors associated to functional recovery were ASA III-IV (OR 0.26; 0.14-0.48), surgical CR-POSSUM score (OR 0.68; 0.57-0.83), early mobilization (OR 4.22; 1.43-12.4) and removal of urinary catheter (OR 3.35; 1.79-6.27), p < 0,001 each of them. ConclusionBetter compliance to ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.

Failure of enhanced recovery after surgery in laparoscopic colorectal surgery: a systematic review.

Enhanced recovery after surgery programs has been applied extensively in laparoscopic colorectal surgery. However, several studies have found that some patients fail from ERAS programs. It is important to identify these patients so that remedial action can be taken in a timely manner. The aim of this study was to perform a systematic review of ERAS failure and related risk factors following laparoscopic colorectal surgery. A literature search of the PubMed, EMBASE, OVID, and Cochrane databases was performed. The search strategy involved terms related to ERAS, failure, and colorectal surgery. The main outcomes were definitions of ERAS failure and related risk factors. Seven studies including 1463 patients were analyzed. The definition of ERAS failure was mostly associated with a prolonged postoperative length-of-stay (poLOS). Twenty-four kinds of identified risk factors were divided into three parts, the operative part, the pathophysiological part, and the ERAS elements, of which operative factors including more intraoperative blood loss and longer operative duration were the most frequently identified. ERAS failure was mostly related to a prolonged poLOS, and operative factors were the most frequently identified risk factors for ERAS failure following laparoscopic colorectal surgery. These findings will help physicians to take remedial action in a timely manner. Nonetheless, high-quality randomized controlled trials following a standardized framework for evaluating ERAS programs are needed in the future.

Performance of a Patient Engagement App for Pre-Op Education [20G

INTRODUCTION: Enhanced recovery after surgery is an innovation in perioperative care with the goal to achieve better patient engagement and improved outcomes like reduced opiate use and decreased hospital stay. Features are designed to accelerate patient recovery by reducing surgical stress and support physiologic function by allowing po intake shortly before surgery, multi-modal pain management, and early mobilization. Keys to success are patient education, engagement and self-efficacy. The program is dependent on assessing several patient reported care milestones like discontinuation of the Foley catheter, ambulation and pain scores. Because this is a human resource intensive endeavor, we developed an app with the goal of better engagement, education and response tracking while reducing human resources. METHODS: We deployed an app with the following components: multimedia education, reminders and check lists with the ability for patient reported data collection. Patients activated the app 3 weeks before surgery and used the tool for data collection pre and post operatively. We wanted to demonstrate patients consumed the educational content, responses to the surveys and compliance with our program preoperatively. RESULTS: We had 285 patients undergo ERAS program with 97.54% activation of our app before surgery, 92.86% response rate in the first week, 75.51% in the second week. 56.16% reported the app prevented 1 or more phone calls and 12.33% reported prevention of 1 or more visits to the hospital. CONCLUSION: We demonstrated both feasibility, high patient engagement and utilization for our app. One should consider using to unburdened staff and means to perform patient driven data collection.

Enhanced recovery care versus traditional non-ERAS care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

BackgroundEnhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopaedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group.MethodsThe ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.ResultsThe mean duration of hospital stay was significantly reduced from 10.0 ± 3.1 in the traditional care group to 6.0 ± 0.8 days in the ERAS(P < 0.001). The average VAS score in the first 3 days was significantly lower in the ERAS group (2.9 ± 0.8) than the traditional non-ERAS group (4.0 ± 0.8) (P < 0.001). However, there was no significant difference in the frequency of break-out pain (VAS > 4) between two groups (29.5 ± 6.3 times vs.30.6 ± 6.5 times, P = 0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery.ConclusionThe ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

