1,446 results on '"ERAS"'
Search Results
2. Effect of Regional Anesthesia on Enhanced Recovery After Spine Surgeries
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Sameh Abdelkhalik Ahmed Ismaiel, Dr
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- 2024
3. Compliance With ERAS and Five Year Survival After Colorectal Cancer Treatment
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Mateusz Rubinkiewicz, MD PhD
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- 2024
4. Immunonutrition in ERAS Protocols in Gynecologic Oncology (NUTRIGO)
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Nikolaos Thomakos, Associate Professor of Obstetrics and Gynecology
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- 2024
5. Early Standing in Minors Operated on for Idiopathic Scoliosis (LevPOS)
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- 2024
6. Effect of Modified ERAS Protocol on Clinical Outcomes in Pediatric Patients With Appendectomy
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Buket MERAL, Research asistant - MSc
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- 2024
7. Comparison of Outcome Between (ERACS) Versus Traditional Methods in Elective CS (ERACS)
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Marwa Abdelrehim Attia Mohamed, Assistant lecturer
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- 2024
8. Impact Of The Nurse Enhanced Recovery After Surgery Coordinator On The Compliance In Colorectal Surgery (nursERAS-BCN) (nursERAS-BCN)
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Germans Trias i Pujol Hospital, University of Barcelona, and José Antonio Jerez González, Enhanced Recovery After Surgery Coordinator
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- 2024
9. PaThERAS: ERAS Protocols in Thyroid & Parathyroid Surgery (PaThERAS)
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Gaurav Agarwal, Professor and Head of Department Endocrine and Breast Surgery
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- 2024
10. Hyper-ERAS Program for Highly Selective Colorectal Cancer Patients
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Lin Wang, Unit III & Ostomy Service, Gastrointestinal Cancer Center
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- 2024
11. Impact of General Anesthesia v/s Spinal Anesthesia on ERAS Parameters in Intestinal Stoma Reversal (SPIGERAS)
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Tushar Subhadarshan Mishra, Professor
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- 2024
12. Adherence and Compliance to ERAS in Gynecological Surgery (ERASGYNBS002)
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Federico Ferrari, Consultant and Assistant Professor at Spedali Civili of Brescia and University of Brescia
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- 2024
13. ERAS After Bariatric Surgery in Morbidly Obese
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BON WOOK KOO, assistnat professor
- Published
- 2024
14. Impact of an enhanced recovery protocol in frail patients after intracorporeal urinary diversion.
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Zennami, Kenji, Kusaka, Mamoru, Tomozawa, Shuhei, Toda, Fumi, Ito, Kazuki, Kawai, Akihiro, Nakamura, Wataru, Muto, Yoshinari, Saruta, Masanobu, Motonaga, Tomonari, Takahara, Kiyoshi, Sumitomo, Makoto, and Shiroki, Ryoichi
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ENHANCED recovery after surgery protocol , *TRANSITIONAL cell carcinoma , *PREHABILITATION , *ODDS ratio , *BLADDER cancer , *URINARY diversion - Abstract
Objective: To determine whether an enhanced recovery after surgery (ERAS) protocol enhances bowel recovery and reduces postoperative ileus (POI) in both non‐frail and frail patients after robot‐assisted radical cystectomy with intracorporeal urinary diversion (iRARC). Patients and Methods: This retrospective cohort study included 186 patients (104 with and 82 without ERAS) who underwent iRARC between 2012 and 2023. 'Frail' patients was defined as those with a low Geriatric‐8 questionnaire score (≤13). The primary outcomes were postoperative bowel recovery and the incidence of POI. Secondary outcomes included length of stay (LOS), 30‐ and 90‐day complications, 90‐day readmission rate, and POI predictors. Results: The ERAS group exhibited a significantly shorter LOS, early bowel recovery, a lower POI rate, fewer 90‐day high‐grade complications, and fewer 90‐day readmissions than the non‐ERAS group in the entire cohort. Non‐frail patients in the ERAS group had a lower rate of POI (7.1% vs. 22.1%; P = 0.008), whereas ERAS did not reduce POI in frail patients (44.1% vs. 36.6%; P = 0.50). In the multivariate analysis, ERAS was associated with a reduced risk of POI in both the entire cohort (odds ratio [OR] 0.39, P = 0.01) and in non‐frail patients (OR 0.24, P = 0.01), whereas ERAS was not likely to reduce POI (OR 1.14, P = 0.70) in frail patients. Prehabilitation was identified as a favourable predictor of POI. Conclusions: The ERAS protocol did not reduce POI in frail patients after iRARC, although it enhanced bowel recovery and reduced POI in non‐frail patients. Prehabilitation for frail patients might reduce POI. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
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15. Development of an Enhanced Recovery After Surgery Program in Ventral Hernia.
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Ewing, John K., Cassling, Kyle E., Hanneman, Michael A., Broucek, Joseph R., Raymond, Britany L., Pierce, Richard A., Geiger, Timothy M., and Bradley 3rd, Joel F.
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ENHANCED recovery after surgery protocol , *VENTRAL hernia , *COMBINED modality therapy , *PROCTOLOGY , *PAIN management - Abstract
Background: Enhanced Recovery After Surgery (ERAS) programs have spread after initial success in colorectal surgery decreasing length of stay (LOS) and decreasing opioid consumption. Adoption of ERAS specifically for ventral hernia patients remains in evolution. This study presents the development and implementation of an ERAS pathway for ventral hernia. Methods: A multidisciplinary team met weekly over 6 months to develop an ERAS pathway specific to ventral hernia patients. 75 process components and outcome measures were included, spanning multiple phases of care: Preoperative-Clinic, Preoperative Day of Surgery (DOS), Intraoperative, and Postoperative. Preoperative components included education and physiologic optimization. Pain control across phases of care focuses on nonopioid, multimodal analgesia. Postoperatively, the pathway emphasizes early diet advancement, early mobilization, and minimization of IV fluids. We compared compliance and outcome measures between a Pre Go-Live (PGL) period (9/1/2020-8/30/2021) and After Go-live (AGL) period (5/12/2022-5/19/2023). Results: There were 125 patients in the PGL group and 169 patients in the AGL group. Overall, ERAS compliance increased from 73.9% to 82.9% after implementation. Length of stay decreased from an average of 2.27 days PGL to 1.92 days AGL. Finally, the average daily postoperative opioid usage decreased from 25.4 to 13.5 MME after the implementation. Discussion: Enhanced Recovery After Surgery can be successfully applied to the care of hernia patients with improvements in LOS and decreased opioid consumption. Institutional support and multidisciplinary cooperation were key for the development of such a program. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Ambulatory bariatric surgery: a prospective single-center experience.
