Enhanced Recovery After Surgery Protocols

Efficacy and Safety of Enhanced Recovery After Surgery (ERAS) Protocols for Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative disease (LDD).

METHODS

Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Clinical Trials.gov, etc. were searched from inception to October 2023. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing ERAS program with traditional protocol of MIS-TLIF for LDD were included.

RESULTS

A total of 11 studies were included for final analysis. The pooled results of RCTs showed that compared with MIS-TLIF, the ERAS program used in MIS-TLIF could reduce the length of hospital stay, operation time, intraoperative blood loss and incidence of postoperative complications, decrease visual analog scale and Oswestry Disability Index (ODI) score, and improve patient satisfaction (P < 0.05). However, the pooled results of CSs revealed no statistical difference in the ODI score, fusion rate, operation time, and incidence of complications between the two groups (P > 0.05).

CONCLUSIONS

Compared with MIS-TLIF, the ERAS program used in MIS-TLIF could effectively shorten the length of hospital stay, operation time, decrease intraoperative blood loss, and incidence of postoperative complications, promote postoperative pain relief, functional recovery, and patient satisfaction. This study confirmed the value of ERAS in MIS-TLIF surgery and provided evidence for the standardization of ERAS in the future. Considering that the pooled results of RCTs and CSs are not completely consistent, more high-quality studies are needed to confirm these conclusions.

Enhanced recovery after robotic ventral hernia repair: factors associated with overnight stay in hospital

PURPOSE

Enhanced recovery after surgery (ERAS) protocols lead to reduced post-operative stay and improved outcomes after most types of abdominal surgery. Little is known about the optimal post-operative protocol after robotic ventral hernia repair (RVHR), including the potential limits of outpatient surgery. We report the results of an ERAS protocol after RVHR aiming to identify factors associated with overnight stay in hospital, as well as patient-reported pain levels in the immediate post-operative period.

METHODS

This was a prospective cohort study of consecutive patients undergoing RVHR. Patients were included in a prospective database, registering patient characteristics, operative details, pain and fatigue during the first 3 post-operative days and pre- and 30-day post-operative hernia-related quality of life, using the EuraHS questionnaire.

RESULTS

A total of 109 patients were included, of which 66 (61%) underwent incisional hernia repair. The most performed procedure was TARUP (robotic transabdominal retromuscular umbilical prosthetic hernia repair) (60.6%) followed by bilateral roboTAR (robotic transversus abdominis release) (19.3%). The mean horizontal fascial defect was 4.8 cm, and the mean duration of surgery was 141 min. In total, 78 (71.6%) patients were discharged on the day of surgery, and factors associated with overnight stay were increasing fascial defect area, longer duration of surgery, and transverse abdominis release. There was no association between post-operative pain and overnight hospital stay. The mean EuraHS score decreased significantly from 38.4 to 6.4 (P < 0.001).

CONCLUSION

An ERAS protocol after RVHR was associated with a high rate of outpatient procedures with low patient-reported pain levels.

Global Perceptions on ERAS® in Pancreatoduodenectomy

BACKGROUND

Uptake of ERAS® pathways for pancreatic surgery have been slow and impacted by low compliance.

OBJECTIVE

To explore global awareness, perceptions and practice of ERAS® peri-pancreatoduodenectomy (PD).

METHODS

A structured, web-based survey (EPSILON) was administered through the ERAS® society and IHPBA membership.

RESULTS

The 140 respondents included predominantly males (86.4%), from Europe (45%), practicing surgery (95%) at academic/teaching hospitals (63.6%) over a period of 10-20 years (38.6%). Most respondents identified themselves as general surgeons (68.6%) with 40.7% reporting an annual PD volume of 20-50 cases, practicing post-PD clinical pathways (37.9%), with 31.4% of respondents auditing their outcomes annually. Reduced medical complications, cost and hospital length of stay, and improved patient satisfaction were perceived benefits of compliance to enhancing-recovery. Multidisciplinary co-ordination was considered the most important factor in the implementation and sustainability of peri-PD ERAS® pathways, while reluctance to change among health care practitioners, difficulties in data collection and audit, lack of administrative support, and recruitment of an ERAS® dedicated nurse were reported to be important barriers.

