Recovery Protocol Research Articles

Local Anesthesia and Enhanced Recovery after Transcarotid Artery Revascularization

ObjectiveTranscarotid artery revascularization (TCAR) is a minimally invasive surgical treatment for carotid artery stenosis. This study describes a ten-year institutional experience of TCAR and the concurrent development of enhanced recovery protocols. MethodsStandardized practices were implemented at a single institution for patients undergoing TCAR. This included protocolized pre-operative imaging and medical optimization, intraoperative workflow, and post-operative care. Additionally, vascular anesthesiology protocols were established for managing local and general anesthesia. A retrospective review of patients undergoing TCAR was subsequently conducted. Data on patient demographics, procedural details, and outcomes were analyzed from a prospectively maintained institutional database. ResultsAcross 321 patients, the median hospital stay after TCAR was 1.0 days with low-post-operative complications, most notably a 1.9% peri-operative stroke-death rate. ConclusionsMultidisciplinary collaboration is necessary to develop sustainable and effective enhanced recovery protocols. Implementation of these care pathways can improve patient outcomes and efficiency of care.

Multi-radio fast routing recovery protocol based on spectrum situation awareness

UAV networks often encounter jamming attacks, under which multi-radio protocols have to switch radios to accelerate communication recovery. However, the existing protocols rely on exchange of hello messages to detect jamming, leading to long sensing time and thus slow routing recovery. To address the issues raised by jamming attacks, we propose a new routing protocol, Electromagnetic Spectrum situation awareness Optimized Link State Routing (ESOLSR) protocol, to improve the existing OLSRv2 protocol. ESOLSR utilizes the spectrum situation awareness capability from the physical layer, and adopts joint-updating of link status, updating of interface functions, and adaptive adjustment of parameters. Our simulation results show that the improved protocol, ESOLSR, can recover routing and resume normal communication 26.6% faster compared to the existing protocols.

Examination of Postgraduate Theses on ERAS Protocol Applications in the Field of Nursing in Türkiye

Aim: This study is designed to examine postgraduate theses conducted in the field of nursing in Türkiye focusing on the Enhanced Recovery After Surgery (ERAS) protocols. Method: In this retrospective literature review, theses conducted in the field of nursing between 2011-2023, focusing on the utilization of ERAS practices, were examined. The inclusion criteria for the theses retrieved from the National Thesis Center database of the Higher Education Council were as follows: having key terms such as "Postoperative enhanced recovery protocol," "Enhanced recovery," "Oral carbohydrate," or "ERAS" in their thesis titles, and being conducted by departments of Nursing and/or Nursing Science. After categorizing the theses into master's and doctoral theses, they were examined in chronological order. Results: The screening process identified 21 theses conducted between 2011-2023, excluding one thesis that was inaccessible for full text. All theses were written within the last 12 years, with 3 theses at the doctoral level and 17 at the master's level. When examining the study designs, one these was a meta-analysis, 13 were descriptive, and 6 were conducted using experimental methods. Among the studies, 75% were conducted with patients, 10% with healthcare workers, and 10% with nursing students. Conclusion: The nursing theses conducted on ERAS have concluded that ERAS practices are effective based on their intended purposes. Additionally, it has been determined that healthcare professionals have insufficient knowledge regarding ERAS practices. Therefore, it is recommended to increase the number of studies conducted in the field of nursing to promote the widespread implementation of ERAS practices and raise awareness.

Using an organizational change model to improve lung cancer surgery services over five years.