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Ali, Abdulaziz Karam, Safar, Ali, Vourtzoumis, Phil, Demyttenaere, Sebastian, Court, Olivier, and Andalib, Amin
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BARIATRIC surgery , *GASTRECTOMY , *AMBULATORY surgery , *BODY mass index , *PATIENT safety , *EMERGENCY room visits , *PATIENT readmissions , *TREATMENT effectiveness , *DISCHARGE planning , *DESCRIPTIVE statistics , *CHI-squared test , *MANN Whitney U Test , *LONGITUDINAL method , *SURGICAL complications , *DISEASES , *RESEARCH methodology , *CONVALESCENCE , *MORBID obesity , *DATA analysis software , *GASTRIC bypass - Abstract
Background: Ambulatory bariatric surgery has recently gained interest especially as a potential way to improve access for eligible patients with severe obesity. Building on our previously published research, this follow-up study delves deeper in the evolving landscape of ambulatory bariatric surgery over a 3-year period, focusing on predictors of success/failure. Methods: In a prospective single-center follow-up study, we conducted a descriptive assessment of all eligible patients as per our established protocol, who underwent a planned same-day discharge (SDD) primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 03/01/2021 and 02/29/2024. Trends in SDD surgeries over time were assessed over six discrete 6 month intervals. Primary endpoint was defined as a successful discharge on the day of surgery without emergency department visit or readmission within 24 h. Secondary outcomes included 30-day postoperative morbidity. Results: A total of 811 primary SG and 325 RYGB procedures were performed during the study period. Among them, 30% (n = 244) were SDD-SGs and 6% (n = 21) were SDD-RYGBs, respectively. At baseline, median age of the entire SDD cohort was 43 years old, 81% were females, and body mass index (BMI) was 44.5 kg/m2. The planned SDD approach was successful in 89% after SG (n = 218/244) and in 90% after RYGB (n = 19/21). Nausea/vomiting was the main reason for a failed SDD approach after SG (46%). The 30-day readmission rate was 1.5% (n = 4) for the entire SDD cohort including only one readmission in the first 24 h. The percentage of SDD-SGs performed as a proportion of total SGs increased over the initial five consecutive six-month intervals (14%, 25%, 24%, 38%, and 49%). Conclusion: Our SDD protocol for bariatric surgery demonstrates a favorable safety profile, marked by high success rate and low postoperative morbidity. These outcomes have led to a continued increase in ambulatory procedures performed over time especially SG. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Principles of preoperative assessment and enhanced recovery optimization for thoracic anaesthesia.
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Ahmed, Mohammed J. and Hartley, Michael
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A comprehensive preoperative assessment is imperative for patients undergoing lung surgery, ideally by way of a multidisciplinary team approach. This not only allows for clinicians to risk stratify patients and gain informed consent, but also to explore avenues in optimizing patients prior to surgery and plan for the delivery of the most appropriate postoperative care. A tripartite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea should be assessed and discussed with patients. Those patients who continue towards surgical management may then be optimized with patient education addressing nutritional status, smoking cessation and alcohol dependency as well as the management of anaemia and physiological prehabilitation. This article aims to review existing guidelines for preoperative assessment in thoracic surgery as well as the latest preoperative guidance for enhanced recovery specific to thoracic surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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18. Enhanced recovery after surgery improves clinical outcomes in adolescent bariatric surgery.
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Schmoke, Nicholas, Nemeh, Christopher, Gennell, Tania, Schapiro, Dana, Hiep-Catarino, Ashley, Alexander, Matthew, Chalphin, Alexander V., Crum, Robert W., Holynskyj, Leign, Kubacki, Tatiana, Schechter, William S., and Zitsman, Jeffrey
- Abstract
Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal approaches to optimize patient recovery and minimize complications. Our team evaluated clinical outcomes following the implementation of an ERAS protocol for adolescents undergoing metabolic and bariatric surgery. Academic hospital, New York, NY, USA. We performed a single-institution longitudinal assessment of adolescents who underwent laparoscopic vertical sleeve gastrectomy (VSG) between August 2021 and November 2022. Unpaired t -tests and Fisher's exact test were used to compare means between groups and categorical factors. Forty-three patients were included in the study, 21 who participated in the ERAS protocol and 22 control patients. ERAS cohort was 52% females, with a median age of 17.5 years and a median body mass index (BMI) of 46.3 kg/m
2 . The non-ERAS cohort was 59% females, with a median age of 16.7 years and a median BMI of 44.0 kg/m2 . There were no significant differences between baseline characteristics. Patients in the ERAS group had a shorter time to oral intake (10.7 hours versus 21.5 hours, P <.01), lower morphine milligram equivalents (18.2 versus 97.0, P <.01), and shorter length of stay (1.5 days versus 2.0 days, P =.01). There were no significant differences between return visits to the emergency department (ED) within 30 days (3 versus 2, P =.66) or readmissions (0 versus 1, P = 1.0). The described ERAS protocol is safe and effective in adolescents undergoing laparoscopic VSG and is associated with shorter time to oral intake, reduced opioid requirements, and shorter hospital lengths of stay with no increase in return ED visits or readmissions. • Patients in the enhanced recovery after surgery (ERAS) group had a shorter time to oral intake. • Patients in the ERAS group had lower morphine milligram equivalents. • Patients in the ERAS group had shorter length of stay. • ERAS protocol is effective in adolescents undergoing laparoscopic sleeve gastrectomy. [ABSTRACT FROM AUTHOR]- Published
- 2024
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19. If the peri‐operative patient pathway was right, what would it look like?