CONCLUSIONS

The EPSILON survey highlighted global clinician perceptions regarding the benefits of compliance to peri-PD ERAS®, the importance of individual components, perceived facilitators and barriers, to the implementation and sustainability of these pathways.

Effect of Enhanced Recovery After Surgery Protocol on Postoperative Outcomes of Women Undergoing Abdominal Hysterectomy

Background

Enhanced recovery after surgery protocol is a standardized, multidisciplinary approach for shorter hospital stay without negatively affecting patient outcomes. The aim of this research was to evaluate the effect of enhanced recovery after surgery protocol on postoperative outcomes of women undergoing abdominal hysterectomy.

Design

A quasi-experimental design was adopted to fulfil the aim of this research.

Setting

The research was conducted at Obstetric and Gynecological Department in Benha University Hospital.

Sample

A purposive sample of 148 women undergoing abdominal hysterectomy divided into two groups.

Data collection

Three tools were used: Tool (I) structured questionnaire sheet. Tool (II) post-operative pain assessment scale (numerical rating scale). Tool (III) post-operative outcomes assessment sheet.

Results

There was a highly statistically significant difference between the studied groups regarding all postoperative outcomes (p = .000). The women in the study group experienced less mean score of pain compared to those in control group on both 2nd and 3rd day after surgery. Also, there was a statistically significant difference between the studied groups regarding postoperative complication and readmission (p = .000).

Conclusion

Women undergoing abdominal hysterectomy who received enhanced recovery after surgery protocol had better postoperative outcomes than women who received routine perioperative care.

Health Professionals Perception of Enhanced Recovery After Surgery: A Scoping Review

PURPOSE

The Enhanced Recovery After Surgery (ERAS) program is currently poorly implemented by healthcare workers. Furthermore, several inhibiting and supporting factors for this implementation have been discovered to influence healthcare workers' perception of the program. This study aims to investigate the perception of healthcare workers regarding the ERAS program.

DESIGN

A scoping review in a systematic manner.

METHODS

A systematic search was performed using six databases: PubMed, ScienceDirect, SCOPUS, EBSCO, Proquest, and Sage Journals, from August 2011 to August 2021. The data was extracted using an excel worksheet, and the results obtained were presented descriptively.

FINDINGS

This study selected a total of 10 articles, where both qualitative and quantitative methods were used to discuss the perceptions of healthcare workers about ERAS.

CONCLUSIONS

Based on this study's findings, not all healthcare workers have a good perception of ERAS. The implementation of ERAS is often hindered by several factors, including resistance to change and lack of knowledge about the program. However, good teamwork and support from hospital management can support the program's implementation.

Enhanced Recovery After Surgery Protocol for Oblique Lumbar Interbody Fusion

BACKGROUND

Enhanced recovery after surgery (ERAS) attempts to decrease the surgical stress response to minimize postoperative complications and improve functional rehabilitation after major surgery, but it has not been widely utilized in spinal surgery. The study reported the development and implementation of an ERAS pathway for patients with lumbar spondylolisthesis undergoing oblique lumbar interbody fusion (OLIF).

METHODS

Seventy-six patients underwent OLIF surgery from January 2018 to December 2019 were enrolled. Thirty-seven patients were included in pre-ERAS group and 39 patients were included in ERAS group. Major outcomes that were collected included demographics, comorbidities, blood loss, operative time, length of hospital stay (LOS), cost, time to walk, blood transfusion, complications, Visual analogue scale (VAS) scores, Oswestry Disability Index (ODI) and factors affecting LOS were also recorded. The ERAS pathway and compliance with pathway elements were also recorded.

RESULTS

After ERAS implementation, the blood loss, LOS, the financial costs, and the time to walk were significantly lower in the ERAS group compared to the pre-ERAS group (all P < 0.05). There was no significant difference in operative time, complications, and blood transfusion between both groups. VAS and ODI between the two groups showed a significant difference during postoperative 3 days and postoperative 1 month (both P < 0.05). The preoperative time to walk was significant factors for hospital stay at the final follow-up.

