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Jolly S, Paliwal S, Gadepalli A, Chaudhary S, Bhagat H, Avitsian R. Designing Enhanced Recovery After Surgery Protocols in Neurosurgery: A Contemporary Narrative Review. J Neurosurg Anesthesiol 2024; 36:201-210. [PMID: 38011868 DOI: 10.1097/ana.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/16/2023] [Indexed: 11/29/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. Implementation of ERAS protocols for neurosurgical procedures has been relatively underexplored and underutilized due to the unique challenges and complexities of neurosurgery. This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.
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Affiliation(s)
- Sagar Jolly
- Department of General Anesthesiology, Cleveland Clinic, OH
| | | | - Aditya Gadepalli
- Department of Anaesthetics and Intensive Care, Royal Free London NHS Foundation Trust, London, UK
| | - Sheena Chaudhary
- Department of Neuroanesthesia and Critical Care, Fortis Memorial Research Institute, Gurugram, HR, India
| | - Hemant Bhagat
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, OH
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Yang IJ, Kim DW, Lee J, Ahn HM, Oh HK, Kang SB, Suh JW, Kim MH, Oh HJ, Kim HK, Kim MJ, Park JW, Ryoo SB, Park KJ, Jeong SY, Oh JH. Are sporadic colorectal cancers in young patients distinct from those in elderly patients? Colorectal Dis 2024; 26:1405-1414. [PMID: 38881232 DOI: 10.1111/codi.17072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/13/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024]
Abstract
AIM The aim of this study was to compare the clinicopathological and oncological characteristics of sporadic colorectal cancer (CRC) between young and elderly patients without any genetic mutations that cause hereditary CRC. METHOD In this cross-sectional, retrospective study conducted at three tertiary referral hospitals, we enrolled 1599 patients with CRC who underwent surgery between January 2010 and December 2017, including 157 young patients (age ≤ 40 years; yCRC) and 1442 elderly patients (age ≥ 70 years; eCRC). The clinicopathological and oncological outcomes were compared between the two groups. RESULTS The median age at diagnosis was 37 years in the yCRC group (range 33.0-39.2 years) and 76 years in the eCRC group (range 72.0-79.0 years). The yCRC group did not present with advanced stages at diagnosis compared with the eCRC group, and the distribution of tumour stages was similar between the two groups. Microsatellite instability (MSI) testing revealed no difference in the frequency of tumours with high MSI (7.8% in yCRC, 5.8% in eCRC), and the frequency of mutations in the KRAS, NRAS and BRAF genes was also similar. The 3-year overall survival was better in the yCRC group than in the eCRC group (97.4% vs. 83.5%, p < 0.001); however, no such difference was observed in cancer-specific survival. CONCLUSION Genetically proven sporadic CRCs did not differ significantly between young and elderly patients in terms of tumour stage, tumour location and various molecular features. CLINICAL TRIAL REGISTRATION NUMBER The study was retrospectively registered with Clinical Trials.gov (no. NCT05601609).
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Affiliation(s)
- In Jun Yang
- Department of Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeehye Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong-Min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung Wook Suh
- Department of Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Min Hyun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeon Jeong Oh
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyung Kyung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, South Korea
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Mazni Y, Syaiful RA, Ibrahim F, Jeo WS, Putranto AS, Sihardo L, Marbun V, Lalisang AN, Putranto R, Natadisastra RM, Sumariyono S, Nugroho AM, Manikam NRM, Karimah N, Hastuty V, Sutisna EN, Widiati E, Mutiara R, Wardhani RK, Liastuti LD, Lalisang TJM. The enhanced recovery after surgery (ERAS) protocol implementation in a national tertiary-level hospital: a prospective cohort study. Ann Med Surg (Lond) 2024; 86:85-91. [PMID: 38222714 PMCID: PMC10783346 DOI: 10.1097/ms9.0000000000001609] [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: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Successful colorectal surgery is determined based on postoperative mortality and morbidity rates, complication rates, and cost-effectiveness. One of the methods to obtain an excellent postoperative outcome is the enhanced recovery after surgery (ERAS) protocol. This study aims to see the effects of implementing an ERAS protocol in colorectal surgery patients. Methods Eighty-four patients who underwent elective colorectal surgery at National Tertiary-level Hospital were included between January 2021 and July 2022. Patients were then placed into ERAS (42) and control groups (42) according to the criteria. The Patients in the ERAS group underwent a customized 18-component ERAS protocol and were assessed for adherence. Postoperatively, both groups were monitored for up to 30 days and assessed for complications and readmission. The authors then analyzed the length of stay and total patient costs in both groups. Results The length of stay in the ERAS group was shorter than the control group [median (interquartile range) 6 (5-7) vs. 13 (11-19), P<0.001], with a lower total cost of [USD 1875 (1234-3722) vs. USD 3063 (2251-4907), P<0.001]. Patients in the ERAS group had a lower incidence of complications, 10% vs. 21%, and readmission 5% vs. 10%, within 30 days after discharge than patients in the control group; however, the differences were not statistically significant. The adherence to the ERAS protocol within the ERAS group was 97%. Conclusion Implementing the ERAS protocol in colorectal patients reduces the length of stay and total costs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rudi Putranto
