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Lele AV, Moreton EO, Mejia-Mantilla J, Blacker SN. The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis. J Neurosurg Anesthesiol 2024:00008506-990000000-00128. [PMID: 39298547 DOI: 10.1097/ana.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/24/2024] [Indexed: 09/22/2024]
Abstract
In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (-2.06; 95% CI, -2.47 to -1.64 d) and HIC (-0.99; 95% CI, -1.28 to -0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.
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Affiliation(s)
- Abhijit V Lele
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | | | | | - Samuel N Blacker
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
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Wang L, Ge H, Xiong L, Xie A, Wu X, Huang J, Liu T, Li X, Jia Y, Liao J, Wang H, Lin Y, Gan X. Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) for benign ovarian cysts is safe and feasible in same-day discharge: a retrospective cohort study. BMC Womens Health 2024; 24:514. [PMID: 39272028 PMCID: PMC11401259 DOI: 10.1186/s12905-024-03352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Advances in minimally invasive surgery and the development of Enhanced Recovery After Surgery (ERAS) have favored the spread of day-surgery programs. Even though Vaginal natural orifice transvaginal endoscopic surgery (vNOTES) is accepted as an innovative treatment for benign ovarian cysts that is rapidly gaining recognition worldwide, the safety and feasibility of same-day surgery (SDS) have yet to be established. OBJECTIVE This study aimed to evaluate the safety and feasibility of day surgery compared to inpatient surgery of patients undergoing vNOTES for benign ovarian cysts by determining perioperative outcomes. MATERIALS AND METHODS The study consisted of 213 patients who underwent vNOTES for ovarian cystectomy at a single institution from January 2020 to November 2022. Based on the hospital stay, patients were classified into the same-day surgery group (SDSG) and the inpatient surgery group (ISG); after data processing and screening considering the balance of the two groups, SDSG has 83 samples(n = 83), and ISG has 113 samples(n = 113). The patient's demographic characteristics and follow-up data were collected during the perioperative period by doctors and nurses for medical tracking and analysis purposes and 1-month postoperatively by doctors in charge of their operation. Independent sample t-tests were performed to verify if there was any major difference between these two groups for continuous data like age, BMI, and cyst diameter, and Pearson's chi-squared tests were used to test whether there was a major difference between these two groups for categorical data like cyst count, abdominal surgery history and whether their cyst is bilateral ovarian cysts or not. The association between exhaust time and postoperative characteristics and the association between levels of pain and postoperative characteristics were further analyzed to unveil the confounding factors contributing to the same-day discharge method's quick recovery nature. RESULTS Upon performing propensity score matching, 196 patients were finally enrolled in this study for the matched comparison, including 83(42.3%) patients in the SDSG and 113(57.7%) patients in the ISG. There was no statistical difference between the two groups in terms of duration of operation (85.0 ± 41.5 min vs. 80.5 ± 33.5 min), estimated blood loss (27.7 ± 28.0 ml vs. 36.3 ± 33.2 ml), preoperative hemoglobin levels (128.8 ± 13.2 g/L vs. 128.6 ± 14.0 g/L), postoperative hemoglobin difference at 24 h (16.5 ± 15.4 g/L vs. 19.3 ± 9.1 g/L), pelvic adhesions (42 (50.6%) vs. 47 (41.6%)), and postoperative complications (7(8.4%) vs. 4(3.5%)). The SDSG group showed less time of feeding/off-bed/exhaust/urination after surgery, shorter hospitalization duration, a lower postoperative 6-hour pain score, and a lower incidence of analgesic drug use. Multiple linear regression analysis showed that advancing the time of postoperative off-bed activity and feeding reduced the postoperative exhaust time by 0.34 (95% CI: 0.185-0.496, 0.34 h, p < 0.001) and 0.299(95% CI: 0.158-0.443, 0.229 h, p = 0.036) hours. In addition, Ordinal logistic regression revealed a correlation between pain scores and bilaterality of cyst, increasing about 25.98 times the risk of pain levels when ovarian cysts are bilateral (OR: 26.98, 95% CI: 1.071-679.859, P = 0.045). CONCLUSION In this pilot study, same-day discharge after vaginal natural orifice transvaginal endoscopic ovarian cystectomy is safe and feasible. The vNOTES for ovarian cystectomy combined with the same-day discharge shorten the exhaust time and duration of hospitalization, reduce postoperative pain, and lower the use incidence of analgesic drugs.