CONCLUSION

Institution of an ERAS protocol for OLIF surgery appears to accelerate functional recovery, reduce length of stay and financial costs.

Effect of Wound Contamination on Outcomes of Abdominal Wall Reconstruction Using Acellular Dermal Matrix: 14-Year Experience with More than 700 Patients

BACKGROUND

Patients with contaminated/dirty-infected defects are at high risk for postoperative complications after abdominal wall reconstruction (AWR). We evaluated outcomes of AWR using acellular dermal matrix (ADM) for mesh reinforcement and identified predictors of hernia recurrence (HR), surgical site occurrences (SSOs), and surgical site infections (SSIs).

STUDY DESIGN

We conducted a retrospective cohort study of patients who underwent AWR using ADM, from March 2005 to June 2019. Outcomes were compared between Centers for Disease Control and Prevention (CDC) wound classifications. The primary outcome measure was HR. Secondary outcomes were SSOs and SSIs.

RESULTS

We identified 725 AWRs using ADM that met the study criteria. Participants had a mean age of 60 ± 11.5 years, mean BMI of 31 ± 7 kg/m², and mean follow-up time of 42 ± 29 months. Three hundred two patients (41.6%) had clean defects, 322 patients (44.4%) had clean-contaminated defects, and 101 patients (13.9%) had contaminated/dirty-infected defects. Patients with contaminated/dirty-infected defects had an HR rate of 20.8%, SSO rate of 54.5%, and SSI rate of 23.8%. Multivariate logistic regression found that contaminated/dirty-infected defects were independent predictors of SSOs (OR 2.99; 95% CI 1.72-5.18; p < 0.0001) and SSIs (OR 2.32; 95% CI 1.27-4.25; p = 0.006), but not HR (OR 1.06; 95% CI 0.57-1.98; p = 0.859).

CONCLUSIONS

SSIs and SSOs increase as contamination levels rise, but the risk of HR does not. AWR with ADM provides safe and durable outcomes, even with increasing levels of contamination.

Utilization of and barriers to enhanced recovery pathway implementation in pediatric urology

INTRODUCTION

Enhanced Recovery Pathways (ERPs), also known as ERAS® pathways, are standardized pathways composed of 21-24 perioperative elements designed to improve post-surgical recovery. ERP has been shown to be safe and effective in children undergoing bladder reconstruction but has not been widely utilized.

OBJECTIVE

The aim of this study was to assess utilization of ERPs in pediatric urology and identify barriers to establishing these standardized pathways.

STUDY DESIGN

Pediatric urologists who were members of the Societies for Pediatric Urology (SPU) were surveyed regarding their familiarity with standardized ERPs, current use of ERP elements, and encountered or perceived barriers to standardized ERP implementation. Willingness to implement ERP elements in a child undergoing bladder reconstruction was assessed with a 5-point Likert scale. Descriptive analysis was performed; Fisher's exact test was performed to assess associations between respondent demographics and ERP familiarity.

RESULTS

Of 714 distributed surveys, 113 (16%) valid responses were collected. 69% of respondents were male, 58% practiced at academic institutions, and 57% performed 1-5 bladder reconstructions a year. 61% were somewhat familiar or not familiar with standardized ERP. While 54% currently utilize individual ERP elements, only 20% have standardized pathways. Out of 24 possible ERP elements, a median of 15 elements (range 0-24) were implemented by the respondents whether they reported they were implementing ERP elements or had standardized pathways in place. 15 of 24 ERP elements were found to be nearly universally acceptable, with greater than 90% of respondents being somewhat or very willing to implement them in the presented case scenario (Summary Figure). 62% and 56% of those who currently implement ERP elements and experienced barriers noted lack of administrative/leadership support and inability to achieve consensus among pediatric colleagues, respectively, as common barriers in standardization. For those who have not attempted standardization, the most common perceived barrier was pathway unfamiliarity (48%).

DISCUSSION

Over half of respondents were not familiar with enhanced recovery pathways but were willing to implement a majority of the pathway elements, suggesting potential for ERP standardization in pediatric urology. Buy-in from colleagues and leadership would be necessary to overcome perceived barriers of standardized pathway development.