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Watters, David Allan, Scott, David A., Sammour, Tarik, Harris, Ben, and Ludbrook, Guy Lawrence
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PREOPERATIVE risk factors , *PATIENT experience , *LITERATURE reviews , *LENGTH of stay in hospitals , *PATIENTS' attitudes - Abstract
Background Methods Results During surgery After surgery Conclusion Patients undergoing surgery deserve the best possible peri‐operative outcomes. Each stage of the peri‐operative patient journey offers opportunities to improve care delivery, with shorter lengths of stay, less complications, reduced costs and better value.These opportunities were identified through narrative review of the literature, with consultation and consensus at the hidden pandemic (of postoperative complications) summit 2, July 2023 in Adelaide, Australia
Before surgery: Some patients who receive timely alternative treatments may not need surgery at all. The period of waiting after listing should be a time of preparation. Risk assessment at the time of surgical listing facilitates recognition of need for comorbidity optimisation and identifies those who will most benefit from prehabilitation, particularly frail and deconditioned patients.During the surgical admission, ERAS programs result in less postoperative complications, shorter length of stay and better patient experience but require agreement between clinicians, and coordinated monitoring of delivery of the elements in the ERAS bundle of care.At‐risk patients need to have the appropriate levels of monitoring for cardiovascular instability, renal impairment or respiratory dysfunction, to facilitate timely, proactive management if they develop. Access to allied health in the early postoperative period is also critical for promoting mobility, and earlier discharge, particularly after joint surgery. Where appropriate, provision of rehabilitation services at home improves patient experience and adds value. The peri‐operative patient journey begins and ends with primary care so there is a need for clear communication, documentation, around sharing of responsibility between practitioners at each stage.Identifying and mitigating risk to reduce complications and length of stay in hospital will improve outcomes for patients and deliver the best value for the health system. [ABSTRACT FROM AUTHOR]- Published
- 2024
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20. Successful Implementation of Enhanced Recovery After Surgery (ERAS) in Paediatric Cardiac Surgery in Australia.
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Andugala, Shalom, McIntosh, Amy, Orchard, Jennifer, Rahiman, Sarfaraz, Miedecke, Anna, Keyser, Janelle, Betts, Kim, Marathe, Supreet, Alphonso, Nelson, and Venugopal, Prem
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ENHANCED recovery after surgery protocol , *PEDIATRIC surgery , *ATRIAL septal defects , *CARDIAC surgery , *INTENSIVE care units , *ARTIFICIAL respiration - Abstract
Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia. All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions. Of 1,084 patients who underwent cardiac surgery during the study period (October 2019–July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8–8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28–53.5 minutes) and 24.5 min (IQR 13–34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1–5.6 hours) and 4 days (IQR 4–5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups. ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources. [ABSTRACT FROM AUTHOR]
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- 2024
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21. A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa.
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Kifle, Fitsum, Kenna, Peniel, Daniel, Selam, Maswime, Salome, and Biccard, Bruce
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ENHANCED recovery after surgery protocol , *LENGTH of stay in hospitals , *HIGH-income countries , *MEDICAL care costs , *DEATH rate - Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation. Methods: We conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results. Results: The search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1). Conclusions: Despite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments. [ABSTRACT FROM AUTHOR]
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- 2024
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22. A systematic review of morphine equivalent conversions in plastic surgery: Current methods and future directions.
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Yessaillian, Andrea, Reese, McKay, Clark, Robert Craig, Becker, Miriam, Lopes, Kelli, Alving-Trinh, Alexandra, Llaneras, Jason, McPherson, Mary, Gosman, Amanda, and Reid, Chris M.
- Abstract
Protocols surrounding opioid reduction have become commonplace in plastic surgery to improve peri-operative outcomes. Within such protocols, opioid requirement is a frequently analyzed outcome. Though often examined, there is no literature standard conversion for morphine milligram equivalents (MME) at present, leading to questionable external validity. We hypothesized significant heterogeneity in MME reporting would exist within plastic surgery literature. Following the PRISMA guidelines, the authors conducted a systematic review of 16 journals. Clinical studies focused on opioid reduction within plastic surgery were identified. Primary outcomes included reporting of morphine equivalents (ME) delivery (IV/oral), operative ME, inpatient ME, outpatient ME, timeline, and method of calculation. Among the 101 studies analyzed, 73% reported opioid requirements in the form of ME. Among those that used ME, 3% reported IV ME, 41% reported oral, 32% reported both, and 25% gave no indication of either. Operative ME were reported in 19% of studies. Furthermore, 54% of studies reported inpatient ME whereas 32% of studies reported outpatient ME. Only 19% reported the number of days opioids were consumed postoperatively. Moreover, 27% of the studies reported the actual method of ME conversion, with 17 unique methods described. Only 8 studies (8%) reported using the Center for Disease Control and Prevention guidelines for ME conversion. There is significant variability among the reported ME conversion methodology within plastic surgery literature. Highlighting these discrepancies is an essential step in creating and implementing a single, standard method to mitigate opioid morbidity in plastic surgery and to optimize enhanced recovery protocols. [ABSTRACT FROM AUTHOR]
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- 2024
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23. Impact of a standardized protocol for chest tube management after VATS pulmonary resections on post-operative outcomes and complications.
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Comacchio, Giovanni M., Mammana, Marco, Cannone, Giorgio, Zambello, Giovanni, Silvestrin, Stefano, Rebusso, Alessandro, Nicotra, Samuele, and Rea, Federico
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Chest tube management represents a major issue after lung surgery as no protocol is widely accepted and tube management is generally based on local or personal habits. Aim of this study is to evaluate the impact of a standardized protocol for chest tube management after pulmonary resections on the post-operative outcomes. We performed a single center retrospective analysis of all adult patients undergoing thoracoscopic pulmonary resection from January 2020 to December 2021. Starting from January 2021 a standardized protocol of chest tube management was applied after all procedures. Patients were divided into two groups according to the chest tube management strategy. he two groups had similar pre-operative characteristics and the extent of lung resection was comparable. Intervention group had significantly shorter time to chest tube removal (median 1 vs 3 days, p < 0.001) and post-operative length of stay (median 3 vs 4 days, p < 0.001). Despite earlier chest tube removal, there was not an increased incidence of post-removal complications. On multivariable analysis, the new chest drain management strategy was an independent predictor of earlier chest tube removal. A standardized protocol of chest tube management allows for an earlier chest tube removal and a shorter hospital stay, without an increase in post-operative complications. [ABSTRACT FROM AUTHOR]
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- 2024
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24. LUNA EMG as a Marker of Adherence to Prehabilitation Programs and Its Effect on Postoperative Outcomes among Patients Undergoing Cytoreductive Surgery for Ovarian Cancer and Suspected Ovarian Tumors.