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Affiliation(s)
- Lulu Wang
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huisheng Ge
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liling Xiong
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Aijie Xie
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xian Wu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Huang
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tianjiao Liu
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Li
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yujian Jia
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianmei Liao
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui Wang
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yonghong Lin
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xiaoqin Gan
- Department of Gynecology and Obstetrics, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Clet A, Guy M, Muir JF, Cuvelier A, Gravier FE, Bonnevie T. Enhanced Recovery after Surgery (ERAS) Implementation and Barriers among Healthcare Providers in France: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:436. [PMID: 38391811 PMCID: PMC10887527 DOI: 10.3390/healthcare12040436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
The implementation of Enhanced Recovery After Surgery (ERAS) is a challenge for healthcare systems, especially in case of patients undergoing major surgery. Despite a proven significant reduction in postoperative complications and hospital lengths of stay, ERAS protocols are inconsistently used in real-world practice, and barriers have been poorly described in a cohort comprising medical and paramedical professionals. This study aims to assess the proportion of French healthcare providers who practiced ERAS and to identify barriers to its implementation amongst those surveyed. We conducted a prospective cross-sectional study to survey healthcare providers about their practice of ERAS using an online questionnaire. Healthcare providers were contacted through hospital requests, private hospital group requests, professional corporation requests, social networks, and personal contacts. The questionnaire was also designed to explore barriers to ERAS implementation. Identified barriers were allocated by two independent assessors to one of the fourteen domains of the Theoretical Domains Framework (TDF), which is an integrative framework based on behavior change theories that can be used to identify issues relating to evidence on the implementation of best practice in healthcare settings. One hundred and fifty-three French healthcare providers answered the online questionnaire (76% female, median age 35 years (IQR: 29 to 48)). Physiotherapists, nurses, and dieticians were the most represented professions (31.4%, 24.2%, and, 14.4%, respectively). Amongst those surveyed, thirty-one practiced ERAS (20.3%, 95%CI: 13.9 to 26.63). Major barriers to ERAS practice were related to the "Environmental context and resources" domain (57.6%, 95%CI: 49.5-65.4), e.g., lack of professionals, funding, and coordination, and the "Knowledge" domain (52.8%, 95%CI: 44.7-60.8), e.g., ERAS unawareness. ERAS in major surgery is seldom practiced in France due to the unfavorable environment (i.e., logistics issues, and lack of professionals and funding) and a low rate of procedure awareness. Future studies should focus on devising and assessing strategies (e.g., education and training, collaboration, institutional support, the development of healthcare networks, and leveraging telehealth and technology) to overcome these barriers, thereby promoting the wider implementation of ERAS.
