Fast-track Surgery Research Articles

Recommendations for fast-track extubation in adult cardiac surgery patients: a consensus statement.

Enhanced recovery after cardiac surgery in selected low-risk patients, has the potential to improve outcomes and reduce the burden of healthcare costs. Anesthesia-related challenges play a major role in the successful implementation of Enhanced Recovery After Surgery (ERAS) protocols, with particular emphasis placed on fast-track extubation. Acknowledging the importance of this practice, the Italian Association of Cardiac Anesthesiologists and Intensive Care (ITACTAIC) has advocated for an initiative to establish a consensus offering practical recommendations for fast-track extubation after adult cardiac surgery. After conducting a systematic review, all randomised control trials (RCTs) published between 2013 and 2023 were meticulously selected and analysed during a consensus meeting that involved statement voting. Out of the 2268 publications identified using the search string, 60 RCTs were selected and classified into six groups, each evaluating specific interventions associated with extubation within 6 hours post-surgery. The authors examined 20 RCTs pertaining to loco-regional anesthesia, 19 analysing elements of general anesthesia, 12 focused on surgery-related aspects and techniques, three examining ventilation, two exploring anesthesia depth monitoring, and four addressing miscellaneous aspects. The expert panel approved 16 statements with 15 achieving high agreement and one obtaining moderate agreement. Finally a total of eight interventions were considered associated with fast-track extubation: parasternal block, erector spinae plane block, alpha agonist in the operating room (OR), opioids in the OR, dexmedetomidine in the intensive care unit (ICU), minimal invasive surgical access, anesthesia depth monitoring, adaptative support ventilation. In the first consensus document ever published by a scientific society addressing practical recommendations for fast-track extubation post-cardiac surgery, the authors identified sixteen interventions commonly associated with fast-track extubation in selected adult cardiac surgery patients.

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.

Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. ClinicalTrials.gov NCT04803422.

Fast-track surgery applied in gynecological oncological surgical treatment: a prospective randomized trial

Background: The study aimed to compare the fast-track and traditional gynaecological oncological surgeries from postoperative recovery. Methods: A total of 107 patients undergoing gynaecological oncological surgery were randomly assigned to the FTS group (n=50) and the traditional group (n=57). Results: No significant differences in LOS (Length of hospitalization post-operation) were observed. A less total cost of hospitalization and a lower C-Reactive protein (CRP) level were found (P &lt; 0.05). Also, the trial revealed a significantly lower number of the overall complications in the FTS Group (P &lt; 0.05). Conclusions: FTS applied in gynaecological oncological surgeries is beneficial to patients in terms of the postoperative recovery. Keywords: fast track surgery; gynaecological surgery; oncological surgery; post-operative length of hospitalization; randomised controlled study.

Unveiling the Impact of Enhanced Recovery After Surgery Programs on Post-Operative Morbidity and Mortality

Enhanced recovery after surgery is an evidence-based and holistic perioperative care approach and a real revolution in surgical settings. Initially, this concept referred to as “fast-track surgery’’ has evolved to enhanced recovery after surgery and acquired remarkable attention for its potential to improve patient recovery and surgical adverse outcomes, reduce the length of hospital stay, and yield beneficial impact on post-surgical mortality and morbidity. Objective: To evaluate the impact of enhanced recovery after surgery programs on Post-Operative Morbidity and Mortality. Methods: A comprehensive overview was provided based on several studies' data on the impact of enhanced recovery after surgery programs on postoperative mortality and morbidity. Nine years of epidemiological studies published between 2014-2023 were included based on the presence of qualitative and quantitative data. Results: Enhanced recovery after surgery significantly reduces the overall morbidity, surgical site infections, and complications associated with different surgeries, and shortens the length of stay at the hospital without escalating the readmission and mortality rate. However, only one study reported a significant difference in mortality rate between enhanced recovery after surgery and the control group. Conclusions: It was concluded that enhanced recovery after surgery protocols have increasingly been recognized as pivotal tools in reducing postsurgical mortality and morbidity, highlighting their efficacy in optimizing surgical consequences. By synthesizing core insights this review emphasizes the concrete advantage of enhanced recovery after surgery programs inpatient rehabilitation mobilization, encompassing faster recovery, and reducing surgical-related adverse effects.