Lung cancer is the most common cause of cancer death in the UK resulting in 21% of all cancer deaths. In 2016, local lung cancer surgery services required improvement due to under-representation in cancer resections and resource scarcity during the pandemic, which affected critical care bed availability and extended postoperative stays. The aim of this service improvement was to increase the number of lung cancer resection; develop minimally invasive techniques and reduce the use of Critical Care Unit beds by 35% (a subsequent goal). A five-year plan, guided by Kotter's 8-step change model, was initiated to address these issues. This model promotes sustainable change by setting clear goals, effective communication, and stakeholder involvement. Initial changes included hiring a thoracic surgeon experienced in uniportal video assisted thoracoscopy and enhanced recovery protocols. The team grew to three thoracic surgeons by 2020. The service increased operating theatre days and adopted new postoperative practices to reduce complications and hospital stays. Lung Cancer Multidisciplinary Team Meetings were consistently covered by thoracic surgeons, ensuring comprehensive care. Data on surgical activity were collected from departmental databases and national audits, with internal audits conducted regularly. Statistical significance was tested using chi-square tests with P values <0.05. The number of surgical procedures more than doubled, with primary lung cancer resections increasing nearly three-fold from 12.8% to 29.8% over six years. Postoperative complications and mortality rates remained low. Critical care bed usage dropped significantly during the pandemic, with new protocols enabling safe recovery in general surgical areas. The successful expansion of thoracic surgical services was attributed to the dedicated minimally invasive surgeons, enhanced recovery measures, and skilled staff. The change model facilitated efficient and dynamic progress. With the introduction of lung cancer screening programs, the demand for surgical services is expected to rise. The effective change model will be re-applied to meet this demand. The organizational change model, focused on patients and staff, achieved sustained quality improvement in lung cancer care despite challenging conditions like the coronavirus disease 2019 pandemic.

The Impact of Sleep on Athletes Performance and Injury Risk

Introduction and purposeSleep is a critical component of an athlete's health, significantly influencing injury risk, performance, and recovery. It plays a vital role in the healing process, contributing to growth, repair, regeneration, and immunity. Current literature suggests that sleep quality impacts various aspects of athletic performance, including physical and cognitive abilities, recovery, injury risk, and mental well-being. This narrative review aims to explore the impact of sleep on the musculoskeletal system of athletes, particularly focusing on injury risk, performance, and recovery. It seeks to synthesize existing research to highlight the importance of sleep quality and duration in maintaining and enhancing athletic performance.Description of the state of knowledgeThe findings indicate that less than 7 hours of sleep is consistently associated with an increased risk of musculoskeletal injury, with athletes experiencing a 1.7 times higher risk if this sleep pattern persists for at least 14 days. Some studies also highlight that athletes obtaining fewer than 6 hours of sleep per day show significant performance declines and higher injury rates.SummaryWhile evidence clearly links certain sleep behaviors to increased musculoskeletal injury and pain, it is crucial to consider sleep as one aspect of an athlete's overall health and well-being. Adequate sleep is essential for optimal athletic performance, injury prevention, and recovery. Tailored sleep strategies should be integrated into training and recovery protocols to enhance the overall health and performance of athletes.

The Impact of Enhanced Recovery Protocols Regarding Postoperative Nausea and Vomiting Following Sleeve Gastrectomy under Triple Prophylaxis: A Controlled Randomized Study

Background Following a sleeve gastrectomy, post-operative nausea and vomiting (PONV) is a typical issue. Furthermore, several prophylactic techniques have been developed, such as preventive antiemetic and accelerated recovery after surgery (ERAS). However, PONV has not entirely disappeared, and clinicians are still working to lower PONV incidence. Aim Our goal was to evaluate how adopting Enhanced Recovery Protocols (ERAS) affects postoperative nausea and vomiting (PONV) in comparison to standard care protocol after laparoscopic sleeve gastrectomy (LSG) while receiving triple antiemetic prophylaxis. Objective The objective of this study was to verify that the ERAS procedure is crucial for lowering PONV despite the use of an efficient and effective antiemetic. Methods This is a computer-generated randomized clinical trial. Haloperidol, dexamethasone, and ondansetron were administered to all patients undergoing elective LSG, 29 patients within an ERAS protocol, and 29 within a standard care protocol. The primary finding was the incidence of PONV within 36 hours following LSG. The time to initially administer rescue antiemetic medication, number of rescue antiemetic medication administrations, postoperative opioid consumption, oral fluid tolerance, complications, and QoR-15 questionnaire for quality of recovery were the secondary outcomes. Results Within the first 36 hours following LSG, the incidence of PONV in the ERAS group was 17.20%, while in the non-ERAS group, it was 51.7%, with P&lt;0.012 and higher PONV severity (P&lt;0.021) in the non-ERAS group. The ERAS group took a longer time (6 hours) for the first rescue antiemetic medicine than the Non-ERAS group (2 hours), with P&lt;0.001 and significantly less number of patients (20.7%) needing rescue antiemetic, compared to the Non-ERAS group (65.5%), with P&lt;0.001. The dosage of nalbuphine needed by the ERAS group was lower (2.7±2.8) than the non-ERAS group (19.9±6.0). Regarding the QoR-15 scores, there was a significant difference in the two groups' overall performance (P &lt;0.001). Between the two groups, there were no significant complications following surgery. Conclusion This study reveals that even though triple antiemetic prophylaxis was used, the ERAS protocol had a beneficial effect on PONV when compared to the standard care approach.

Relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran: a cross-sectional survey

ObjectiveTo examine the relationship between burnout and occupational fatigue exhaustion and recovery among orthopaedic nurses in Tabriz, Iran.DesignDescriptive, cross-sectional survey and correlational analysis.SettingTwo hospitals associated with Tabriz University of Medical...

Fidelity of Enhanced Recovery Protocol Implementation With Assessment of Hospital-Specific Materials

IntroductionVariability in implementation of enhanced recovery protocols (ERPs) often reduces the effects of an intervention on clinical outcomes. This study aimed to evaluate hospital-level implementation fidelity to a pediatric gastrointestinal surgery ERP by assessing site-specific implementation materials. MethodsThis document analysis study operationalized implementation fidelity as adherence to the creation of specified materials at each study site. During the 12-mo implementation phase within the stepped-wedge cluster randomized control trial, ENhanced Recovery In CHildren Undergoing Surgery, study sites were provided with materials (e.g., order sets), access to peer-counseling, and given key ERP elements spanning multiple phases of care. Sixteen of the 18 total study sites submitted implementation materials, including 14 anesthesia protocols, 11 order sets, and 16 sets of patient/family education materials. These materials were assessed and graded for fidelity using prespecified criteria. Hospital-level fidelity scores could range from 0 to a maximum score of 18, and were categorized as either high or low, based on whether the score was above or below/equal to the median. Descriptive statistics and Wilcoxon rank sum test were used for analysis. ResultsThe overall hospital-level median fidelity score for inclusion of ERP elements in the implementation materials was 10.5. The median score was 12.8 at nine high-fidelity sites and was 5.6 at nine low-fidelity sites (P < 0.01). Higher adherence was noted for avoiding prolonged fasting (n = 16/18 hospitals; 89%) and preventing nausea and vomiting (n = 16/18 hospitals; 89%) in anesthesia protocols and/or order sets. Lower adherence was noted for incorporation of minimally invasive surgical techniques (n = 2/18 hospitals, 11%) and of preoperative optimization of medical comorbidities (n = 0/18 hospitals, 0%) in implementation materials. ConclusionsDespite substantial resources to promote ERP elements, there was wide variation in fidelity for incorporating ERPs into implementation materials among hospital sites. Development of high-fidelity implementation materials for complex ERPs for gastrointestinal surgery in children may require longer than 12 months. Additional implementation strategies, resources, and modification of implementation-focused materials may be needed.

Morbidity after accelerated enhanced recovery protocol for colon cancer surgery

Previous studies showed that accelerated enhanced recovery programs (ERPs) with discharge 1–3 days after colorectal surgery are feasible for specific patients without compromising patients’ safety. This study aimed to examine the incidence, severity, and treatment of complications after treatment according to an accelerated ERP (CHASE). This accelerated ERP consisted of adjustments in pre-, peri- and postoperative care. Patients treated according to the CHASE protocol were compared to a retrospective cohort of patients who received standard ERAS care. The primary outcome was the rate of severe complications. The overall complication rates were similar in both cohorts (CHASE 30.7% vs ERAS 31.4%, p = 0.958) as well as severe complications (CHASE 20.9% vs ERAS 21.4%, p = 0.950). Among the 113 patients with a complicated course, the readmission rate was significantly higher in the CHASE cohort (41.9% vs 21.4%, p = 0.020). LOS after readmission was longer in the CHASE cohort (p = 0.018), but the total LOS was shorter (4 versus 6 days, p = 0.001). This study demonstrates that accelerated recovery can be safe for ASA I-II patients and has the potential to become a standard of care. Moreover, the CHASE protocol proved to be beneficial in terms of total LOS for patients with complications.