CONCLUSION

Administrative support and more widespread knowledge of ERP amongst pediatric urologists are necessary to facilitate further implementation in children undergoing bladder reconstruction.

Enhanced recovery after surgery for head and neck free flap reconstruction: A systematic review and meta-analysis

INTRODUCTION

Head and neck free flap reconstruction requires multidisciplinary and coordinated care in the perioperative setting to ensure safe recovery and success. Several institutions have introduced enhanced recovery after surgery (ERAS) protocols to attenuate the surgical stress response and improve postoperative recovery. With multiple studies demonstrating mixed results, the success of these interventions on clinical outcomes has yet to be determined.

OBJECTIVE

To evaluate the impact of ERAS protocols and clinical care pathways for head and neck free flap reconstruction.

METHODS

We searched PubMed, SCOPUS, EMBASE, and grey literature up to September 1st, 2020 to identify studies comparing patients enrolled in an ERAS protocol and control group. Our primary outcomes included hospital length of stay (LOS) and readmission. Mortality, reoperations, wound complication and ICU (intensive care unit) LOS comprised our secondary outcomes.

RESULTS

18 studies met inclusion criteria, representing a total of 2630 patients. The specific components of ERAS protocols used by institutions varied. Nevertheless, patients enrolled in ERAS protocols had reduced hospital LOS (MD -4.36 days [-7.54, -1.18]), readmission rates (OR 0.64 [0.45;0.92]), and wound complications (RR 0.41 [0.21, 0.83]), without an increase in reoperations (RR 0.65 [0.41, 1.02]), mortality (RR 0.38 [0.05, 2.88]), or ICU LOS (MD -2.55 days [-5.84, 0.74]).

CONCLUSION

There is growing body of evidence supporting the role of ERAS protocols for the perioperative management of head and neck free flap patients. Our findings reveal that structured clinical algorithms for perioperative interventions improve clinically-meaningful outcomes in patients undergoing complex ablation and microvascular reconstruction procedures.

Early Prediction of Length of Stay After Pancreaticoduodenectomy

BACKGROUND

Enhanced recovery after surgery (ERAS) is an evidence-based clinical pathway designed to standardize and optimize care. We studied the impact of ERAS and sought to identify the most important recommendations to predict shorter length of stay (LOS) after pancreaticoduodenectomy (PD).

METHODS

We retrospectively reviewed all patients undergoing PD at our institution between January 2014 and June 2018. We compared clinicopathologic outcomes for patients before and after ERAS implementation. We defined "A-recommendations" as those that were graded "strong" and had "moderate" or "high" levels of evidence. We then compared outcomes of the ERAS group with adherence to "A-recommendations" and performed a subset analysis of "A-recommendations" over the first 72 h after surgery, which we termed "early factors".

RESULTS

A total of 191 patients underwent PD during the study period. We excluded 87 patients who had minimally invasive PD (22), vascular reconstruction (53), or both (12). Of the 104 patients studied, 56 (54%) were pre-ERAS and 48 (46%) were ERAS. There were no differences in comorbidities or demographics between these groups, and morbidity, mortality, and readmission rates were also similar (P > 0.6). Median LOS was 3.5 d shorter in the ERAS group (7 versus 10.5 d, P < 0.001). Adherence to "A-recommendations" within ERAS was associated with a decreased LOS (r = -0.52 P = 0.0001). Patients with >5 "early factors" had a median LOS of 6 d, whereas patients with <5 "early factors" had a median LOS of 9 d (P = 0.008).

CONCLUSIONS

ERAS is an effective protocol that standardizes care and reduces LOS after PD. Implementation of ERAS resulted in a 3.5-day reduction in our LOS with no change in morbidity, mortality, or readmissions. Adherence to ERAS protocol "A-recommendations" and ≥5 "early factors" may be predictive of shortened LOS.

Enhanced recovery after abdominal wall reconstruction: a systematic review and meta-analysis

BACKGROUND

Enhanced recovery after surgery (ERAS) are evidence-based protocols associated with improved patient outcomes. The use of ERAS pathways is well documented in various surgical specialties. The aim of this systematic review and meta-analysis was to examine the efficacy of ERAS protocols in patients undergoing abdominal wall reconstruction (AWR).