Management of Patients with Colorectal Cancer through Fast-Track Surgery.

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN "Antonio Cardarelli" Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66-75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days.

Factors associated with postoperative discharge readiness and continuing care needs in patients with lung cancer undergoing fast-track surgery: A prospective cohort study.

To investigate and analyze the characteristics and factors associated with readiness for hospital discharge and continuing care needs of postoperative patients with lung cancer undergoing fast-track surgery (FTS). FTS aims to reduce the body's stress response to surgery and improve patient outcomes. The study included adult patients with confirmed lung cancer who underwent lung cancer surgery under FTS management and were discharged from the Cancer Institute and Hospital, Chinese Academy of Medical Sciences, between June 2020 and September 2020. Patients with severe illnesses, comorbidities, disturbance of consciousness, cognitive disorders, or communication impairments were excluded. One-hundred-and-eighty patients were included, and 167 (92.8%) indicated that they were discharge-ready. Multivariable regression analysis showed that age 60 years or older (β = 16.29, 95% confidence interval (CI): 4.11-28.46, P = .009) and living alone (β = 37.07, 95% CI: 16.30-45.84, P < .001) were associated with the discharge readiness scores. In addition, those who were able to take care of themselves (β = 43.57, 95% CI: 19.60-67.54, P < .001) and needed little assistance at home (β = 28.39, 95% CI: 5.52-51.26, P = .015) had higher discharge readiness scores than those who needed a lot of assisted care. Patients who were cared for at home by children (β = 40.32, 95% CI: 4.91-75.73, P = .026), parents (β = 56.68, 95% CI: 12.33-101.03, P = .013), or spouses (β = 35.92, 95% CI: 2.45-69.38, P = .036), had higher discharge readiness scores than nursemaid. The discharge readiness scores of patients requiring continuing care were 146.5 ± 39.3, while patients who had no need scored 179.8 ± 36.5 (P < .01). Most patients with lung cancer undergoing FTS are discharge-ready. Discharge readiness is influenced by living conditions and self-care ability. This study identified factors influencing discharge readiness, and that could be used to identify patients who could benefit from help to improve discharge readiness.

Fast-track surgery with three-port versus conventional perioperative management of bladder cancer associated laparoscopic radical cystectomy and Ileal conduit diversion: Chinese experience

ObjectiveThis study seeks to explore the impact of fast track surgery (FTS) with three-port in patients treated with laparoscopic radical cystectomy and ileal conduit on postoperative recovery, hospital stay and the complications.MethodsThis retrospective study analyzed 230 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy at the Second Hospital of Anhui Medical University between December 2011 to January 2023. 50 patients received conventional surgery (CS) and 180 patients received FTS with three-port. Patients were assessed for time to normal diet consumption, time to passing first flatus, number of postoperative recovery days and complications. Trends of serum C-reactive protein levels were monitored preoperatively and on postoperative days 1, 3 and 7.ResultsPatients who underwent FTS with three-port had a shorter duration to first flatus (P < 0.05). And number of postoperative hospital days and the length of hospital stay were notably shorter in contrast to the CS group (P < 0.05). Serum CRP levels on postoperative day 7 were markedly reduced in those of the FTS group compared to the CS group (P < 0.05). Those of the CS group experienced more frequent rates of complications compared to those of the FTS with three-port group (P < 0.05).ConclusionOur findings demonstrate that the FTS with three-port program hastens postoperative recovery and reduces duration of hospital stay. It is safer and more effective than the CS program in the Chinese population undergoing laparoscopic radical cystectomy.