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Affiliation(s)
- Augustin Clet
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
| | - Marin Guy
- Centre Aquitain Du Dos, Hôpital Privé Saint-Martin, F-33600 Pessac, France
| | - Jean-François Muir
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, F-76000 Rouen, France
| | - Antoine Cuvelier
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, F-76000 Rouen, France
| | - Francis-Edouard Gravier
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
| | - Tristan Bonnevie
- Université Rouen Normandie, Normandie Univ, GRHVN UR 3830, F-76000 Rouen, France
- ADIR Association, Rouen University Hospital, F-76000 Rouen, France
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Yanada BA, Dias BH, Corcoran NM, Zargar H, Bishop C, Wallace S, Hayes D, Huang JG. Implementation of the enhanced recovery after surgery protocol for radical cystectomy patients: A single centre experience. Investig Clin Urol 2024; 65:32-39. [PMID: 38197749 PMCID: PMC10789537 DOI: 10.4111/icu.20230282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The enhanced recovery after surgery (ERAS) protocol for radical cystectomy aims to facilitate postoperative recovery and hasten a return to normal daily activities. This study aims to report on the perioperative outcomes of implementation of an ERAS protocol at a single Australian institution. MATERIALS AND METHODS We identified 73 patients with pT1-T4 bladder cancer who underwent open radical cystectomy at Western Health, Victoria between June 2016 and August 2021. A retrospective analysis of a prospectively maintained database was performed. Perioperative outcomes included length of hospital stay, nasogastric tube requirement and duration of postoperative ileus. RESULTS The median age was 74 years (interquartile range [IQR] 66-78) for the ERAS group and 70 years (IQR 65-78) for the pre-ERAS group patients. All patients in each group underwent ileal conduit formation. The median length of hospital stay was 7.0 days (IQR 7.0-9.3) for the ERAS group and 12.0 days (IQR 8.0-16.0) for the pre-ERAS group (p=0.003). Within the ERAS group, 25.0% had a postoperative ileus, and 25.0% had a nasogastric tube inserted, compared with 64.9% (p=0.001) and 45.9% (p=0.063) respectively within pre-ERAS group. The median bowel function recovery time, defined as duration from surgery to first bowel action, was 5.0 days (IQR 4.0-7.0) in the ERAS group and 7.5 days (IQR 5.0-8.5) in the pre-ERAS group (p=0.016). CONCLUSIONS Implementation of an ERAS protocol is associated with a reduction in hospital length of stay, postoperative ileus and bowel function recovery time.
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Affiliation(s)
- Brendan A Yanada
- Department of Urology, Western Health, Footscray, VIC, Australia.
| | - Brendan H Dias
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Niall M Corcoran
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Homayoun Zargar
- Department of Urology, Western Health, Footscray, VIC, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Conrad Bishop
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - Sue Wallace
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - Diana Hayes
- Department of Urology, Western Health, Footscray, VIC, Australia
| | - James G Huang
- Department of Urology, Western Health, Footscray, VIC, Australia
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Yoon SH, Lee HJ. Challenging issues of implementing enhanced recovery after surgery programs in South Korea. Anesth Pain Med (Seoul) 2024; 19:24-34. [PMID: 38311352 PMCID: PMC10847003 DOI: 10.17085/apm.23096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/25/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
This review discusses the challenges of implementing enhanced recovery after surgery (ERAS) programs in South Korea. ERAS is a patient-centered perioperative care approach that aims to improve postoperative recovery by minimizing surgical stress and complications. While ERAS has demonstrated significant benefits, its successful implementation faces various barriers such as a lack of manpower and policy support, poor communication and collaboration among perioperative members, resistance to shifting away from outdated practices, and patient-specific risk factors. This review emphasizes the importance of understanding these factors to tailor effective strategies for successful ERAS implementation in South Korea's unique healthcare setting. In this review, we aim to shed light on the current status of ERAS in South Korea and identify key barriers. We hope to encourage Korean anesthesiologists to take a leading role in adopting the ERAS program as the standard for perioperative care. Ultimately, our goal is to improve the surgical outcomes of patients using this proactive approach.