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Zębalski, Marcin Adam, Parysek, Krzysztof, Krzywon, Aleksandra, and Nowosielski, Krzysztof
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PREHABILITATION , *OVARIAN tumors , *STATISTICAL sampling , *CYTOREDUCTIVE surgery , *TUMOR markers , *DESCRIPTIVE statistics , *RANDOMIZED controlled trials , *MUSCLE strength , *ROBOTICS , *LENGTH of stay in hospitals ,PREVENTION of surgical complications - Abstract
Simple Summary: Prehabilitation is a multimodal intervention including preoperative exercises, a high-protein diet, psychological support, smoking/alcohol cessation, and the optimization of preoperative laboratory results. The effectiveness of prehabilitation is different for each patient and depends on many factors. Ensuring reliable compliance with prehabilitation recommendations and active patient involvement are pivotal. To accurately assess patient adherence to prehabilitation guidelines, it is crucial to employ innovative assessment tools. To the best of our knowledge, this is the first study utilizing a LUNA EMG device as a marker of prehabilitation compliance. In this study, we implemented a prehabilitation program in a group of patients with suspected ovarian cancer and compared the results with those of the control group in which only the ERAS protocol was used. We observed an improvement in muscle strength and tension during the prehabilitation program and found an association between prehabilitation using this device and fewer complications and shorter hospital stays compared to the control group. Background: Prehabilitation is a novel strategy in preoperative management. The aim of this study was to investigate the effect of prehabilitation programs on peri- and postoperative outcomes and to verify if LUNA EMG has the capacity to monitor compliance with prehabilitation programs. Methods: A total of seventy patients with suspected ovarian cancer were recruited between April 2021 and September 2022 and were divided into a prehabilitation group (36 patients) or a control group (34 patients). A LUNA EMG device was utilized to monitor muscle strength and tension. Results: Within the prehabilitation group, we observed a significant increase in the 6-Minute Walk Test distance by 17 m (median, IQR: 0–42.5, p < 0.001) and a significant increase in muscle strength measured with LUNA EMG. In comparison to the control group, the prehabilitation group showed fewer complications according to the Clavien–Dindo classification (47.2% vs. 20.6%, p = 0.02) and shorter postoperative hospital stays (median 5.0 days [IQR: 4.0–6.2] vs. 7.0 days [IQR: 6.0–10.0], p < 0.001). Conclusion: Prehabilitation has a positive effect on physical capacity and muscle strength and is associated with a reduction in the number of complications after surgery. LUNA EMG can be a useful tool for monitoring patients' adherence to prehabilitation programs. [ABSTRACT FROM AUTHOR]
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- 2024
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25. To wean or not to wean: proton pump inhibitor management after anti-reflux surgery amongst foregut experts.
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Pflüger, Michael Johannes, Coker, Alisa Mae, Zosa, Brenda Marie, Adrales, Gina Lynn, and Parker, Brett Colton
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POSTOPERATIVE care , *MEDICAL protocols , *TERMINATION of treatment , *MEDICAL care , *DECISION making , *DESCRIPTIVE statistics , *GASTROENTEROLOGISTS , *FUNDOPLICATION , *PROTON pump inhibitors , *EVIDENCE-based medicine , *DATA analysis software , *GASTROESOPHAGEAL reflux - Abstract
Background: Most patients undergoing anti-reflux surgery (ARS) have a history of preoperative proton pump inhibitor (PPI) use. It is well-established that ARS is effective in restoring the anti-reflux barrier, eliminating the ongoing need for costly PPIs. Current literature lacks objective evidence supporting an optimal postoperative PPI cessation or weaning strategy, leading to wide practice variations. We sought to objectively gauge current practice and opinion surrounding the postoperative management of PPIs among expert foregut surgeons and gastroenterologists in the United States. Methods: We created a survey of postoperative PPI management protocols, with an emphasis on discontinuation and timing of PPI cessation, and aimed to determine what factors played a role in the decision-making. An electronic survey tool (Qualtrics XM, Qualtrics, Provo, UT) was used to distribute the survey and to record the responses anonymously for a period of three months. Results: The survey was viewed 2658 times by 373 institutions and shared with 644 members. In total, 121 respondents participated in the survey and 111 were surgeons (92%). Fifty respondents (42%) always discontinue PPIs immediately after ARS. Of the remaining 70 respondents (58%), 46% always wean or taper PPIs postoperatively and 47% wean or taper them selectively. The majority (92%) of practitioners taper within a 3-month period postoperatively. Five respondents never discontinue PPIs after ARS. Overall, only 23 respondents (19%) stated their protocol is based on medical literature or evidence-based medicine. Instead, decision-making is primarily based on anecdotal evidence/personal preference (42%, n = 50) or prior training/mentors (39%, n = 47). Conclusions: There are two major protocols used for PPI discontinuation after ARS: Nearly half of providers abruptly stop PPIs, while just over half gradually tapers them, most often in the early postoperative period. These decisions are primarily driven by institutional practices and personal preferences, underscoring the need for evidence-based recommendations. [ABSTRACT FROM AUTHOR]
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- 2024
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26. Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: A randomized controlled trial.
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Karthik, N., Lodha, Mahendra, Baksi, Aditya, Dutt, Akshat, Banerjee, Niladri, Swathi, M., Choudhary, Indra Singh, Meena, Satya Prakash, Sharma, Naveen, and Puranik, Ashok Kumar
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TRANSCUTANEOUS electrical nerve stimulation , *GASTROINTESTINAL motility , *RANDOMIZED controlled trials , *ABDOMINAL surgery - Abstract
Introduction: Postoperative Ileus (POI) negatively impacts patient outcomes and increases healthcare costs. Transcutaneous electrical nerve stimulation (TENS) has been found to improve gastrointestinal (GI) motility following abdominal surgery. However, its effectiveness in this context is not well‐established. This study was designed to evaluate the role of TENS on the recovery of GI motility after exploratory laparotomy. Methods: Patients undergoing exploratory laparotomy were randomized in a 1:1 ratio into control (standard treatment alone) and experimental (standard treatment + TENS) arms. TENS was terminated after 6 days or after the passage of stool or stoma movement. The primary outcome was time for the first passage of stool/functioning stoma. Non‐passage of stool or nonfunctioning stoma beyond 6 days was labeled as prolonged POI. Patients were monitored until discharge. Results: Median (interquartile range) time to first passage of stool/functioning stoma was 82.6 (49–115) hours in the standard treatment group and 50 (22–70.6) hours in the TENS group [p < 0.001]. Prolonged POI was noted in 11 patients in the standard treatment group (35.5%) and one in the TENS group (3.2%) [p = 0.003]. Postoperative hospital stay was similar in the two groups. Conclusion: TENS resulted in early recovery of GI motility by shortening the duration of POI without any improvement in postoperative hospital stay. Trial Registration Number: CTRI/2021/10/037054. [ABSTRACT FROM AUTHOR]
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- 2024
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27. Fast‐track recovery after surgery for perforated peptic ulcer safely shortens hospital stay: A systematic review and meta‐analysis of six randomized controlled trials and 356 patients.
