Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

Abstract

Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient-and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Enhanced recovery; Surgery; Fast track; Perioperative management; Postoperative outcomeCore tip: There is a strong and evolving evidence base to support Enhanced Recovery After Surgery (ERAS) programs in abdominal surgery. Such pathways are safe and efficient in enhancing recovery and reducing morbidity. However, patient-related outcomes, cost effectiveness and long-term benefits from ERAS protocols need to be studied more carefully in the future. To support efficient and successful implementation, further educational efforts have to be performed on a national or regional level to improve the standard of care in the general population.

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

“…Despite technical improvements and advances in perioperative care, major abdominal operations are still associated with a high rate of severe complications, long‐term disability, and health and social costs3, 4, 5, 6, 7. Moreover, the likelihood of successfully rescuing patients from surgery‐related morbidity is still unpredictable.…”

Minimally Invasive Distal Pancreatectomy: Review of the English Literature

“…79 In recent years, ERP has been gradually applied in various surgical procedures. The application of ERP for LDP include the following: (1) preoperative use of a phosphate enema for bowel preparation; (2) patient-controlled analgesia (PCA) administered on the day of surgery and the first day after surgery, and PCA discontinued on the second day after surgery; (3) resumption of water consumption on the day of surgery.…”

Accelerated postoperative rehabilitation: multidisciplinary issue. Part 2

“…Это связано в том числе и с отношением администрации стационаров, с личностными особенностями ведущих специалистов. Не стоит забывать и о всепроникающем консерватизме врачей, нежелании и/или отсутствии времени для анализа результатов применения новых методик [28].…”