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Affiliation(s)
- Soo-Hyuk Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Elsenosy AM, Hassan E, Abdelgader M, Elgamily OS, Hegazy A. Enhanced Recovery After Surgery (ERAS) Approach: A Medical Complex Experience. Cureus 2023; 15:e51208. [PMID: 38161529 PMCID: PMC10756688 DOI: 10.7759/cureus.51208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary approach aimed at reducing organ failure and mitigating stress reactions in surgery patients. This investigation sought to assess available data concerning the benefits of ERAS protocols in improving patient outcomes for individuals undergoing significant colorectal surgery. METHODS The study involved 65 patients who underwent colectomy and lower anterior resection for rectal cancers. Patients were divided into three groups: Group 1 comprised 22 patients enrolled retrospectively who received the traditional protocol; Group 2 consisted of 20 patients enrolled prospectively who received the ERAS protocol; and Group 3 included 23 patients enrolled retrospectively who received the ERAS protocol. Each patient underwent a comprehensive history, physical examination, laboratory testing, computed tomography, MRI, and chest radiography. RESULTS Hospital stay durations were significantly shorter in both ERAS groups during the first and second cycles compared to the non-ERAS group (P<0.001, <0.001), with no significant difference between ERAS groups in either cycle. Delayed intestinal motility was significantly more pronounced in the non-ERAS group compared to ERAS groups in both cycles (P=0.005), with only five (22.7%) cases reported in the non-ERAS group. CONCLUSION ERAS implementation in the perioperative management of colorectal surgery patients is associated with improved outcomes and shorter recovery times. Implementation of ERAS in hospitals is feasible and beneficial.
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Affiliation(s)
| | - Eslam Hassan
- Trauma and Orthopaedics, Poole General Hospital, Poole, GBR
| | | | - Omar S Elgamily
- General Surgery and Surgical Oncology, Maadi Armed Forces Medical Complex, Cairo, EGY
| | - Abdelhares Hegazy
- General Surgery and Surgical Oncology, Maadi Armed Forces Medical Complex, Cairo, EGY
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Zhang W, Wang F, Qi S, Liu Z, Zhao S, Zhang N, Ping F. An evaluation of the effectiveness and safety of the Enhanced Recovery After Surgery (ERAS) program for patients undergoing colorectal surgery: a meta-analysis of randomized controlled trials. Wideochir Inne Tech Maloinwazyjne 2023; 18:565-577. [PMID: 38239585 PMCID: PMC10793149 DOI: 10.5114/wiitm.2023.131426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/29/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The Enhanced Recovery After Surgery (ERAS) protocol reduces surgery-related stress and hospital stays for complicated surgical patients. It speeds recovery, reduces readmissions, and lowers morbidity and mortality. However, the efficacy of ERAS in colorectal surgery is still debatable. Aim To evaluate the effectiveness and safety of the ERAS program for patients undergoing colorectal surgery. Material and methods PRISMA-compliant searches were performed on Medline, Embase, PubMed, the Web of Sciences, and the Cochrane Database up to March 2023. The included articles compared ERAS protocol results for colorectal surgery patients to those of conventional care. RevMan was used for the meta-analysis, and the Cochrane RoB Tool was used to assess the study quality. Results The meta-analysis included 12 randomized controlled trials with a total of 1920 participants. There were 880 individuals in ERAS care and 1002 in conventional care. Weighted mean difference: -1.07 days, 95% confidence interval (CI): -1.53 to -0.60, p = 0.00001), overall length of stay: -4.12 days, 95% CI: -5.86 to -2.38, p = 0.00001), and post-operative hospital stay: -1.91 days, 95% CI: -4.73 to -0.91, p = 0.00001). Readmissions were higher in the ERAS group than in the normal care group (odds ratio (OR) = 1.20, 95% CI: 0.82 to 1.75, p = 0.35). Post-operative complications were lower in the ERAS care group (OR = 0.42; 95% CI: 0.27 to 0.65, p < 0.0001) and SSIs (OR = 0.75; 95% CI 0.52 to 1.08, p = 0.00001) than in the routine care group. Conclusions Care provided in line with the ERAS protocol has been shown to be successful and beneficial for patients following colorectal surgery, because it minimizes post-operative problems and length of hospital stay, and improves outcomes.