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Zeyara, Adam, Thomasson, Jacob, Andersson, Bodil, and Tingstedt, Bobby
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PEPTIC ulcer , *FIXED effects model , *RANDOM effects model , *LENGTH of stay in hospitals , *POSTOPERATIVE care - Abstract
Background: Postoperative management after surgery for perforated peptic ulcer is still burdened by old traditions. All available data for fast‐track recovery in this setting are either very unspecific or underpowered. The aim of this study was to evaluate fast‐track recovery in this diagnosis‐specific context in a larger sample. Methods: Electronic data sources were searched. Eligible studies were randomized controlled trials (RCTs) comparing fast‐track recovery and traditional management after surgery for perforated peptic ulcer in adults. A systematic review and meta‐analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines regulated the process. Quality and risk of bias assessments of individual RCTs were performed by means of the Let Evidence Guide Every New Decision criteria and the Cochrane risk‐of‐bias tool. Primary endpoints were length of hospital stay and risk of complications. Random or fixed effects modeling were applied as indicated. Outcomes were measured by mean difference and risk difference. Results: Six RCTs with a total cohort of 356 patients were included. Results of our meta‐analysis showed significantly shortened length of hospital stay (mean difference −3.50 days [95% CI ‐4.51 to −2.49], p ≤ 0.00001), significantly less superficial and deep surgical‐site infections (risk differences −0.12 [95% CI −0.20, −0.05], p = 0.002 and −0.03 [95% CI −0.09, 0.03], and p = 0.032, respectively), and significantly fewer pulmonary complications (risk difference −0.10 [95% CI −0.17, −0.03], p = 0.004) in the fast‐track group. Conclusion: This systematic review and meta‐analysis shows that fast‐track recovery after surgery for perforated peptic ulcer significantly shortened hospital stay in the studied cohort without increasing the risk of postoperative complications. [ABSTRACT FROM AUTHOR]
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- 2024
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28. Risk factors for anastomotic leakage in colonic procedures within an ERAS‐protocol. A retrospective cohort study from the Swedish part of the international ERAS‐database.
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Bjerregaard, Felix, Asklid, Daniel, Ljungqvist, Olle, Elliot, Anders H., Pekkari, Klas, and Gustafsson, Ulf O.
- Subjects
- *
ENHANCED recovery after surgery protocol , *SURGICAL excision , *INHALATION anesthesia , *STAPLERS (Surgery) , *SMALL intestine , *COHORT analysis - Abstract
Background: Research on anastomotic leakage (AL) in colonic procedures within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL after colonic surgery. Methods: The study included all consecutively recorded patients operated with colonic resection surgery in the Swedish part of the international ERAS® Interactive Audit System (EIAS) between September 2009 and June 2022. The cohort was analyzed and evaluated regarding risk factors for AL. Results: Altogether 10,632 patients were included, 10,219 were without AL and 413 (3.9%) were with AL. After adjusted analysis, male sex (4.6% AL), OR: 1.49; 95% CI (1.16–1.90), obesity (4.8% AL), OR: 1.62; 95% CI (1.18–2.24), previous surgery (4.4% AL), OR: 1.45; 95% CI (1.14–1.86), open surgery (4.4% AL), OR: 1.36; 95% CI (1.02–1.83), anastomosis between small bowel and rectum (13.1% AL), OR: 3.97; 95% CI (2.23–7.10), stapled anastomosis (5.3% AL), OR: 2.46; 95% CI (1.79–3.38), inhalation anesthesia (4.2% AL), OR: 1.80; 95% CI (1.26–2.57), and conversion to open surgery (5.5% AL), OR 1.49; 95% CI (1.02–2.19) were significant risk factors for AL. Although pre and intraoperative compliance to the ERAS‐protocol was similar, excess of fluids day 0 was an independent predictor for AL. Conclusion: Male sex, obesity, previous surgery, open surgery, stapled anastomotic technique, anastomosis between small bowel and rectum, inhalation anesthesia, conversion to open surgery, and among ERAS interventions, excess of fluids day 0, were significant risk factors for AL. [ABSTRACT FROM AUTHOR]
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- 2024
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29. Implementing a nurse-led prehabilitation program for patients undergoing spinal surgery.
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SHIELDS, LISA B. E., CLARK, LISA, REED, JENNA, and TICHENOR, STEPHANIE
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SPINAL cord surgery , *PATIENT education , *PATIENT autonomy , *HUMAN services programs , *SELF-efficacy , *STRESS management , *PREHABILITATION , *HOSPITAL nursing staff , *PSYCHOLOGICAL adaptation , *DESCRIPTIVE statistics , *ASSISTIVE technology , *CONVALESCENCE , *WELL-being , *SURGICAL decompression - Abstract
Prehabilitation, or "prehab," helps patients optimize strength, function, and nutrition before surgery. This evidence-based practice project presents strategies for implementing a prehab program to prepare patients for spinal surgery. Nurses play an integral role in educating patients preoperatively about the myriad lifestyle changes associated with spinal surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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30. A retrospective study of pre-operative fasting times prior to elective or emergency cesarean birth in a large maternity hospital: Lessons to be learned to minimize the fasting time.
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Kaijomaa, Marja, Myllymäki, Anni, and Väänänen, Antti J.
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CESAREAN section ,WOMEN'S hospitals ,OPERATING rooms ,HEALTH outcome assessment - Abstract
Introduction: When managing elective and emergency cesarean births in the same operating room, unpredictable variations in the start times of the cesareans can prolong fasting periods. Methods: The fasting times were retrospectively analyzed on 279 consecutive cesarean births at Helsinki University Women's Hospital, Finland, during January–February 2023. The fasting times were compared between the urgency groups and for elective cesareans according to their scheduled order on the operation list. The primary outcome was the difference in the fasting times for food and drink, while the secondary outcome was fasting for both food >12 h and fluids >4 h. The fasting times were compared by one-way ANOVA and chi-squared test, respectively. Dichotomous data are presented as unadjusted odds ratios (OR with 95% CI). Results: Increasing urgency was associated with shorter fasting times. Fasting times for elective cesareans increased with the scheduled order on the daily list. The mean fasting periods (SD) increased from 10.55 h (SD=1.57) to 14.75 h (SD=2.02) from the first to the third cesarean of the day (p<0.01). The unadjusted odds ratio (95% CI) for fasting of the scheduled cesareans to exceed 12 h for solid foods and 4 h for clear fluids was 6.53 (95% CI: 2.67–15.9, p<0.001), for the third and fourth cesareans compared to the first two cesareans of the day. Conclusions: When elective and emergency cesareans are performed by the same team, the woman undergoing the third elective surgery of the day should be advised to have breakfast before 5 a.m. at home. While waiting for the operation, a carbohydrate drink should be offered to limit the fast. [ABSTRACT FROM AUTHOR]
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- 2024
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31. Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study.