Fast-track Effectiveness in Abdominal Surgery (Literature Review)

The study aimed to evaluate the literature on fast-track laparoscopic bariatric surgery (LRYGB and LAGB) to determine its feasibility and safety. Articles from PubMed, EMBASE, and Cochrane Library discussing next-day discharge for LRYGB and same-day discharge for LAGB were analyzed. The review included 13 studies with evidence levels of 3b or 4, comprising seven studies on LAGB, five on LRYGB, and one on both. The next-day discharge rate for LRYGB ranged from 81% to 100%, and the same-day discharge rate for LAGB ranged from 76% to 98%. Complication, readmission, and mortality rates were comparable to conventional care. The results indicate that fast-track management of LRYGB and LAGB is feasible with careful patient selection and preparation in high-volume centers, potentially offering cost benefits. However, further studies are needed to confirm the safety and cost-effectiveness of this approach outside specialized bariatric units.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 3: Day surgery and fast-track surgery.

European guidelines on peri-operative venous thromboembolism prophylaxis: first update.: Chapter 3: Day surgery and fast-track surgery.

Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study

Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia. Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension. Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P &lt; 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033). Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.

Fast-Track surgery protocol in perioperative care for gynecological laparoscopy.

This study aimed to compare fast-track surgery (FTS) and traditional perioperative care protocols in laparoscopic gynecological surgeries, assessing their impact on length of stay (LOS), recovery time, and postoperative complications. A case-control retrospective study was conducted at Suzhou Hospital of Integrated Chinese and Western Medicine, involving 167 patients undergoing laparoscopic gynecological surgery from June 2021 to June 2023. Of them, 81 patients underwent surgery based on the FTS protocol (FTS group) and 86 patients received a traditional perioperative management (control group). Patients in both groups underwent gynecologic laparoscopic procedures, including uterine, ovarian and tubal surgeries. Data were collected on general patients' characteristics, including age, BMI, surgery type and time, intestinal recovery and out-of-bed activity time, LOS, pain levels, and postoperative complications. Wilcoxon rank sum test with continuity correction was used to assess the difference in operative characteristics and postoperative pain levels. Fisher's exact test was used to assess the difference in overall frequency of postoperative complications between groups. Patients in the FTS group exhibited faster intestinal recovery, shorter mobilization time, and reduced LOS compared to the control group. Pain levels were significantly lower at one, six and twelve hours post-surgery in the FTS group. Overall, the proportion of postoperative complications was significantly lower in the FTS group than in the control group. Implementing the FTS protocol in laparoscopic gynecological surgeries for benign conditions can reduce LOS, accelerate recovery, and minimize pain without increasing postoperative complications. Further research with more diverse patient populations is warranted to validate these findings.

Evaluation of the clinical efficacy of ultra-fast track anesthesia for endoscopic thoracic sympathectomy of palmar hyperhidrosis.

In this study, we investigated the safety and practicability of ultra-fast track anesthesia (UFTA) for endoscopic thoracic sympathectomy (ETS). A total of 72 patients with palmar hyperhidrosis undergoing ETS were randomly divided into three groups: the UFTA group (group I), the group undergoing single-lumen tracheal intubation with local infiltration anesthesia technique (group II), and the group undergoing single-lumen tracheal intubation with routine anesthesia (group III). Mean arterial pressure (MAP) and heart rate (HR) were recorded for all three groups at the following six time points: Before anesthetics administration (T0), the time of intubating or inserting laryngeal mask airway (T1), the time of incising skin (T2), the time of disconnecting of the right sympathetic nerve (T3), the time of disconnecting of the left sympathetic nerve (T4), the time of withdrawing the tracheal tube or laryngeal mask airway (T5), and the time of transferring the patient to a post-anesthesia care unit (PACU) (T6). The three groups were compared from the following perspectives: surgery duration; anesthesia recovery duration, that is, the duration from discontinuation of anesthesia to extubating the tracheal tube; the dose of propofol and remifentanil per kilogram body mass per unit time interval (the time at the end of the procedure, which lasted from anesthesia induction to incision suturing); and the visual analog scale (VAS) in the resting state in the PACU. Based on pairwise comparisons, the average HR and average MAP values of the three groups differed significantly from T2 to T6 (p < 0.05). As demonstrated by the correlation analysis between remifentanil and propofol with HR and MAP, the doses of the total amount of remifentanil and propofol were lower, and group I used less remifentanil and propofol than group II. No patient in group I experienced throat discomfort following surgery. Patients in groups II and III experienced a range of postoperative discomfort. The VAS scores of groups I and II were significantly lower than those of group III, with group I lower than group II. When utilized in ETS, UFTA can provide effective anesthesia for minor traumas. It is safe, effective, and consistent with the enhanced recovery philosophy of fast-track surgery departments.