METHODS

This systematic review and meta-analysis were reported according to PRISMA and MOOSE guidelines. The databases PubMed, EMBASE, CINAHL, Web of Science and Cochrane Library were searched for original studies comparing ERAS with standard care in patients undergoing AWR. The primary outcome was length of stay (LOS) and secondary outcomes were readmission and surgical site infection (SSI) and/or surgical site occurrences (SSO).

RESULTS

Five studies were included in the meta-analysis. All were retrospective cohort studies including 453 patients treated according to ERAS protocols, and 494 patients treated according to standard care. The meta-analysis demonstrated that patients undergoing AWR managed with ERAS had a mean 0.89 days reduction in LOS compared with patients treated with standard care (95% CI - 1.70 to - 0.07 days, p = 0.03). There was no statistically significant difference in readmission rate (OR 1.00, 95% CI 0.53 to 1.87, p = 1.00) or SSI/SSO (OR 1.19, 95% CI 0.67 to 2.11, p = 0.56) between groups.

CONCLUSIONS

The use of ERAS in patients undergoing AWR was found to significantly reduce LOS without increasing the readmission rate or SSI/SSO. Based on the existing literature, ERAS protocols should be implemented for patients undergoing AWR.

Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5–11) days] was shorter than that of the control group [8 (5–13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

Implementation of an enhanced recovery program for lower extremity bypass

OBJECTIVE

Enhanced recovery programs (ERPs) have gained wide acceptance across multiple surgical disciplines to improve postoperative outcomes and to decrease hospital length of stay (LOS). However, there is limited information in the existing literature for vascular patients. We describe the implementation and early results of an ERP and barriers to its implementation for lower extremity bypass surgery. Our intention is to provide a framework to assist with implementation of similar ERPs.

METHODS

Using the plan, do, check, adjust methodology, a multidisciplinary team was assembled. A database was used to collect information on patient-, procedure-, and ERP-specific metrics. We then retrospectively analyzed patients' demographics and outcomes.

RESULTS

During 9 months, an ERP (n = 57) was successfully developed and implemented spanning preoperative, intraoperative, and postoperative phases. ERP and non-ERP patient demographics were statistically similar. Early successes include 97% use of fascia iliaca block and multimodal analgesia administration in 81%. Barriers included only 47% of patients achieving day of surgery mobilization and 19% receiving celecoxib preoperatively. ERP patients had decreased total and postoperative LOS compared with non-ERP patients (n = 190) with a mean (standard deviation) total LOS of 8.32 (8.4) days vs 11.14 (10.1) days (P = .056) and postoperative LOS of 6.12 (6.02) days vs 7.98 (7.52) days (P = .089). There was significant decrease in observed to expected postoperative LOS (1.28 [0.66] vs 1.82 [1.38]; P = .005). Variable and total costs for ERP patients were significantly reduced ($13,208 [$9930] vs $18,777 [$19,118; P < .01] and $29,865 [$22,110] vs $40,328 [$37,820; P = .01], respectively).

CONCLUSIONS

Successful implementation of ERP for lower extremity bypass carries notable challenges but can have a significant impact on practice patterns. Further adjustment of our current protocol is anticipated, but early results are promising. Implementation of a vascular surgery ERP reduced variable and total costs and decreased total and postoperative LOS. We believe this protocol can easily be implemented at other institutions using the pathway outlined.

Enhanced recovery after spine surgery: a systematic review

OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.

Best Practice in Surgical Treatment of Malignant Head and Neck Tumors

Purpose of review: Defining the best practice of surgical care for patients affected by malignant head and neck tumors is of great importance. In this review we aim to describe the evolution of “best practice” guidelines in the context of quality-of-care measures and discuss current evidence on “best practice” for the surgical treatment of cancers of the sino-nasal tract, skull base, aero-digestive tract, and the neck.

Recent findings: Current evidence based on certain structure and outcome indicators, but mostly based on process indicators already helps defining the framework of “Best practice” for head and neck cancer surgery. However, many aspects of surgical treatment still require in-depth research.