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Affiliation(s)
- Wenxian Zhang
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Fang Wang
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Shujung Qi
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Zhijun Liu
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Subin Zhao
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Ning Zhang
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
| | - Fumin Ping
- Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China
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Mithany RH, Daniel N, Shahid MH, Aslam S, Abdelmaseeh M, Gerges F, Gill MU, Abdallah SB, Hannan A, Saeed MT, Manasseh M, Mohamed MS. Revolutionizing Surgical Care: The Power of Enhanced Recovery After Surgery (ERAS). Cureus 2023; 15:e48795. [PMID: 38024087 PMCID: PMC10646429 DOI: 10.7759/cureus.48795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
The development of Enhanced Recovery After Surgery (ERAS) has brought about substantial transformations in perioperative care, substituting conventional methods with a patient-centric, evidence-based strategy. ERAS protocol adopts a holistic approach to patient care, which includes all stages preceding, during, and following the operation. These programs prioritize patient-specific therapies that are tailored to their specific requirements. Nutritional assessment and enhancement, patient education, minimally invasive procedures, and multimodal pain management are all fundamental components of ERAS. ERAS provides a multitude of advantages, including diminished postoperative complications, abbreviated hospital stays, heightened patient satisfaction, and healthcare cost reductions. This article examines the foundational tenets of ERAS, their incorporation into the field of general surgery, their suitability for diverse surgical specialties, the obstacles faced during implementation, and possible directions for further investigation, such as the integration of digital health technologies, personalized patient care, and the long-term viability of ERAS protocols.
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Affiliation(s)
- Reda H Mithany
- Department of General and Emergency Surgery, Kingston Hospital National Health Service (NHS) Foundation Trust, Kingston Upon Thames, GBR
| | - Nesma Daniel
- Medical Laboratory Science, Ain Shams University, Cairo, EGY
| | | | - Samana Aslam
- General Surgery, Lahore General Hospital, Lahore, PAK
| | - Mark Abdelmaseeh
- General Surgery, Faculty of Medicine, Assuit University, Assuit, EGY
| | - Farid Gerges
- Department of General and Emergency Surgery, Kingston Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | - Muhammad Umar Gill
- Accident and Emergency, Kings College Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | | | - Abdul Hannan
- Surgery, Glangwili General Hospital, Carmarthen, GBR
| | | | - Mina Manasseh
- General Surgery, Torbay and South Devon National Health Service (NHS) Foundation Trust, Torquay, GBR
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Wang XM, Hou Q. Application of multidisciplinary collaborative nursing with family care for enhanced recovery after surgery in children with inguinal hernia. World J Gastrointest Surg 2023; 15:1932-1940. [PMID: 37901721 PMCID: PMC10600756 DOI: 10.4240/wjgs.v15.i9.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children. AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery (ERAS) with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis. METHODS The data of 100 children with inguinal hernia were retrospectively analyzed. The participants were divided into three groups according to different nursing methods: Groups A (n = 38), B (n = 32), and C (n = 30). Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing; Group B received multidisciplinary collaborative nursing for ERAS; and Group C received routine nursing. The postoperative recovery results of the three groups were compared, including intraoperative blood loss and postoperative feeding time, time of getting out of bed, hospitalization time, and defecation time. Furthermore, the incidence of common complications was also compared between the three groups. RESULTS There was less intraoperative blood loss in Groups A and B than in Group C (P < 0.05), and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C (P < 0.05). There was no significant difference in postoperative feeding time among the three groups (P > 0.05). Each index had no statistical significance between Groups A and B (P > 0.05). The incidence of urinary retention, infection, hematoma, and hernia recurrence in Group A was less than that in Group C (P < 0.05). No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C (P > 0.05). CONCLUSION The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.
