Enhanced Recovery Program in Colorectal Surgery: A Meta‐analysis of Randomized Controlled Trials

Greco, Massimiliano; Capretti, Giovanni; Beretta, Luigi; Gemma, Marco; Pecorelli, Nicolò; Braga, Marco

doi:10.1007/s00268-013-2416-8

Cited by 768 publications

(555 citation statements)

References 70 publications

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“…For example, implementation of ERAS pathways has been associated with favourable short-term benefits, including a reduction in direct costs (anesthetic, nursing, laboratory medicine), hospital length of stay, readmission rates, and complications. [55][56][57][58] Nevertheless, it is yet to be definitively determined whether this is an overall reduction or a reduction at the expense of cost transfer to the community through increased indirect costs due to delayed complications, losses in productivity (i.e., delayed return to employment), and utilization of community resources. 21,22 Dichotomizing recovery A fundamental difference in recovery tools is their assessment of recovery as a dichotomous vs a continuous variable at an individual vs a group level.…”

Section: Measurement Of Recoverymentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. As a result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients' perceived quality of care, recovery, and satisfaction. Recovery tools also differ in their assessment of recovery as a continuous vs dichotomous variable and in their focus at the group vs individual level. Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels, respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.Résumé La qualité de récupération est un construit complexe dont la définition est fortement influencée par les opinions et les biais du patient, du clinicien, voire de l'établissement. Dès lors, les outils d'évaluation de la récupération diffèrent de par la définition-même de la récupération, leur envergure, et le cadre temporel de l'évaluation. Une évaluation précise de la récupération est essentielle; en effet, une récupération sous-optimale a des implications tant économiques que pronostiques. Au niveau institutionnel, on utilise souvent la qualité des soins comme substitut de la qualité de récupération mais, d'un point de vue idéologique, ce concept se distingue de la qualité des soins, de la récupération et de la satisfaction telles que perçues par les patients. Les outils de récupération diffèrent également dans leur évaluation de la récupération en tant que variable continue ou dichotomique et dans leur emphase sur le groupe ou l'individu. Dans l'idéal, les mesures de la récupération devraient évaluer les pronostics de manière dichotomique simple et maintenir leur pertinence en évaluant plusieurs domaines à différents moments dans le temps. L'évaluation dichotomique de la récupération a également des applications cliniques et en recherche. Elle permet d'identifier une récupération sous-optimale tant au niveau du groupe que de l'individu. D'autre part, lorsque ce type d'évaluation est réalisé en temps réel, elle nous donne la possibilité d'intervenir d'une manière ciblée et opportune spécifique à chaque patient tout en rationnalisant les ressources.Author contributions Andrea Bowyer and Colin Royse contributed substantially to the conception and design of the manuscript and drafted the version to be published.

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Section: Measurement Of Recoverymentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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“…In colorectal surgery, ERAS pathways allow significant reduction in postoperative complications, faster functional recovery, shorter hospital stays and reduced costs, even in elderly patients [4][5][6]. Patients within ERAS pathways mainly benefit from reduced medical complications, while surgical morbidity remains generally unchanged [5].…”

Section: Introductionmentioning

confidence: 99%

“…The ERAS strategy has been validated in colorectal surgery and is applied in other specialties including urology, thoracic, vascular and orthopedic surgery [1][2][3]. In colorectal surgery, ERAS pathways allow significant reduction in postoperative complications, faster functional recovery, shorter hospital stays and reduced costs, even in elderly patients [4][5][6]. Patients within ERAS pathways mainly benefit from reduced medical complications, while surgical morbidity remains generally unchanged [5].…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. Methods A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. Results A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. Conclusions The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

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“…5,6 Enhanced recovery pathways have been efficacious in improving outcomes after colorectal and orthopedic surgery, [7][8][9][10] whereas enhanced recovery following gynecologic surgery has been less clearly defined. 11 The few multifaceted enhanced recovery pathways currently described in the literature enrolled fewer than 100 patients, 12,13 were specific to minimally invasive procedures, 12,14 or mixed benign and malignant diagnoses.…”

Section: Résumémentioning

confidence: 99%

Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study

Miller

McIsaac

Chaput

et al. 2015

Can J Anesth/J Can Anesth

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Enhanced Recovery Program in Colorectal Surgery: A Meta‐analysis of Randomized Controlled Trials

Abstract: The ERAS pathway reduced overall morbidity rates and shortened the length of hospital stay, without increasing readmission rates. A significant reduction in nonsurgical complications was evident, while no significant reduction was found for surgical complications.

Cited by 768 publications

References 70 publications

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study

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