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Refugia, Justin M., Thakker, Parth U., Roebuck, Emily, Brownstead, Hilary A., Rodriguez, Alejandro R., and Tsivian, Matvey
- Abstract
Objective: To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. Methods: Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0–12, 12–24, 24–36, and 36–48 h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. Results: 34 patients were included. During the median length of stay of 4 days (interquartile range [IQR] 3–7), only 30/34 (88%) of patients required opioids within the first 12 h post-op, decreasing to 38% by 48 h post-op. The median consumption decreased in the first 48 h from 21 MMEs (IQR 9–38) to 10 MMEs (IQR 8–15) at the 0–12 and 36–48 h intervals, respectively. The median time to perform block procedure was 6 min (IQR 4–8 min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. Conclusion: Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted. [ABSTRACT FROM AUTHOR]
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- 2024
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32. The effect of a local anesthetic cocktail in a serratus anterior plane and PECS 1 block for implant-based breast reconstruction
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Nicholas F. Lombana, Courtney Beard, Ishan M. Mehta, Reuben A. Falola, Peter Park, Andrew M. Altman, and Michel H. Saint-Cyr
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Outpatient ,Enhanced recovery after surgery ,ERAS ,Breast reconstruction ,Implant ,Tissue expander ,Surgery ,RD1-811 - Abstract
Introduction: Enhanced recovery after surgery (ERAS) protocols have been implemented to decrease opioid use and decrease patient hospital length of stay (LOS, days). Serratus anterior plane (SAP) blocks anesthetize the T2 through T9 dermatomes of the breast and can be applied intraoperatively. The purpose of this study was to compare postoperative opioid (OME) consumption and LOS between a control group, an ERAS group, and an ERAS/local anesthetic cocktail group in patients who underwent implant-based breast reconstruction. Methods: In this study, 142 women who underwent implant-based breast reconstruction between 2004 and 2020 were divided into Group A (46 patients), a historical cohort; Group B (73 patients), an ERAS/no-block control group; and Group C (23 patients), an ERAS/anesthetic cocktail study group. Primary outcomes of interest were postanesthesia care unit (PACU), inpatient and total hospital OME consumption, and PACU LOS. Results: A significant decrease was observed from Group A to C in PACU LOS (103.3 vs. 80.2 vs. 70.5; p = 0.011), OME use (25.1 vs. 11.4 vs. 5.7; p < 0.0001), and total hospital OME (120.3 vs. 95.2 vs. 35.9; p < 0.05). No difference was observed in inpatient OMEs between the three groups (95.2 vs. 83.8 vs. 30.8; p = 0.212). Despite not reaching statistical significance, Group C consumed an average of 50–60 % less opioids per patient than did Group B in PACU, inpatient, and total hospital OMEs. Conclusion: Local anesthetic blocks are important components of ERAS protocols. Our results demonstrate that a combination regional block with a local anesthetic cocktail in an ERAS protocol can decrease opioid consumption in implant-based breast reconstruction.
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- 2024
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33. Enhanced recovery after surgery in children with congenital scoliosis
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Li Su, Feiran Wu, and Hui Wang
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ERAS ,Pediatric ,Congenital scoliosis ,Perioperative management ,Outcome analysis ,Medicine ,Science - Abstract
Abstract To assess the impact of Enhanced Recovery After Surgery (ERAS) protocol in children undergoing corrective surgery for congenital scoliosis. A retrospective analysis was conducted on children undergoing surgical correction for congenital scoliosis, with participants categorized into either the ERAS group or the control group. Comparative evaluations were made across clinical, surgical, laboratory, and quality of life parameters. Following propensity score matching, 156 patients were analyzed. Within the initial 3 days following surgery, the ERAS cohort demonstrated lower pain intensity and exhibited higher daily oral intake compared to their counterparts in the control group. A mere 14.1% of patients in the ERAS group experienced a peak body temperature exceeding 38.5°, illustrating a significantly lower incidence compared to the 33.3% recorded in the control group. The ERAS cohort displayed expedited timeframes for the onset of initial bowel function and postoperative discharge when contrasted with the control group. Levels of IL-6 assessed on the third day post-surgery were markedly reduced in the ERAS group in comparison to the control group. Noteworthy is the similarity observed in postoperative hemoglobin and albumin levels measured on the first and third postoperative days between the two groups. Assessments of quality of life using SF-36 and SRS-22r questionnaires revealed comparable scores across all domains in the ERAS group when juxtaposed with the control cohort. ERAS protocol has demonstrated a capacity to bolster early perioperative recovery, alleviate postoperative stress responses, and uphold favorable quality of life outcomes in children undergoing corrective surgery for congenital scoliosis.
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- 2024
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34. A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa
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Fitsum Kifle, Peniel Kenna, Selam Daniel, Salome Maswime, and Bruce Biccard
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ERAS ,Africa ,Outcomes ,Review ,Surgery ,RD1-811 - Abstract
Abstract Background Enhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation. Methods We conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results. Results The search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1). Conclusions Despite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments.
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- 2024
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35. Enhanced recovery after surgery in percutaneous transhepatic cholangioscopic lithotripsy for patients with hepatolithiasis and choledocholithiasis
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Peng Zhang, Xi Dang, Xiaojie Li, Bo Liu, and Qingliang Wang
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ERAS ,Percutaneous transhepatic cholangioscopic lithotripsy ,Hepatolithiasis ,Choledocholithiasis ,Complication ,Surgery ,RD1-811 - Abstract
Background: Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an effective alternative procedure for the management of complex hepatolithiasis and choledocholithiasis. Enhanced recovery after surgery (ERAS) program is an evidence-based approach that was developed to reduce surgical stress and accelerate postoperative recovery. However, little is known regarding PTCSL in the context of ERAS. The aim of this study was to evaluate the efficacy and safety of PTCSL within ERAS programs. Patient and methods: The clinical data of patients who underwent PTCSL within ERAS programs consulted at our hospital between November 2017 and November 2022 was retrospectively reviewed. Individualized perioperative ERAS items were evaluated for all patients. The demographics, intraoperative variables, and postoperative outcomes were analyzed. Results: A total of 43 patients who underwent PTCSL were included in the study. There were 13 men and 30 women aged between 39 and 89 years with an average age of 60 years (60.49 ± 12.37). The stone clearance rate was 77 % after the first operation, and the final clearance rate was 95 %. The incidence of complications in this study is 18.6 % (8/43), including 6 patients with Clavien-Dindo I-II, and 2 patients with Clavien-Dindo III. Pleural effusion, abdominal effusion, infection, bile leakage, and biliary bleeding are the most common complications, however, all patients recovered after aggressive treatment. Conclusion: PTCSL is a relatively safe, feasible, and efficient method for treating complex hepatolithiasis and choledocholithiasis within ERAS programs. Individualized ERAS entries and precise disease management are required to minimize the occurrence of complications and to provide effective treatment.
