Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

Carmichael, Joseph C.; Keller, Deborah S.; Baldini, Gabriele; Bordeianou, Liliana; Weiss, Eric G.; Lee, Lawrence; Boutros, Marylise; McClane, James; Steele, Scott R.; Feldman, Liane S.

doi:10.1007/s00464-017-5722-7

Cited by 58 publications

(45 citation statements)

References 363 publications

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“…Enhanced recovery after surgery (ERAS), also known as fast-track surgery, was first proposed by H. Kehelt 5–8. This technique has undergone rapid development due to its significant safety benefits.…”

Section: Introductionmentioning

confidence: 99%

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Changsheng

Feng

2019

Postgraduate Medical Journal

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PurposeThis study aimed to assess the safety and efficiency of the enhanced recovery after surgery (ERAS) protocol in radical gastrectomy.MethodsStudies published before February 2019 were searched from EMBASE, PubMed, Cochrane Library and Quanfang databases without language and region restrictions. A total of 15 randomised controlled trials (RCTs) with 1216 participants were included in the analysis, of whom 605 underwent ERAS protocol and 611 received traditional perioperative treatment for radical gastrectomy.ResultsThere was a significant reduction in pulmonary infection (p=0.02) after radical gastrectomy. Further, there was a significant decrease in the length of postoperative hospital days (p<0.00001), first passage time of defection and flatus (p<0.00001), and medical cost (p<0.0001) in the group that received the ERAS protocol. However, the ERAS protocol group had a higher risk for readmission (p=0.007), vomiting (p=0.002) and gastric retention (p=0.0003) compared with the traditional treatment group.ConclusionsERAS protocol application for radical gastrectomy accelerated postoperative recovery, shortened postoperative hospital days and first passage time of defection and flatus, and saved on medical costs, and did not increase the occurrence rate of severe complications.

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Section: Introductionmentioning

confidence: 99%

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Changsheng

Feng

2019

Postgraduate Medical Journal

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“…Enhanced recovery after surgery (ERAS) protocols provide the standardization of pre-, intra-, and postoperative patient care [ 1 ]. They were developed to decrease postoperative nausea and pain, promote early return of bowel function, and ultimately decrease the length of hospitalization and enhance functional recovery.…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

et al. 2018

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PurposeEnhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GC-ERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States.Materials and MethodsWe reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015–October 1, 2016) with the historical control (HC) group (January 1, 2012–October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy.ResultsOf a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively).ConclusionsThe implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

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“…The 2014 systematic review by Pöpping and co-workers [14] confirms reviews in 2000 [13] and 2010 [1] that epidural alone, or combined with GA during surgery, and followed by postoperative epidural analgesia, reduces risks for supraventricular tachycardia, deep venous-thrombosis, atelectasis, pneumonia, respiratory failure, paralytic ileus and postoperative nausea and vomiting when compared with GA followed by pharmacological postoperative analgesia. According to an enhanced recovery after surgery (ERAS) programme for open gastrointestinal surgery, thoracic epidural analgesia provides better postoperative analgesia and accelerates recovery of gastrointestinal functions [17].…”

Section: Perioperative Morbidity Is Reduced With Thoracic Epidural Anmentioning

confidence: 99%

Reducing risk of spinal haematoma from spinal and epidural pain procedures

Breivik

Norum

Fenger-Eriksen

et al. 2018

Scandinavian Journal of Pain

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Abstract Background and aims: Central neuraxial blocks (CNB: epidural, spinal and their combinations) and other spinal pain procedures can cause serious harm to the spinal cord in patients on antihaemostatic drugs or who have other risk-factors for bleeding in the spinal canal. The purpose of this narrative review is to provide a practise advisory on how to reduce risk of spinal cord injury from spinal haematoma (SH) during CNBs and other spinal pain procedures. Scandinavian guidelines from 2010 are part of the background for this practise advisory. Methods: We searched recent guidelines, PubMed (MEDLINE), SCOPUS and EMBASE for new and relevant randomised controlled trials (RCT), case-reports and original articles concerning benefits of neuraxial blocks, risks of SH due to anti-haemostatic drugs, patient-related risk factors, especially renal impairment with delayed excretion of antihaemostatic drugs, and specific risk factors related to the neuraxial pain procedures. Results and recommendations: Epidural and spinal analgesic techniques, as well as their combination provide superior analgesia and reduce the risk of postoperative and obstetric morbidity and mortality. Spinal pain procedure can be highly effective for cancer patients, less so for chronic non-cancer patients. We did not identify any RCT with SH as outcome. We evaluated risks and recommend precautions for SH when patients are treated with antiplatelet, anticoagulant, or fibrinolytic drugs, when patients’ comorbidities may increase risks, and when procedure-specific risk factors are present. Inserting and withdrawing epidural catheters appear to have similar risks for initiating a SH. Invasive neuraxial pain procedures, e.g. spinal cord stimulation, have higher risks of bleeding than traditional neuraxial blocks. We recommend robust monitoring routines and treatment protocol to ensure early diagnosis and effective treatment of SH should this rare but potentially serious complication occur. Conclusions: When neuraxial analgesia is considered for a patient on anti-haemostatic medication, with patient-related, or procedure-related risk factors, the balance of benefits against risks of bleeding is decisive; when CNB are offered exclusively to patients who will have a reduction of postoperative morbidity and mortality, then a higher risk of bleeding may be accepted. Robust routines should ensure appropriate discontinuation of anti-haemostatic drugs and early detection and treatment of SH. Implications: There is an on-going development of drugs for prevention of thromboembolic events following surgery and childbirth. The present practise advisory provides up-to-date knowledge and experts’ experiences so that patients who will greatly benefit from neuraxial pain procedures and have increased risk of bleeding can safely benefit from these procedures. There are always individual factors for the clinician to evaluate and consider. Increasingly it is necessary for the anaesthesia and analgesia provider to collaborate with specialists in haemostasis. Surgeons and obstetricians must be equally well prepared to collaborate for the best outcome for their patients suffering from acute or chronic pain. Optimal pain management is a prerequisite for enhanced recovery after surgery, but there is a multitude of additional concerns, such as early mobilisation, early oral feeding and ileus prevention that surgeons and anaesthesia providers need to optimise for the best outcome and least risk of complications.

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Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

Cited by 58 publications

References 363 publications

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Application of enhanced recovery after surgery (ERAS) protocol in radical gastrectomy: a systemic review and meta-analysis

Enhanced Recovery after Surgery for Gastric Cancer Patients Improves Clinical Outcomes at a US Cancer Center

Reducing risk of spinal haematoma from spinal and epidural pain procedures

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