PD60-12 DISCRETIONARY AND NECESSARY READMISSION AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive VI (PD60)1 Apr 2020PD60-12 DISCRETIONARY AND NECESSARY READMISSION AFTER RADICAL CYSTECTOMY Ahmet M Aydin*, Salim Cheriyan, Richard Reich, Ali Hajiran, Logan Zemp, Michael Poch, Brandon Manley, Philippe Spiess, Julio Pow-Sang, Wade Sexton, Roger Li, and Scott M Gilbert Ahmet M Aydin*Ahmet M Aydin* More articles by this author , Salim CheriyanSalim Cheriyan More articles by this author , Richard ReichRichard Reich More articles by this author , Ali HajiranAli Hajiran More articles by this author , Logan ZempLogan Zemp More articles by this author , Michael PochMichael Poch More articles by this author , Brandon ManleyBrandon Manley More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Julio Pow-SangJulio Pow-Sang More articles by this author , Wade SextonWade Sexton More articles by this author , Roger LiRoger Li More articles by this author , and Scott M GilbertScott M Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000977.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complications and readmissions are common after radical cystectomy (RC) and urinary diversion and have been subject to extensive examination in efforts to improve recovery after surgery. However, it is unclear if readmissions after RC are mutable, even though ERAS programs are increasingly used in cystectomy care. Therefore, we examined indications for readmission to better understand the proportion that are discretionary vs. medically necessary and to estimate how responsive RC is to readmission reduction efforts. METHODS: Records for patients treated with cisplatin-based neoadjuvant chemotherapy followed by RC between 2007 and 2017 were reviewed for 90-day complications and readmission. Postoperative complications were categorized and assigned Clavien-Dindo grades and readmissions were classified as necessary or discretionary based on independent clinician review. The association between any and major complications and necessary or discretionary readmission were examined with adjusted regression models. RESULTS: A total of 250 patients were included in the analysis. There were 76 readmissions within 90 days of surgery (19 discretionary and 57 necessary). There were no differences in age, insurance coverage, or comorbidity between readmitted and non-readmitted patients. Readmission was more likely after neobladder than ileal conduit (39% vs. 23.7%, p=0.02). Major (grade ≥ 3) complications were more likely to result in necessary as opposed to discretionary readmissions (40% vs. 21% p<0.001), and median length of stay on readmission was twice as long in necessary cases compared to discretionary cases (2.5 vs. 5 days, p<0.001). Gastrointestinal (GI) and infectious complications were associated with discretionary readmission in adjusted analyses, while infectious, renal/genitourinary and thromboembolic complications were highly associated with necessary readmission (Table). CONCLUSIONS: Our findings indicate that the type and grade of complications influence both discretionary and necessary readmission. Notably, 25% of readmissions were categorized as discretionary and were driven primarily by low-grade GI complications, such as nausea, vomiting and marginal PO intake, suggesting that better coordinated post-discharge supportive care could help avoid a significant proportion of readmissions. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1279-e1279 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmet M Aydin* More articles by this author Salim Cheriyan More articles by this author Richard Reich More articles by this author Ali Hajiran More articles by this author Logan Zemp More articles by this author Michael Poch More articles by this author Brandon Manley More articles by this author Philippe Spiess More articles by this author Julio Pow-Sang More articles by this author Wade Sexton More articles by this author Roger Li More articles by this author Scott M Gilbert More articles by this author Expand All Advertisement PDF downloadLoading ...

Does a pulmonary rehabilitation based ERAS program (PREP) affect pulmonary complication incidence, pulmonary function and quality of life after lung cancer surgery? Study protocol for a multicenter randomized controlled trial

BackgroundLung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). Preliminary evidence suggests that ERAS processes can reduce overall incidence of PPCs as short- and long-term recovery improved by supporting units to adopt evidence-based care. However, the evidence is inconclusive due to insufficient high-level studies in this research field. No well-designed, adequately powered, randomized controlled trials (RCTs) have investigated the effects of pulmonary rehabilitation based ERAS program (PREP) on post-operative pulmonary complications, pulmonary function, and health related quality of life following lung cancer surgery.MethodsThe PREP trial is a pragmatic, investigator-initiated, multi-center, randomized controlled, parallel group, clinical trial. Five hundred patients scheduled for minimally invasive pulmonary resection at six hospitals in China will be randomized with concealed allocation to receive either i) a pre-operative assessment and an information booklet or ii) a pre-operative assessment, an information booklet, plus an additional education, a 30-min pulmonary rehabilitation training session and the post-operative pulmonary rehabilitation program. The primary outcome is incidence of PPCs defined with the Melbourne Group Scale diagnostic scoring tool. Secondary outcomes include incidence of cardiopulmonary and other complications, pulmonary function, cardiopulmonary endurance, muscle strength, activity level, health-related quality of life (HRQoL), pre- and post-operative hospital length of stay (LOS), and total hospital LOS.DiscussionThe PREP trial is designed to verify the hypothesis that pulmonary rehabilitation based ERAS program reduces incidence of PPCs and improves pulmonary function and HRQoL in patients following lung cancer surgery. This trial will furthermore contribute significantly to the limited knowledge about the pulmonary rehabilitation based ERAS program following lung cancer surgery, and may thereby form the basis of future recommendations in the surgical community.Trial registrationChinese Clinical Trial Registry: ChiCTR1900024646, 21 July 2019.