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Affiliation(s)
- Xiu-Mei Wang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Qiang Hou
- Department of Burns, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
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汪 夏, 朱 晓, 吴 茜. [Current Status of and Barriers to the Implementation of Enhanced Recovery After Surgery in 77 Tertiary Hospitals]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:1000-1005. [PMID: 37866959 PMCID: PMC10579079 DOI: 10.12182/20230960601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 10/24/2023]
Abstract
Objective To investigate the status of and obstacles to the implementation of enhanced recovery after surgery (ERAS) in tertiary-care general hospitals in China. Methods Questionnaire on the Current Status of and Barriers to the Implementation of ERAS in Tertiary-Care Hospitals, a self-developed questionnaire, was used to conduct a survey of 77 tertiary hospitals from 21 provinces across China between May 2022 and June 2022. The participating hospitals were selected by convenience sampling. The questionnaire on the current implementation status of ERAS was mainly focused on the departments involved and the ERAS programs implemented, incorporating a total of 25 items of three dimensions, preoperative, intraoperative, and postoperative. The answer to each question consisted of 5 options from "never" to "always", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating better implementation of the program concerned. In the questionnaire on barriers to ERAS implementation and recommendations, 10 items of two dimensions, including hospital management, and patient and caregiver, were concerned with the barriers to implementation. The answer to each question consisted of 5 options from "disagree" to "strongly agree", which corresponded to 1 to 5 points on the scoring scale, with the higher scores indicating the greater importance of the barriers. Results ERAS programs were implemented in 73 (94.8%) hospitals. The best-implemented items were preoperative education (4.73±0.51), prevention and treatment of deep vein thrombosis (4.55±0.71), and postoperative follow-up (4.40±0.81). The items of poor implementation status were preoperative prehabilitation (2.71±1.40), preoperative oral carbohydrate drinks (3.03±1.49), and early ambulation after surgeries (3.04±1.22). The main obstacles to ERAS implementation included a lack of effective incentive systems, poor motivation among the medical and nursing staffs (3.21±0.93), a lack of disease-specific clinical implementation pathways (3.16±1.06), and a lack of experience in multidisciplinary teamwork (2.98±1.17). Conclusion There is a high rate of ERAS implementation in tertiary general hospitals in China, but clinical implementation and dissemination are still confronted with many obstacles.
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Affiliation(s)
- 夏云 汪
- 江西科技学院 (南昌 330000)Jiangxi University of Technology, Nanchang 330000, China
| | - 晓萍 朱
- 江西科技学院 (南昌 330000)Jiangxi University of Technology, Nanchang 330000, China
| | - 茜 吴
- 江西科技学院 (南昌 330000)Jiangxi University of Technology, Nanchang 330000, China
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王 丹, 赵 萍, 邵 英, 李 卡, 颜 萍. [Investigation and Analysis of the Implementation Status of Enhanced Recovery After Surgery in the Context of Precision Nursing in Xinjiang]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:765-770. [PMID: 37545071 PMCID: PMC10442617 DOI: 10.12182/20230760304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 08/08/2023]
Abstract
Objective To investigate the current status of surgical nurses' implementation of enhanced recovery after surgery (ERAS) concepts in the context of precision nursing in Xinjiang and to provide a basis for the development of precision nursing of ERAS. Methods By way of convenience sampling, surgical nurses from 8 tertiary-care hospitals were involved in a survey on their ERAS implementation status in March and April 2023 and the results were collected by online questionnaire. Results A total of 985 valid questionnaires were collected. Out of the 8 hospitals covered in the survey, the orthopedics departments of 7 hospitals have implemented ERAS concepts, accounting for 87.50%. The average score for the ERAS Knowledge, Attitude, and Practice Questionnaire among the surgical nurses was (182.98±17.69), of which, the average score for ERAS knowledge was (13.08±1.51), the average score for ERAS attitude was (88.75±8.30), and the average score for ERAS practice was (81.15±11.96). A total of 61.02% of the surgical nurses implemented ERAS pathways that concentrated on 4-6 pathways, with the prevention of postoperative ileus after surgery being the most commonly implemented pathway, accounting for 498 (50.56%) surgical nurses. A total of 78.48% of the nurses considered work overload to be the most important obstacle to implementing ERAS in the context of precision nursing. Poor multidisciplinary team collaboration and poor awareness of implementation among the nurses ranked the second and the third, accounting for 74.92% and 71.57%, respectively, of the surgical nurses. Conclusion ERAS has won the approval of surgical nurses in Xinjiang, but it is still not widely implemented in all surgical fields. In addition, the quantity and quality of ERAS pathways implemented still need to be further improved. The development of ERAS in the context of precision nursing remains a long-term challenge.