Hayden-Preskill recovery in chaotic and integrable unitary circuit dynamics

The Hayden-Preskill protocol probes the capability of information recovery from local subsystems after unitary dynamics. As such it resolves the capability of quantum many-body systems to dynamically implement a quantum error-correcting code. The transition to coding behavior has been mostly discussed using effective approaches, such as entanglement membrane theory. Here, we present exact results on the use of Hayden-Preskill recovery as a dynamical probe of scrambling in local quantum many-body systems. We investigate certain classes of unitary circuit models, both structured Floquet (dual-unitary) and Haar-random circuits. We discuss different dynamical signatures corresponding to information transport or scrambling, respectively, that go beyond effective approaches. Surprisingly, certain chaotic circuits transport information with perfect fidelity. In integrable dual-unitary circuits, we relate the information transmission to the propagation and scattering of quasiparticles. Using numerical and analytical insights, we argue that the qualitative features of information recovery extend away from these solvable points. Our results suggest that information recovery protocols can serve to distinguish chaotic and integrable behavior, and that they are sensitive to characteristic dynamical features, such as long-lived quasiparticles or dual-unitarity.

A retrospective cohort study on enhanced recovery after surgery (ERAS) in patients with diabetic foot ulcer

Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P < 0.001) and lower hospital costs (CNY 62,165.27 vs. CNY 118,326.84; P < 0.001), as well as a higher patient satisfaction score and Barthel Index score (P < 0.05). Additionally, we found a lower APAIS score, incidence of DVT, and circumference reduction in lower limbs in the ERAS group compared to the non-ERAS group (P < 0.05). In comparison, the wound healing time, nutritional status, and pain levels of participants in both groups showed no significant difference (P > 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures.Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation,...

Nursing Palliative Care for Elderly Surgical Patients: A Scoping Review

Introduction: The discussion on palliative care in high-tech environments and interventional practice represents one of the various aspects to be considered in the challenge of providing a continuum of wellness in living and dying for the elderly. Objective: To map and identify the existing works in the literature on nursing actions that focus on palliative care for elderly patients in surgical hospitalization settings. Materials and methods: This scoping review was conducted on eight databases, following the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Review-Scoping Review guidelines. The following descriptors were used: nursing care; palliative care; elderly; surgery. The inclusion criteria were the following: primary research, systematic reviews, meta-analyses, and clinical trials. The search was performed in three stages: database listing / pilot test; broad search/application of the “PCC” strategy (population, concept, context); and full reading of the content. A total of 509 productions were retrieved and then managed using the Rayyan® software, of which 13 studies were selected. The protocol was registered in the Open Science Framework. Results: The total population consisted of 10,417 people aged from 60 to 109. The most frequent interventions included the physical dimension, for symptomatic control; the cultural dimension, in which the dilemmas present in an environment with a high expectation for recovery and rigid interventionist protocols were highlighted, as well as the communication dimension, which is a basic tool of palliative care. Conclusions: Elderly people with serious conditions can benefit from palliative care in the perioperative setting. However, there is a need for training nurses in pain management, empowerment to participate in ethical decisions, and training for better communication. It should be noted that evidence on interventions to improve palliative care is still limited by methodological flaws, so rigorous evaluations are needed to measure significant results for patients and care.

Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial.

Few studies report outcomes for enhanced recovery pathways in ambulatory anorectal surgery. We hypothesize that an ambulatory anorectal enhanced recovery pathway with multimodal analgesia can reduce postoperative opioid use. To compare postoperative opioid use in patients undergoing ambulatory anorectal surgery who receive multimodal analgesia vs. standard of care without multimodal analgesia. A prospective randomized trial of patients undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Urban teaching hospital. Adults aged 18 to 70 undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Multimodal enhanced recovery pathway including pre- and postoperative non-opioid analgesia with oral acetaminophen, gabapentin and ketolorac. Primary endpoint was oral opioid use during the first postoperative week. Secondary endpoints included maximum pain and nausea scores, adverse events and emergency room or hospital admissions during the first 30 days postoperatively. Of the 109 enrolled patients, 20 were lost to follow-up. The remaining 89 patients had a median age of 38 (range, 20-67) years and included 41 (46%) females. There were no significant differences between the enhanced recovery protocol (Arm E) and non-enhanced recovery protocol (Arm NE) groups in terms of preoperative and surgical characteristics. The study primary endpoint, oral MME use during the first week, was significantly higher among patients in the NE arm (79 mg; range, 0-600) than patients in the E arm (8 mg; range, 0-390) (p = 0.002). On subgroup analysis, both fistula and hemorrhoid surgery patients assigned to the NE arm took significantly higher oral MME in the first week than patients in the E arm. There was no significant difference in secondary endpoints. Patients and providers were not blinded. Our findings are limited to hemorrhoid and fistula surgery and may not be applicable to other anorectal procedures. Enhanced recovery protocols including multimodal analgesia should be used in elective anal fistula and hemorrhoid surgery to decrease postoperative opioid use. See Video Abstract . ClinicalTrials.gov ID NCT03738904.