Laparoscopic Colon Surgery within a Setting with Fully Implemented ERAS Protocols Makes Discharge within 24 Hours Feasible and Safe.

Background: Implementation of multidisciplinary approached ERAS programs results in a significant improvement of perioperative care. Due to this improvement, the length of hospital stay (LOS) can be reduced and is directly related to the adherence to ERAS protocols. The Median LOS in the Holland is 5d for colon surgery. Since 2 years our hospital is ERAS center of excellence and able to reduce complications by more than 40% and reduce LOS significantly. The objective of this retrospective analysis is to demonstrate that the LOS can be reduced to less than 24h when the multidisciplinary approached ERAS programs are fully executed.

Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the "Lazio Network" collective database.

ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions. Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions. A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197-0.9202 and 95%CI 0.7821-0.9603), hospitalization (OR 0.53 95%CI 0.4917-0.5845) and reinterventions (OR 0.84 95%CI 0.7536-0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036-0.5801), left-sided (OR 0.48 95%CI 0.3984-0.5815), and rectal resections (OR 0.46 95%CI 0.3753-0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976-0.9773 and 95%CI 0.7418-0.9634). Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.

Early peroral feeding after pancreaticoduodenecomy

Objective. To analyze the various ways for enteral feeding after pancreaticoduodenectomy.&#x0D; Materials and methods. There were investigated the results of pancreaticoduodenectomy, performed in 78 patients, suffering tumors of pancreatic head and periampullary zone, in whom various methods of nutritive support, in 2003 - 2017 yrs were applied. For comparative analysis the patients were divided into two groups: the first - 39 patients, perioperative treatment of whom was conducted in accordance to the ERAS program, and the second - 39 patients, who were treated using a standard method. In patients of the first group the effects of a peroral way of nutrition were compared, as well as combined peroral and enteral nutrition via microjejunostomy. There were studied the terms of restoration of peroral feeding, the gastrostasis rate, the nutrition calorage during 7 postoperative days, levels of general protein and albumin on the first, third and seventh postoperative day.&#x0D; Results. In 33 (84.6%) patients of the first group the peroral nutrition restoration have occurred in complete order to the protocol. The gastrostasis rate in patients of the first group was essentially lesser, than in patients of the second group. In the first group this complication have occurred in 6 (15.4%) patients, in the second group - in 14 (35.9%) patients (p = 0.009). Dynamics of level of general protein and albumin of the blood in postoperative period did not depend on method and energetic estimate of the nutrition.&#x0D; Conclusion. Application of peroral feeding, in accordance to the concept of the program for accelerated restoration of the patients, survived after pancreaticododenectomy, constitutes an optimal way for the nutrient support of an organism and permits to reduce the gastrostasis rate trustworthily.

Discussion

Discussion

Implementation of a Successful Enhanced Recovery after Surgery Program in a Community Hospital.

BackgroundEnhanced recovery after surgery (ERAS) protocols have been shown to be effective at accelerating return to functioning, reducing length of stay, and reducing cost per encounter at major medical centers and health systems across the United States and Europe. Implementation in the community hospital setting has been considered more challenging due to a wide range of factors. This study demonstrates the successful creation of such a program in a community hospital in central North Carolina.MethodsStarting in the spring of 2016, an anesthesiology-led, multidisciplinary ERAS team was formed with the purpose of developing an enhanced recovery after major urologic surgery program. A clinical protocol was developed by the team that met quarterly to review metrics. Outcome data were collected by chart review and compared to pre-ERAS values in a retrospective, nonrandomized, consecutive fashion and underwent statistical analysis.ResultsOverall, a reduction in both average and median length of stay (37% reduction) was observed in the post-ERAS group along with a reduction in 90-day readmission. Statistical analysis confirmed a very strong likelihood (p<.0001) that the ERAS protocol resulted in the observed reduction in the length of stay.DiscussionThis study demonstrated the feasibility of starting an ERAS program in a community hospital as well as the critical role that anesthesiology leadership can provide. An anesthesiology-led ERAS program offers a solution to some of the challenges faced by community hospitals regarding variable and silo-based care. ERAS pathways aim to implement standardized and coordinated evidence-based care protocols through multidisciplinary teams representing the entirety of the surgical encounter, leading to more consistent and favorable outcomes for patients and hospitals. This model can be applied to many other services in addition to the major urology effort described here.