Summary: While a framework of “Best practice” strategies already exists for the conduction of the surgical treatment of head and neck cancers, many questions still require additional research in particular in case of rare histologies in the head and neck region.

Quality assurance in head and neck cancer surgery: where are we, and where are we going?

PURPOSE OF REVIEW

The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated.

RECENT FINDINGS

Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC.

SUMMARY

Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.

Enhanced recovery after surgical repair of incisional hernias

AIM

Enhanced recovery programmes (ERPs) were developed to improve the patient's post-operative comfort and reduce post-operative morbidity after several types of major surgery including the incisional hernia repair. The aim of this review was to describe the features of ERPs in the setting for incisional hernia repair.

METHODS

The literature review was conducted until March 2019, but retrieved very few papers (n = 4) on this topic. All studies were retrospective.

RESULTS

Setting and comorbidities of incisional hernia patients are of such importance in many cases that prehabilitation (including tobacco use cessation, management of obesity, diabetes or malnutrition) should play a greater role compared with other specialties. The other peri-operative measures are similar to other specialties but their implementation was very heterogeneous in the published studies.

CONCLUSIONS

Like in other surgeries, ERPs were feasible and probably efficient to improve the post-operative course of incisional hernia patients. But the level of evidence remains low.

Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics

BACKGROUND

Platelet-rich plasma (PRP) injections have recently been marketed as a form of autologous cell therapy under the banner of regenerative medicine despite limited scientific evidence on its use for treating erectile dysfunction (ED).

AIM

To evaluate the evidence on PRP treatment for ED and determine the current trends in provision of this treatment.

METHODS

A critical review of the literature on PRP using the PubMed and Embase databases.

OUTCOMES

This narrative review focuses on the clinical use of, regulation of, and evidence for PRP in the treatment of ED.

RESULTS

There is a limited number of published peer-reviewed articles demonstrating clinical outcomes pertaining to the use of PRP for ED in human. The technique of PRP application for ED is currently patented, with a global total of 683 registered clinics. The majority of PRP clinics do not provide cost estimates on their websites.

CONCLUSION

Despite a global presence of PRP clinics and ongoing active marketing and public interest in regenerative medicine, no scientific evidence has been published to establish an evidence-based risk-benefit profile for PRP use for ED in humans. Given the limited data on clinical efficacy and potential harmful side effects, there is a need for a proper clinical trial to examine the role of PRP before it is accepted as standard of care in treatment for ED. Scott S, Roberts M, Chung E. Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics. Sex Med Rev 2019;7:306-312.

The Effects of Locally Administered Morphine Over the Dura on Postoperative Morphine Consumption and Pain After Lumbar Disc Surgery: A Prospective, Randomised, Double-Blind and Placebo-Controlled Study

Objective

Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h.

Methods

The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively.

Results

Morphine consumption, pain scores and opioid-related side effects were similar among the groups.

Conclusion

Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects.

Effect of postoperative coffee consumption on gastrointestinal function after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials

Coffee is believed to prevent postoperative ileus. This systematic review and meta-analysis was undertaken to determine the effectiveness of coffee consumption in stimulating gastrointestinal function after abdominal surgery. A number of databases for randomized controlled trials comparing coffee consumption following abdominal surgery versus water drinking or no intervention were searched. Cochrane’s Risk of Bias tool was used to assess risk of bias in included studies. Six trials involving 601 participants were included. All studies had high risk of performance bias. Three studies had an unclear risk of selection bias. Postoperative coffee consumption reduced time to first defecation (mean difference (MD), −9.98 hours; 95% CI, −16.97 to −2.99), time to first flatus (MD, −7.14 hours; 95% CI, −10.96 to −3.33), time to first bowel sound (MD, −4.17 hours; 95% CI, −7.88 to −0.47), time to tolerance of solid food (MD, −15.55 hours; 95% CI, −22.83 to −8.27), and length of hospital stay (MD, −0.74 days; 95% CI, −1.14 to −0.33). Benefits increased with increasing complexity of the procedure. None of the included studies reported adverse events associated with coffee consumption. Postoperative coffee consumption is effective and safe for enhancing the recovery of gastrointestinal function after abdominal surgery.