Rigid Sternal Fixation and Enhanced Recovery for Opioid-Free Analgesia After Cardiac Surgery

BackgroundWe evaluated the individual contributions of rigid-plate fixation (RPF) and an enhanced recovery protocol (ERP) on postoperative pain, opioid use, and other outcomes after median sternotomy as they were sequentially adopted into practice. MethodsThis single-center, retrospective, case-cohort study compared outcomes between median sternotomy patients (all comers) who underwent operation before implementation of RPF or ERP (“controls”), patients closed with RPF before ERP implementation (“RPF-only”), and patients managed with RPF and ERP during early “RPF+ERP-2020” and late “RPF+ERP-2022” implementation. ResultsThe analysis included 608 median sternotomy patients (mean age, 65.7 ± 10.8 years; 29.6% women). Of those, 59.2% were isolated coronary artery bypass grafting, 7.7% were isolated valve procedures, and the rest were mixed/concomitant procedures. Median in-hospital, postoperative opioid administration was 172.5 morphine milligram equivalents (MMEs) in the control cohort vs 0 MMEs for RPF+ERP-2022 (P < .0001), despite similar or slightly reduced patient-reported pain scores. The proportion of patients discharged directly to home was 66.2% for controls, 79.6% for RPF-only (P = .010), and 93.5% for RPF+ERP-2022 (P < .0001). Median opioids prescribed at discharge were 600 MMEs for controls and 0 for RPF+ERP-2020 and RPF+ERP-2022 (P < .0001). At discharge, 86.7% of RPF-only patients received prescription opioids vs 5% in RPF+ERP-2020 and 4.3% RPF+ERP-2022 (P < .0001). These outcomes occurred without increased readmissions. ConclusionsSystematic implementation of RPF and ERP was associated with a significant and clinically meaningful decrease in opioid use in this large, real-world patient population.

ASO Visual Abstract: Enhanced Recovery Protocol Versus Conventional Care in Patients Undergoing Esophagectomy for Cancer-Advantages in Clinical and Patient-Reported Outcomes.

ASO Visual Abstract: Enhanced Recovery Protocol Versus Conventional Care in Patients Undergoing Esophagectomy for Cancer-Advantages in Clinical and Patient-Reported Outcomes.

Hot But Not Cold Water Immersion Mitigates the Decline in Rate of Force Development following Exercise-Induced Muscle Damage.

In recent years, there has been significant advancement in the guidelines for recovery protocols involving heat or cold water immersion. Yet, comparison between the effects of hot and cold water immersion on key markers of neuromuscular recovery following exercise-induced muscle damage (EIMD) is lacking. Thirty physically active males completed an individualized and tailored EIMD protocol immediately followed by one of the following recovery interventions: cold water immersion (11 °C, CWI11), hot water immersion (41 °C, HWI41) or warm-bath control (36 °C, CON36). Gastrointestinal temperature was tracked throughout HWI41. Knee extensors' maximal isokinetic strength [peak torque (Tpeak)] and explosive strength [late-phase rate of force development, (RFD100-200)] were measured prior to EIMD (pre-), 24 h (post-24 h) and 48 h (post-48 h) post-EIMD. In addition, pressure pain threshold (PPT) was measured to quantify the recovery from muscle soreness. Surface electromyography signals (sEMG) from the vastus lateralis were captured to extract the rates of electromyography rise (REMGR) and the spectral power in the low-frequency band. At post-48 h, Tpeak returned to baseline values following both CWI11 (-8.3 ± 6.8 %, p = 0.079) and HWI41 (-1.4 ± 4.1%, p = 1). In contrast, RFD100-200 (-2.3 ± 29.3%, p = 1) and PPT (+5.6 ± 14.6%, p = 1) returned to baseline values at post-48 h only following HWI41. Spectral analysis of the sEMG signal revealed that the low-frequency band was significantly increased following CWI11 (+9.0 ± 0.52%, p = 0.012). REMGR was unchanged regardless of the condition (all p > 0.05). A single session of HWI41, rather than CWI11, improved the recovery of the late-phase rate of force development following EIMD in physically active males. This suggests that in athletic contexts where a rapid force development is a key performance determinant, hot bath should be preferred over cold bath.