- Division of Psychosomatic and Palliative Care, Department of Internal Medicine
| | | | | | | | - Nurul Ratna Mutu Manikam
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo Hospital
| | - Nurrul Karimah
- Dr. Cipto Mangunkusumo General Hospital
- Nutrition and Food Production Installation Unit, Cipto Mangunkusumo, National General Hospital
| | - Vyanty Hastuty
- Dr. Cipto Mangunkusumo General Hospital
- Nutrition and Food Production Installation Unit, Cipto Mangunkusumo, National General Hospital
| | | | | | - Rina Mutiara
- Dr. Cipto Mangunkusumo General Hospital
- Nutrition and Food Production Installation Unit, Cipto Mangunkusumo, National General Hospital
| | - Rizky Kusuma Wardhani
- Department of Physical Medicine and Rehabilitation, Cipto Mangunkusumo, National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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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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Jiang L, Wang M, Che G. Establishment and Clinical Application of the General Comfort Scale for Postoperative Lung Cancer Patients. Cureus 2023; 15:e49415. [PMID: 38149163 PMCID: PMC10750135 DOI: 10.7759/cureus.49415] [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: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Background and purpose The concept of enhanced recovery after surgery (ERAS) not only reflects rapid perioperative recovery but also focuses on the comfort experience of inpatients. This study intends to establish a clinically applicable general comfort questionnaire (GCQ) for patients with lung cancer after surgery and verify its clinical application effect. Methods The comfort index items for postoperative lung cancer were formed by combining previous research and literature, clinically applied comfort scales, and expert interviews. The Delphi method was used to conduct two rounds of expert consultations to determine the final index and establish a postoperative comfort scale for lung cancer patients. This scale was used to conduct a questionnaire survey on 200 patients to test the reliability and validity of the scale. Results The comfort scale contains 3 dimensions and 10 items and is easy to operate and evaluate in clinical applications. The Cronbach's α coefficient of the comfort scale is 0.801, and the scale content validity index (SCVI/ave) is 0.97. The common factor 1 and 2 characteristic roots of scale structural validity evaluation are 3.257 and 1.352 respectively, both greater than 1, with cumulative variance contribution rates of 32.57% and 13.52%. Pain and getting out of bed are the main factors influencing patient comfort. Conclusion The postoperative comfort scale for lung cancer patients has high clinical application reliability and validity. This study identified pain and mobility (early ambulation or getting out of bed) as the primary factors influencing the postoperative comfort of lung cancer patients.
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Affiliation(s)
- Lisha Jiang
- Day Surgery Center, West China Hospital of Sichuan University, Chengdu, CHN
| | - Mingming Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, CHN
| | - Guowei Che
- Lung Cancer Center/Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, CHN
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Kaewborisutsakul A, Kitsiripant C, Kaewsridam S, Kaewborisutsakul WK, Churuangsuk C. The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies. World Neurosurg X 2023; 19:100196. [PMID: 37181587 PMCID: PMC10173293 DOI: 10.1016/j.wnsx.2023.100196] [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: 08/22/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives Enhanced recovery after surgery (ERAS) protocols have reduced the length of hospital stay (LOS) and healthcare costs without increasing adverse outcomes. We describe the impact of adherence to an ERAS protocol for elective craniotomy among neuro-oncology patients at a single institution. Methods This retrospective study enrolled adult patients who underwent elective craniotomy and the ERAS protocol at our institute between January 2020 and April 2021. The patients were divided into high- and low-adherence groups depending on their adherence to ≥9 or <9 of the 16 items, respectively. Inferential statistics were used to compare group outcomes, and multivariable logistic regression analysis was used to examine factors related to delayed discharge (LOS>7 days). Results Among the 100 patients assessed, median adherence was 8 items (range, 4-16), and 55 and 45 patients were classified into the high- and low-adherence groups, respectively. Age, sex, comorbidities, brain pathology, and operative profiles were comparable at baseline. The high-adherence group showed significantly better outcomes, including shorter median LOS (8 days vs. 11 days; p = 0.002) and lower median hospital costs (131,657.5 baht vs. 152,974 baht; p = 0.005). The groups showed no differences in 30-day postoperative complications or Karnofsky performance status. In the multivariable analysis, high adherence to the ERAS protocol (>50%) was the only significant factor preventing delayed discharge (OR = 0.28; 95% CI = 0.10 to 0.78; p = 0.04). Conclusions High adherence to ERAS protocols showed a strong association with short hospital stays and cost reductions. Our ERAS protocol was feasible and safe for patients undergoing elective craniotomy for brain tumors.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Division of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chanatthee Kitsiripant
- Division of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Corresponding author. Division of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Sukanya Kaewsridam
- Division of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Chaitong Churuangsuk
- Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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