Multi-level bilateral ultrasound-guided retrolaminar block for fast-track spinal deformity surgery.

Multi-level bilateral ultrasound-guided retrolaminar block for fast-track spinal deformity surgery.

Elastic Compression Dressing after Total Hip Replacement Slightly Reduces Leg Swelling: A Randomized Controlled Trial.

Background: Even minor adverse reactions after total hip replacement (THR), including lymphedema, postoperative leg swelling, and blood loss, compromise patient comfort in times of minimally invasive fast-track surgery. Compression dressings are commonly used in surgical practice to reduce swelling or blood loss. However, the use of spica hip compression dressings after primary THR is controversial, and prospective studies are lacking. Methods: We conducted a prospective, single-center, two-arm, randomized controlled trial (RCT) of patients undergoing THR for primary osteoarthritis. A total of 324 patients were enrolled; 18 patients were excluded, and 306 patients were finally analyzed. Leg swelling as primary endpoint was measured pre- and postoperatively with a rotating 3D infrared body scanner. Secondary endpoints were transfusion rate and blood loss, estimated by Nadler and Gross formulas. Results: Postoperative leg swelling was lower in the compression group (241 ± 234 mL vs. 307 ± 287 mL; p = 0.01), even after adjustment for surgery time and Body-Mass-Index (BMI) (p = 0.04). Estimated blood loss was also lower in the compression group on the first (428 ± 188 mL vs. 462 ± 178 mL; p = 0.05) and third (556 ± 247 mL vs. 607 ± 251 mL; p = 0.04) postoperative days and leveled off on the fifth postoperative day, but lost significance after adjustment for BMI and surgery time. Neither group received a transfusion. Conclusions: Compression dressing after THR in the context of minimally invasive surgery slightly reduces leg swelling, but has no effect on blood loss or blood transfusion rate. So, this method could not generally be recommended in primary hip replacement.

Health-related quality of life after minimal-invasive treatment of aortic valve stenosis in the elderly.