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- 2024
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36. Ultrasound-Guided Peripheral Nerve Block as Post-Operative Management of Lower Abdominal Surgery in Ksatria Airlangga Floating Hospital
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Vina Lidya Setjaputra, Steven Christian Susianto, Jessica Deborah Silitonga, Maya Hapsari Kusumaningtyas, I Putu Agni Rangga Githa, Robbi Tri Atmaja, Burhan Mahendra Kusuma Wardhana, I Ketut Mega Purnayasa Bandem, Khildan Miftahul Firdaus, and Agus Harianto
- Subjects
eras ,floating hospital ,good health and well-being ,ksatria airlangga ,peripheral nerve block ,Anesthesiology ,RD78.3-87.3 - Abstract
Introduction: Enhanced Recovery After Surgery (ERAS) implementation in remote areas by operating hospital ships is immensely helpful due to high patient turnover, reducing costs, and minimizing the effects of surgical stress. Utilization of regional anesthetics, namely ultrasound-guided Transversus Abdominis Plane (TAP) block or Quadratus Lumborum (QL) block, is applicable and beneficial in this setting. Objective: Due to the limited time, facilities, and health personnel available in floating hospital services surgery, several adjustments in anesthetic methods are required to rapidly return patients to their preoperative physiologic state. Therefore, we wrote this case report. Case Series: We presented case series of lower abdominal surgery performed in Ksatria Airlangga Floating Hospital with the implementation of peripheral nerve blocks as one of the ERAS protocols in one of the remote islands in Indonesia, Gili Iyang Island. Two patients underwent TAP blocks, while the remaining two received QL Blocks. A peripheral nerve block was performed under ultrasound guidance and a 20-mL injection of 0.25% levobupivacaine to QL muscle or TAP. During the observation, we found Visual Analogue Score (VAS) of 1-2 after surgery, no post-operative sedation needed, only 1 patient experienced nausea without vomiting, and the length of health facility stay were less than 3 days. Discussion: Nearly all of our patients who underwent lower abdomen surgery got benefits from the application of peripheral nerve block. Because there was no opioid consumption in our cases, the risk of unwanted effect of opioids like postoperative nausea and vomiting, were also decreased. Conclusion: Peripheral nerve block, as mentioned TAP Block and QL Block, has emerged as a promising alternative to prevent and manage post-operative pain in remote medicine settings, namely Ksatria Airlangga Floating Hospital, particularly in areas with few medical facilities.
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- 2024
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37. A randomized translational study on protein- and glucose metabolism in skeletal muscles evaluated by gene-ontology, following preoperative oral carbohydrate loading compared to overnight peripheral parenteral nutrition (PPN) before major cancer surgery
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Britt-Marie Iresjö, Ulrika Smedh, Cecilia Engström, Jan Persson, Christian Mårtensson, and Kent Lundholm
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ERAS ,Preoperative nutrition ,Skeletal muscle metabolism ,Gene expression ,Carbohydrate loading ,Parenteral nutrition ,Medicine - Abstract
Abstract Background Effects of preoperative drinks on muscle metabolism are unclear despite general recommendations. The aim of the present study was therefore to compare metabolic effects of a preoperative oral nutrition drink, recommended by protocols for enhanced recovery after surgery (ERAS), compared to overnight preoperative peripheral total parenteral nutrition (PPN) on skeletal muscle metabolism in patients aimed at major gastrointestinal cancer surgery. Methods Patients were randomized, based on diagnosis and clinical characteristics, to receive either a commercial carbohydrate-rich nutrition drink (Drink); or overnight (12 h) peripheral parenteral nutrition (PPN) as study regimens; compared to isotone Ringer-acetate as Control regimen. Arterial blood- and abdominal muscle tissue specimens were collected at start of surgery. Blood chemistry included substrate- and hormone concentrations. Muscle mRNA transcript analyses were performed by microarray and evaluated for changes in gene activities by Gene Ontology algorithms. Results Patient groups were comparable in all measured preoperative assessments. The Nutrition Drink had significant metabolic alterations on muscle glucose metabolism (p
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- 2024
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38. Navigating the Residency Application Process: A Recent Applicant’s Perspective on Choosing a Residency Program
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Negrete Vasquez, Ofelia, Kao, Lillian, Series Editor, Chen, Herbert, Series Editor, Gillis, Andrea, editor, and Aarons, Cary B., editor
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- 2024
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39. Post-Operative Complications After Emergency Laparotomy
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Ng, Zi Qin, Weber, Dieter, Faintuch, Joel, editor, and Faintuch, Salomao, editor
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- 2024
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40. Colorectal Surgery in Critically Unwell Patients
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Subramaniam, Ashwin, Wengritzky, Robert, Bolshinsky, Vladimir, Faintuch, Joel, editor, and Faintuch, Salomao, editor
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- 2024
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41. Brief Postoperative Hypnosis Intervention as Multimodal Analgesia After Major Abdominal Surgery (Hypn+ERAS)
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Chantal Berna, Professor
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- 2023
42. Compliance With ERAS Protocol in Pancreatic Surgery, Stress Response and Outcomes
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IASO Thessalias, Larissa University Hospital, and DESPOINA LIOTIRI, MD, DESAIC, PgCert HBE(UK), EDRA, MSc, PhD(c), Consultant Anaesthesiologist
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- 2023
43. Goal-Directed Fluid Therapy in Patients Undergoing Lower Limb Surgeries
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Mahmoud Aboubakr Abdelkader, resident doctor of anesthesia, Intensive Care and Pain Management
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- 2023
44. "Analgesic Efficacy of Combined Transversus Abdominis Plane Block and Posterior Rectus Sheath Block in Patients Undergoing Laparoscopic Appendectomy"
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Rashid Saeed Khokhar, consultant anesthetist
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- 2023
45. Web-Based Education on ERAS Protocols Applied in Gynecological and Obstetric Surgery
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Aslı SİS ÇELİK, Associate Professor
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- 2023
46. Pediatric Enhanced Recovery After Cardiac Surgery (PERCS)
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- 2023
47. Comparison of Propofol and Sevoflurane Anaesthesia in Terms of Postoperative Nausea-Vomiting Complication in Cardiac Surgery Patients Undergoing Enhanced Recovery After Surgery Protocol: A Prospective Randomized Study
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Aslıhan Aykut, Nevriye Salman, Zeliha Aslı Demir, Ayşegül Özgök, and Serdar Günaydın
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cardiac surgery ,eras ,postoperative nausea-vomiting ,propofol ,sevoflurane ,Anesthesiology ,RD78.3-87.3 - Abstract
Objective: Postoperative nausea (PN) and vomiting (PONV) in cardiac surgery increases adrenergic stimulation, limits mobilization and oral intake, and can be distressing for patients. The primary aim of our study was to investigate the effect of sevoflurane and propofol anaesthesia on the incidence of PONV in cardiac surgery patients undergoing Enhanced Recovery After Surgery (ERAS) protocol. Methods: Following ethics committee approval, 62 patients undergoing elective coronary artery bypass surgery with ERAS protocol were included in this prospective randomized study. After standard induction of anaesthesia, Group S received 1.5-2% sevoflurane and Group P received 50-100 µg kg-1 min-1 propofol infusion as maintenance anaesthetic agent with a bispectral index of 40-50. The incidence of PN and PONV between 0-6 hours (early) and 6-24 hours (late) after extubation was compared as the primary outcome. The incidence of delirium was analyzed as a secondary outcome for similar periods. Results: In the propofol group, 3 patients were excluded due to postoperative tamponade revision and prolonged mechanical ventilation. PN in the early post-extubation period (29% vs. 7.1%, P=0.031) was significantly higher in Group S. The incidence of delirium was similar between the groups in both periods. Conclusion: Propofol may reduce the incidence of PN in the first 6 hours after extubation compared with sevoflurane. We believe that this period will be beneficial for gastrointestinal tolerance as it is the period when oral intake is initiated in patients. In conclusion, propofol maintenance in cardiac surgery patients may facilitate patient rehabilitation as part of the ERAS protocol.
