Functional recovery is considered the most important target: a survey of dedicated professionals (original) (raw)
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Enhanced recovery protocol in early recovery of patients undergoing abdominal surgery
International journal of health sciences
Background : Enhanced recovery after surgery (ERAS) programme is designed to reduce perioperative and intraoperative stress responses, and to support the recovery of organ function aiming to help patients getting better sooner after surgery.There is paucity in literature regading successful application of Enhanced recovery after surgery (ERAS) protocol in India. Material and Methods : 100 patients underwent abdominal colorectal surgery. Fifty patients underwent enhanced recovery after surgery protocol while other half were observed under conventional protocol. Time for 1st flatus , 1st defecation , time to tolerance of diet , time to normal routine ,Hospital stay , complications , readmission within 30 days and hospital cost were compared as study outcome variables. Result : Patients underwent ERAS protocol were found to have statistically significant shorter time for 1st flatus , 1st defecation , time to tolerance of diet , time to normal routine and hospital stay than compare...
Enhanced Recovery after Surgery Program for Elective Abdominal Surgery at Three Victorian Hospitals
Anaesthesia and Intensive Care, 2012
The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgery in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A postimplementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rat...
Essential Elements for Enhanced Recovery After Intra-abdominal Surgery
Current Pain and Headache Reports, 2019
Purpose of Review Enhanced recovery pathways provide a framework outlining the best perioperative care for intra-abdominal surgical procedures. To date, no evidence-based umbrella guidelines exist for all intra-abdominal surgeries. Recent Findings A PubMed and worldwide web search was performed with the keywords: "ERAS," "enhanced recovery after surgery", ± "protocol." Manuscripts addressing intra-abdominal procedures were selected, resulting in studies with the date range: 2012-2017. The basic philosophy behind enhanced recovery is the realization that a traditional hospital works in silos that need to be broken to ensure a care protocol that follows and optimizes the journey the patient makes during the perioperative care. Enhanced recovery interventions can be categorized into preoperative, perioperative, and postoperative interventions. By design, each intervention is planned and coordinated by a multidisciplinary ERAS team. Depending on the particular procedure and patient receiving the interventions, some of the interventions below may be more or less applicable. Summary In this review, the most common elements of ERAS protocols in intra-abdominal procedures are reviewed, particularly those which provided the best outcomes and are most generalizable to all intra-abdominal procedures.
Surgical endoscopy, 2018
We initiated a research program to develop a novel patient-reported outcome measure (PROM) to assess postoperative recovery from the perspective of abdominal surgery patients. In light of FDA recommendations, the first stage of our program aimed to, based on previous literature and expert input, develop a hypothesized conceptual framework portraying the health domains that are potentially relevant to the process of recovery after abdominal surgery. This study was conducted in three phases: (1) systematic review to identify PROMs with measurement properties appraised in the context of recovery after abdominal surgery, (2) content analysis to categorize the health domains covered by the PROMs according to the ICF, and (3) two-round Delphi study to gain expert input regarding which of these health domains are relevant to the process of recovery. Participants were experts in perioperative care identified through two major surgical societies (35 invited). The systematic review identified...
Factors associated with recovery among patients after abdominal surgery
2016
Purpose: To examine the level of postoperative recovery and identify relationships among age, postoperative pain, co-morbidity, intra surgical condition, length of incision, and recovery in patients after abdominal surgery. Design: Descriptive correlational design. Method: Sample was 190 patients aged 18 years and older after abdominal surgery at Bach Mai Hospital, Hanoi, Vietnam. Data were collected by interviewing with questionnaires and obtaining demographic and medical data from patient's chart review. Patient's recovery was measured by the quality of recovery scale (QoR-15). Spearman's Rho correlation was employed for data analysis. Main Findings: The average age of subjects was 54.14 years. The length of hospital stay ranged from 3 to 20 days. Main cause of surgery was gastrointestinal disease found in 114 subjects (59.7%), and 54 subjects with urological disease (28.3%). The surgical approach included laparotomy and laparoscopic surgery. There were 38.2% of subjects with one or more co-morbid diseases. The overall QoR scores were good with the mean of 128.91. Age, pain, co-morbidity, and length of incision were negatively correlated with recovery (rs =-.350, rs =-.411, rs =-.428, rs =-.231, p < .05 respectively). Surgical Apgar score was positively correlated with recovery (rs = .289, p < .05). Conclusion and recommendations: To enhance the patient's postoperative recovery and their optimum health outcomes, pain control has to be taken into action. Patients with long wounds have co-morbid diseases and show instability in their hemodynamic status during operation has to be closely monitored.
How well are we measuring postoperative “recovery” after abdominal surgery?
Quality of Life Research, 2015
Purpose The content validity of patient-reported outcomes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after abdominal surgery and to analyze the content of PRO instruments against this conceptual framework. Methods Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were interviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework. Results A total of 17 patients and 15 healthcare professionals were interviewed. A total of 22 important recoveryrelated concepts were identified and linked to the ICF. The four most important concepts were ''Energy level,'' ''Sensation of pain,'' ''General physical endurance,'' and ''Carrying out daily routine.'' The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recovery concepts. No instrument covered all of the important concepts. Conclusions The comparison of the contents of PRO instruments commonly used to measure postoperative recovery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals.
Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery
Medical Oncology, 2018
Enhanced Recovery After Surgery (ERAS) is an evidence-based paradigm shift in perioperative care, proven to lower both recovery time and postoperative complication rates. The role of ERAS in several surgical disciplines was reviewed. In colorectal surgery, ERAS protocol is currently well established as the best care. In gastric surgery, 2014 saw an establishment of ERAS protocol for gastrectomies with resulting meta-analysis showing ERAS effectiveness. ERAS has also been shown to be beneficial in liver surgery with many centers starting implementation. The advantages of ERAS in pancreatic surgery have been strongly established, but there is still a need for large-scale, multicenter randomized trials. Barriers to implementation were analyzed, with recent studies concluding that successful implementation requires a multidisciplinary team, a willingness to change and a clear understanding of the protocol. Additionally, the difficulty in accomplishing necessary compliance to all protocol items calls for new implementation strategies. ERAS success in different patient populations was analyzed, and it was found that in the elderly population, ERAS shortened the length of hospitalization and did not lead to a higher risk of postoperative complications or readmissions. ERAS utilization in the emergency setting is possible and effective; however, certain changes to the protocol may need to be adapted. Therefore, further research is needed. There remains insufficient evidence on whether ERAS actually improves patients' course in the long term. However, since most centers started to implement ERAS protocol less than 5 years ago, more data are expected.
Overview of Enhanced Recovery After Surgery
Surgical Clinics of North America, 2018
Ever striving to perform the best operation and to provide the best perioperative care is inherent to the surgeon personality. Why did we adopt principles of handwashing, antisepsis, and then aseptic technique? Why do we debate the effectiveness of surgical headdress? Why do we benchmark, compare, and compete to prove best care? Why do we prepare the colon for a colon resection or challenge immediate postoperative enteral diets? 1-4 The answer to any of these questions is, again, found in the surgeon's drive for best care. Over the past 2.5 decades, this drive has been variably defined by perioperative quality, value care in surgery, and outcome effectiveness. The coined phrase, Enhanced Recovery, has been applied to the application of perioperative care principles for best surgical outcomes. 5 The author has nothing to disclose.
Annals of Surgery, 2015
The ERAS Ò represents a dynamic culmination of upon perioperative care elements, successfully applied to different surgical specialties with shorter hospital stay and lower morbidity rates. The aim of this study is to describe the introduction of the ERAS protocol in colorectal surgery in our hospital analysing our first series. Between September 2014 and June 2016, 120 patients suffering from colorectal diseases were included in the study. Laparoscopic approach was used in all patients if not contraindicated. Patients were discharged when adequate mobilization, canalization, and pain control were obtained. Analysed outcomes were: length of hospital stay, readmission rate, perioperative morbidity, and mortality. Malignant lesions were the most common indication (84.2%; 101/120). Laparoscopic approach was performed in the 95.8% of cases (115/120) with a conversion rate of 4.4% (5/115). Surgical procedures performed were: 36 rectal resections (30%), 36 left colonic resections (30%), 42 right hemicolectomy (35%), and 6 Miles (5%). The median hospital stay was of 4 (3-34) days in the whole series with a morbidity rate of 10% (12/120); four patients experienced Clavien-Dindo C IIIa complications; and only one anastomotic leak was observed. No 30-day readmission and no perioperative mortality were recorded. At the univariate analysis, the presence of complications was the only predictive factor for prolonged hospital stay (p \ 0.001). In our experience, implementation of ERAS protocol for colorectal surgery allows a significant reduction of hospital stay improving perioperative management and postoperative outcomes.
Enhanced recovery after surgery (ERAS) for the anaesthesiologist
Indian Journal of Clinical Anaesthesia
Enhanced recovery after surgery (ERAS) protocol consists of entire spectrum of pre, intra and postoperative designed to enhance patient outcomes. Since its first introduction for major abdominal surgery in the 1990's, ERAS protocols have been successfully used extensively in many countries in several major surgical procedures. When effectively implemented, ERAS resulted in reduction in hospitalization, improvement in satisfaction of the patients, and reduction in complication rate without an increase in readmissions. Implementation of ERAS in India has also positively affected the patient experience and led to efficient utilization of valuable hospital resources. Many of the ERAS components are linked to the anaesthesia team. Anaesthesiologists help in preparing anaesthesia, they also ascertain the fasting regime in preoperative period, assess premedication, and introduce prophylaxis for post-operative nausea and vomiting (PONV). Intraoperatively, they introduce low sodium fluid therapy, help in preventing hypothermia, and utilize short acting drugs. They also help in important decision making during postoperative analgesia. An anaesthesiologist role is foremost important in the implementation of ERAS protocol. The article aims to discuss the various components of ERAS and the role of anaesthesiologist in implementing them.