Although transfemoral transcatheter aortic valve implantation (TF-TAVI) offers superior early outcome over open surgical aortic valve replacement (SAVR) in the elderly, a comparison of TF-TAVI with surgery performed through partial upper mini sternotomy (PUMS) hasn't yet been validated. The aim of the present study is to evaluate the clinical outcome and quality of life of patients subjected to TF-TAVI and open surgical aortic valve replacement through partial upper mini sternotomy (PUMS-SAVR). Baseline, procedural and post-treatment data of 197 consecutive patients: 137 TF-TAVI and 60 PUMS-SAVR treated at Philipps University of Marburg, were retrospectively collected. The propensity score method was used to create two groups in a 1:1 fashion. Questionnaire assessment (SF36_LQ) of quality of life of the matched patients was carried out at the ambulant routine control presentation. A competing risk regression model is used to evaluate the impact of the clinical outcome on health-related quality of life (HrQoL). After propensity matching, TF-TAVI remained associated with lower procedural time (136±50 vs. 298±36 min, P<0.01), intensive care unit stay (2.68±2.70 vs. 4.29±2.43 days, P<0.01), transfusion of packed red cell units (0.46±2.05 vs. 1.60±2.00 U, P=0.02) and higher heart block (42.86% vs. 0%, P<0.01) and permanent pacemaker implantation rates (14.29% vs. 0%, P=0.05) compared to PUMS-SAVR. TF-TAVI is associated with less complains, superior HrQoL (excellent 40% and very good 60% vs. very good 100% in PUMS). Partial sternotomy is the main predictor of the inferior HrQoL, with the regression coefficient of -1.11 (95% confidential interval, -1.503 to -0.726; R2=0.324, P<0.0001). Transfusion (P=0.26), paravalvular leakage (0.618), pacemaker implantation (P=0.19) and delirium (P=0.92) did not influence HrQoL after the minimal-invasive treatment of aortic valve stenosis in elderly patients. Although PUMS-SAVR offers better technical outcomes with less permanent pacemaker implantation and less paravalvular leakage than TF-TAVI, it is still associated with more need for transfusion, longer ventilation-and intensive care unit-times, and prolonged hospital stay. In the elderly, PUMS-SAVR achieves inferior quality of life compared to TF-TAVI. Partial sternotomy reveals as the strongest risk factor of perceived health-level post-treatment. It remains to be revealed whether fast-track open heart surgery that maintains a fully intact sternum and allows immediate postoperative extubation-as performed through video-assisted mini-thoracotomy or thoracoscopic robotic procedures with percutaneous cannulation - should be favored against PUMS-SAVR.

Research Progress on Perioperative Nursing of Fast Track Surgery for Thyroid Cancer

Thyroid cancer is a common disease, and surgical intervention is the preferred treatment option. However, in order to ensure surgical effectiveness and safety, perioperative nursing is crucial. Chinese experts have put forward various opinions and recommendations regarding the nursing care for thyroid cancer, among which fast track surgery (FTS) has gained popularity as a nursing approach. FTS encompasses preoperative and postoperative care, with the aim of promoting early patient recovery and emphasizing a patient-centered care philosophy. It has shown significant application value. This article provides a brief overview of the emergence and development of FTS, and introduces the perioperative nursing of FTS for thyroid cancer, hoping to offer theoretical reference for healthcare professionals in the field.

MULTIMODAL ANESTHESIA AS AN IMPORTANT COMPONENT OF ERAS

Introduction. The ideology of Fast Track-Surgery (FTS) and Enhanced Recovery After Surgery (ERAS) represents modern trends in global surgical practice. Anesthesiology aims to provide ideal and universal solutions for protecting patients from surgical aggression. A multimodal approach, which includes multilevel, multifaceted antinociception, is well-founded, where maximum effectiveness is combined with minimal side effects.&#x0D; The aim. To analyze the issue of multimodal pain management as an important component of ERAS (Enhanced Recovery After Surgery) from modern sources of literature for optimizing perioperative care in the minimally invasive surgery department.&#x0D; Materials and methods. Bibliosemantic, comparative, and systemic analysis methods were employed. The proposed recommendations were developed based on an analysis of modern literature, the results of randomized trials and meta-analyses, as well as our own studies dedicated to the study of perioperative pain issues.&#x0D; The results. It has been proven that the use of opioids in anesthesia practice is decreasing. New and modern methods of continuous monitoring of vital organs in patients are being introduced as supplements to classical monitoring protocols. These methods are used to avoid excessive or inadequate dosing of anesthetics, adjust the concentration of substances used, reduce post-anesthesia complications, and improve patient comfort. The method of perioperative energy monitoring significantly complements the "International Standards for Safe Anesthetic Practice", WFSA (2010), and enhances perioperative patient safety by detecting metabolic disturbances and implementing appropriate pathogenetic correction. The importance of regional anesthesia under ultrasound control, nociception-antinociception balance management, and the impact of these methods on opioid consumption, patient satisfaction, and postoperative recovery have been proven.&#x0D; Conclusions. The most commonly used combination of drugs for multimodal analgesia often includes acetaminophen and NSAIDs (strong recommendation). It has been proven that deep and prolonged sedation in intensive care unit (ICU) patients is associated with worse outcomes, longer mechanical ventilation duration, extended ICU and hospital stays, and higher rates of complications, including infections and sometimes even death.