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Affiliation(s)
- 丹 王
- 新疆医科大学 护理学院 (乌鲁木齐 830017)Nursing School, Xinjiang Medical University, Urumqi 830017, China
| | - 萍 赵
- 新疆医科大学 护理学院 (乌鲁木齐 830017)Nursing School, Xinjiang Medical University, Urumqi 830017, China
| | - 英梅 邵
- 新疆医科大学 护理学院 (乌鲁木齐 830017)Nursing School, Xinjiang Medical University, Urumqi 830017, China
| | - 卡 李
- 新疆医科大学 护理学院 (乌鲁木齐 830017)Nursing School, Xinjiang Medical University, Urumqi 830017, China
| | - 萍 颜
- 新疆医科大学 护理学院 (乌鲁木齐 830017)Nursing School, Xinjiang Medical University, Urumqi 830017, China
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Nelson G, Fotopoulou C, Taylor J, Glaser G, Bakkum-Gamez J, Meyer LA, Stone R, Mena G, Elias KM, Altman AD, Bisch SP, Ramirez PT, Dowdy SC. Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Gynecol Oncol 2023; 173:58-67. [PMID: 37086524 DOI: 10.1016/j.ygyno.2023.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. METHODS Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- G Nelson
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - C Fotopoulou
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - J Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - J Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - L A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Stone
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Mena
- Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - A D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S P Bisch
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - P T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - S C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Wang D, Hu Y, Liu K, Liu Z, Chen X, Cao L, Zhang W, Li K, Hu J. Issues in patients' experiences of enhanced recovery after surgery (ERAS) : a systematic review of qualitative evidence. BMJ Open 2023; 13:e068910. [PMID: 36810180 PMCID: PMC9945048 DOI: 10.1136/bmjopen-2022-068910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To explore patients' experiences of enhanced recovery after surgery (ERAS) and to identify issues in the implementation of ERAS from the patient's perspective. DESIGN The systematic review and qualitative analysis were based on the Joanna Briggs Institute's methodology for conducting synthesis. DATA SOURCES Relevant studies published in four databases, that is, Web of Science, PubMed, Ovid Embase and the Cochrane Library, were systematically searched, and some studies were supplemented by key authors and reference lists. STUDY SELECTION Thirty-one studies were identified, involving 1069 surgical patients enrolled in the ERAS programme. The inclusion and exclusion criteria were formulated based on the Population, Interest of phenomena, Context, Study design criteria recommended by the Joanna Briggs Institute to determine the scope of article retrieval. The inclusion criteria were as follows: ERAS patients' experiences; qualitative data; English language and published from January 1990 to August 2021. DATA EXTRACTION Data were extracted from relevant studies using the standardised data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument for qualitative research. DATA SYNTHESIS The themes in the structure dimension are as follows: (1) patients cared about the timeliness of healthcare professionals' help; (2) patients cared about the professionalism of family care; and (3) patients misunderstood and worried about the safety of ERAS. The themes in the process dimension are as follows: (1) patients needed adequate and accurate information from healthcare professionals; (2) patients needed to communicate adequately with healthcare professionals; (3) patients hoped to develop a personalised treatment plan and (4) patients required ongoing follow-up services. The theme in the outcome dimension is as follows: patients wanted to effectively improve severe postoperative symptoms. CONCLUSIONS Evaluating ERAS from the patient's perspective can reveal the omissions and deficiencies of healthcare professionals in clinical care so that problems in patients' recovery process can be solved in a timely manner, reducing potential barriers to the implementation of ERAS. PROSPERO REGISTRATION NUMBER CRD42021278631.
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Affiliation(s)
- Dan Wang
- Post-doctoral Mobile Research Station of Public Health and Preventive Medicine, School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
- School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yanjie Hu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Kai Liu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinrong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Weihan Zhang
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jiankun Hu
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS ®) Programs. J Clin Med 2023; 12:jcm12020631. [PMID: 36675560 PMCID: PMC9861533 DOI: 10.3390/jcm12020631] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as "surgical pharmacy" by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists' work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.
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