[Translated article] Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway

IntroductionThere is an increase in degenerative arthropathies because of the increase in the longevity of world's population, making primary knee arthroplasties a procedure to recover quality of life without pain. There are factors associated with the length of hospital stay after this procedure. ObjectiveTo determine the risk factors influencing the hospital stay during the postoperative period of patients undergoing primary total knee arthroplasty with an enhanced recovery after surgery protocol (ERAS). MethodsA retrospective study is carried out on patients undergoing primary total knee arthroplasty at an University Hospital in the period 2017–2020 using the ERAS protocol, during which 957 surgeries were performed. ResultsAverage age of 71.7±8.2years, 62.4% were women and the 77.3% were classified as ASA II. The significantly associated factors to an increased length of stay are: age (p=.001), ASA scale (p=.04), day of surgery (p<.001), blood transfusion (p<.001), postoperative haemoglobin level at 48–72h (p<.001), the time of first postoperative mobilisation to ambulate and climb stairs (p<.001), the need for analgesic rescues (p=.003), and the presence of postoperative nausea and vomiting (p=.008). ConclusionsThere are statistically significant and clinically relevant factors associated with hospital stay. Determining these factors constitutes an advantage in hospital management, in the development of strategies to improve and optimise the quality of care and available health resources.

Enhanced Recovery after Surgery Protocol (ERAS) versus Standard Protocol for Undergoing Radical Cystectomy in an Egyptian Population

Abstract Background bladder cancer has been one of the commonest cancer. The gold standard for treatment of muscle invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy and associated with considerable morbidity and mortality and healthcare cost. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures. Aim and Objectives The aim of this study was to compare between the standard preoperative bowel preparation (SP) and ERAS protocol in terms of postoperative length of stay (LOS) and postoperative morbidity. Subjects and Methods This was a prospective randomized study was conducted in Ain shams university hospital – Alexandria university hospital involving fifty (50) patients were randomly divided into two equal groups twenty-Five (25) patient in group A follow ERAS protocol and twenty-Five (25) patients in group B following standard protocol. The duration of the study ranged from 6-12 months. Results There was statistically significant difference found between group A and group B regarding the studied parameters ( Readmission in 30 days, Ileus, Vomiting, and UTI) while there was no statistically significant difference between them regarding (early mobilization, urine leakage, dehesince and DVT), there was no statistically significant difference found between group A and group B regarding (Length of stay). Conclusion In patients undergoing radical cystectomy, enhanced recovery protocol is considered as a safe procedure and not associated with any increase in intraoperative and postoperative complications compared to standard protocol. The length of hospital stay was shorter in ERAS group.

Exercise and recovery after surgery in patients with breast cancer: An analysis of the literature

This review explores the impact of exercise on post-surgical recovery in breast cancer patients. Breast cancer, the most prevalent cancer globally, necessitates treatments beyond conventional modalities such as surgery, chemotherapy, radiotherapy, and immunotherapy. While exercise as an adjuvant therapeutic tool is not novel, it is generally accepted for improving cancer outcomes. Yet, it is not included in current treatment guidelines. This study reviews literature using the FACT-B (Functional Assessment of Cancer Therapy – Breast) tool to evaluate quality of life in breast cancer patients undergoing exercise interventions post-surgery. Despite mixed results, with some studies showing significant improvements and others indicating no notable benefits, the general consensus suggests potential advantages of integrating structured exercise programs into recovery protocols. Standardizing the use of quality of life measures like FACT-B could enhance future research and clinical practices, leading to more effective patient care strategies.