Post-Caesarean Rehabilitation: Evaluation Of Practices

Background: Early Rehabilitation, "Fast-Track Surgery," or Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in various surgical procedures, including caesarean sections. These protocols aim to expedite recovery, reduce hospital stays, and minimize complications through a multidisciplinary approach. Despite their proven effectiveness, the implementation of such protocols in post-caesarean recovery remains uneven and warrants further investigation. Objective: This study aims to evaluate the current practices of early post-caesarean rehabilitation, focusing on pain management, early nutritional intake, mobilization, and mother-child bonding to identify gaps and opportunities for improvement. Methods: A prospective observational multicenter study was conducted between January and April 2021 at the Maternity and Neonatology Center of Tunis and the Principal Military Hospital of Tunis. The study involved 170 parturients undergoing caesarean section under spinal anesthesia, excluding those with contraindications. Data were collected using a standardized form, covering demographic details, medical history, surgical and anesthesia details, and post-operative recovery metrics, including pain assessment (VAS scores), timing of first oral intake, mobilization, and mother-child bonding. Statistical analysis was performed using SPSS version 25. Results: The average age of parturients was 30 ± 5 years. A majority (73%) of caesarean sections were planned, with surgery durations mostly within one to two hours. Post-operative pain management revealed that 73% of parturients reported a VAS ≤ 2 at the 3rd hour, but 77% experienced a VAS ≥ 4 by the 6th hour. Early oral intake was initiated by 66% of parturients before the 6th hour for liquids and before the 12th hour for light meals. The urinary catheter was removed before the 12th postoperative hour in 56% of cases. Early mobilization was achieved by 67% of parturients before the 12th hour, and 82% were breastfeeding naturally, with 79.7% satisfaction with care. Conclusion: The study highlights the partial implementation of ERAS protocols in post-caesarean recovery, pinpointing areas for improvement, particularly in pain management, early oral intake, and mobilization. A standardized approach to early post-caesarean rehabilitation could significantly enhance maternal and neonatal outcomes, reduce complications, and improve patient satisfaction.

Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis.

Enhanced recovery after surgery (ERAS) is a multimodal perioperative management concept, but there is no article to comprehensively review the collaboration and impact of countries, institutions, authors, journals, references, and keywords on ERAS from a bibliometric perspective. This study assessed the evolution of clustering of knowledge structures and identified hot trends and emerging topics. Articles and reviews related to ERAS were retrieved through subject search from the Web of Science Core Collection. We used the following strategy: "TS = Enhanced recovery after surgery" OR "Enhanced Postsurgical Recovery" OR "Postsurgical Recoveries, Enhanced" OR "Postsurgical Recovery, Enhanced" OR "Recovery, Enhanced Postsurgical" OR "Fast track surgery" OR "improve surgical outcome". Bibliometric analyses were conducted on Excel 365, CiteSpace, VOSviewer, and Bibliometrics (R-Tool of R-Studio). Totally 3242 articles and reviews from 1997 to 2022 were included. These publications were mainly from 684 journals in 78 countries, led by the United States and China. Kehlet H published the most papers and had the largest number of co-citations. Analysis of the journals with the most outputs showed that most journals mainly cover Surgery and Oncology. The hottest keyword is "enhanced recovery after surgery". Later appearing topics and keywords indicate that the hotspots and future research trends include ERAS protocols for other types of surgery and improving perioperative status, including "bariatric surgery", "thoracic surgery", and "prehabilitation". This study reviewed the research on ERAS using bibliometric and visualization methods, which can help scholars better understand the dynamic evolution of ERAS and provide directions for future research.