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- 2024
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48. Outcome improvement for anaemia and iron deficiency in ERAS hip and knee arthroplasty: a descriptive analysis
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Christoffer Calov Jørgensen, Henrik Kehlet, and The Center for Fast-track Hip, Knee Replacement Collaborative Group
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Anaemia ,ERAS ,Hip ,Knee ,Arthroplasty ,Outcomes ,Surgery ,RD1-811 - Abstract
Abstract Background and purpose Preoperative anaemia including iron deficiency anaemia (IDA) is a well-established perioperative risk factor. However, most studies on iron therapy to treat IDA have been negative and few have been conducted within an enhanced recovery after surgery (ERAS) protocol. Furthermore, patients with IDA often have comorbidities not necessarily influenced by iron, but potentially influencing traditional study endpoints such as length of stay (LOS), morbidity, etc. The aim of this paper is to discuss patient-related challenges when planning outcome studies on the potential benefits of iron therapy in patients with IDA, based upon a large detailed prospective database in ERAS total hip (THA) and knee arthroplasty (TKA). Methods A prospective observational cohort study in ERAS THA and TKA from 2022 to 2023. Detailed complete follow-up through questionnaires and electronic medical records. Results Of 3655 included patients, 276 (7.6%) had IDA defined as a haemoglobin (Hb) of 2 days occurred in 11.6% of patients with IDA vs. 4.3% in non-anaemics. The proportion with 30- or 90-day readmissions was 6.5% vs. 4.1% and. 13.4% vs6.0%, in patients with IDA and non-anaemics, respectively. However, potentially anaemia or iron deficiency-related causes of LOS > 2 days or 90-day readmissions were only 5.4% and 2.2% in patients with IDA and 1.9% and 1.0% in non-anaemics. Conclusion Conventional randomised trials with single or composite “hard” endpoints are at risk of being inconclusive or underpowered due to a considerable burden of other patient-related risk factors and with postoperative complications which may not be modifiable by correction of IDA per se. We will propose to gain further insights from detailed observational and mechanistic studies prior to initiating extensive randomised studies.
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- 2024
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49. Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial
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Jung-Pil Yoon, Hee Young Kim, Jieun Jung, Jimin Lee, Seyeon Park, and Gyeong-Jo Byeon
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Block ,ERAS ,Laparoscopic cholecystectomy ,Rectus sheath ,Sleep quality ,Transversus Abdominis plane block ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. Methods The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. Results There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. Conclusion Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.
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- 2024
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50. Impact of postoperative dietary types on nutrition and treatment prognosis in hospitalized patients undergoing oral and maxillofacial surgery: a comparative study
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Sung Bin Youn, Se-Hui Ahn, Dong-Ho Cho, and Hoon Myoung
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postoperative nutrition ,oral and maxillofacial surgery ,dental surgery ,soft blend diet ,eras ,Nutrition. Foods and food supply ,TX341-641 ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Objectives The objective of this study is to compare a nutritionally balanced soft blend diet (SBD) with a soft fluid diet (SFD) on the health of inpatients who have undergone oral and maxillofacial (OMF) surgery, ultimately aiming to enhance care outcomes, improve health-related quality of life (QOL), and increase satisfaction with the hospital. Methods Thirty-two patients were randomized into two groups: sixteen received SFD and sixteen received SBD. Anthropometric, laboratory evaluations were conducted upon admission and discharge. Patients filled out questionnaires on demographics, diet satisfaction, food intake amount, and health-related QOL on the day of discharge, assessed using the EuroQoL 5 Dimensions 3 Level and EuroQoL Visual Analogue Scale (EQ-VAS) instruments. Data were analyzed with descriptive statistics, χ2 tests for group differences, and paired nonparametric t-tests for within-group comparisons. The Mann-Whitney U test evaluated inter-group differences in preoperative weight and body mass index (BMI), postoperative changes, meal satisfaction, intake, health-related QOL, and self-assessed health status. P-values were set at a significance level of 0.05. Results The SBD group had higher dietary intake (63.2% vs. 51.0%) and greater diet satisfaction (80.6 vs. 48.1, P < 0.0001) compared to SFD group. Health-related QOL, measured by EQ-VAS, was better in SBD group (70.3 vs. 58.8, P < 0.05). Postoperative weight and BMI decreased in SFD group but increased in SBD group (P < 0.01). Changes in laboratory results showed more stability in the SBD group. No postoperative infections were reported in SBD group, whereas SFD group had a 31.25% complication rate. Conclusions While SFD is often recommended after OMF surgery to protect oral wound healing process, our study reveals that SBD not only enhances physical and psychological outcomes but also, somewhat unexpectedly, supports wound healing and reduces complications. Essentially, SBD promotes physical recovery and enhances health-related QOL than SFD by supporting both somatic and mental healing aspects.
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- 2024
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