Implementing Fast‐Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial

Ionescu, Daniela; Iancu, Cornel; Ion, Daniela Adriana; Al-Hajjar, Nadim; Mărgărit, Simona; Mocan, Lucian; Mocan, Teodora; Deac, Delia; Bodea, Raluca; Vasian, Horatiu

doi:10.1007/s00268-009-0197-x

Cited by 60 publications

(76 citation statements)

References 36 publications

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“…The mean age of the included patients was between 16 and 94 years (5,8), except one of them (16) that had a small group of children of 10 years, whom were not considered in this revision and only adults were included in the review. Men were more predominant within 18 (66.6%) of the studies (10)(11)(12)(13)(14)(17)(18)(19)(20)22,23,(25)(26)(27)(28)(29)(30)(31) and there was no mention about sex proportion in 2 (7.4%) works (6,8). Most of the studies proposed 2 groups, the intervention group (fast-track, G-FT) and the control group (traditional, G-T), only in 2 works 4 groups were designed (22,28) (Table I).…”

Section: Resultsmentioning

confidence: 99%

“…Most of the studies proposed 2 groups, the intervention group (fast-track, G-FT) and the control group (traditional, G-T), only in 2 works 4 groups were designed (22,28) (Table I). The number of treated patients was available in all works, some of them had the same number in each study group (6,7,13,15,17,20). The postoperative follow-up varied by time and used method ranging from a minimum of 3 postoperative days (POD) and a maximum of 29 POD (8,11,12,(15)(16)(17)19,22,27), only on author didn't mention the total follow-up period (9).…”

Section: Resultsmentioning

confidence: 99%

“…To reinforce the articles quality assessment the Critical Appraisal Skills Programme Spain (CASPe) was used among its 11 items applying the first three of them for screening and the questionnaire for the quantification of the critical analysis of scientific studies: clinical trials (CACEC-EC) which with its initial screening part reject the papers that don't reach the score of 6 points and has the following quality assessment values: low (0-6), good (7)(8)(9)(10)(11)(12)(13)(14) and excellent (15)(16)(17)(18)(19)(20).…”

Section: Articles Selectionmentioning

confidence: 99%

“…A colorectal surgery was performed in all studies, technique wasn't specified in 7 of them (6,11,12,15,24,29,31), others described an open surgery (7,9,14,(16)(17)(18)(19)(20)25,30), a laparoscopic procedure (5,10,13,26,27) and both techniques were used in another occasions (21,22,28).…”

Section: Surgical Techniquementioning

confidence: 99%

“…In the preoperative stage between 3 and 12 hours before surgery was given nil by mouth (6,8,9,12,15,16,(18)(19)(20)(21)(22)28,30) the rest of author didn't reported its duration.…”

Section: Nutritional Intervention Traditional Groupmentioning

confidence: 99%

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Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

et al. 2016

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ResumenIntroducción y objetivo: el estado nutricional (NS) preoperatorio tiene consecuencias sobre la recuperación postoperatoria (POSTOP). El objetivo fue revisar sistemáticamente las intervenciones nutricionales (NI) en los protocolos de fast-track en la cirugía de cáncer colorrectal y evaluar la morbilidad-mortalidad y la recuperación del paciente. Método: revisión sistemática de la literatura científi ca previa consulta a las bases de datos bibliográfi cas: Medline, Cochrane Library, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Descriptores MeSH: "colorectal surgery", "fast-track", "perioperative care", "nutrition therapy" and "enhanced recovery programme". Filtros: "humans", "adult (19+ years)" and "clinical trial". Variables resultados después de la operación: recuperación del intestino (BR), estancia hospitalaria (HS), complicaciones y la muerte. Resultados: los 27 estudios seleccionados tenían buena o excelente calidad metodológica. Incluían desde 25 a 597 pacientes, con edades comprendidas entre 16-94 años; los hombres fueron predominantes en el 66,6%. El estado nutricional se evaluó en 13 estudios; 7 por el índice de masa corporal, mientras que uno lo fue por la evaluación subjetiva general. Uno de ellos presentó datos después de la operación. Los grupos fast-track ingirieron, líquidos o suplementos (SS) en 2-8 horas antes. SS contenían altas cantidades de hidratos de carbono, inmunonutrientes y sin-residuos. En POSTOP se administraron líquidos, sólidos y SS. Los grupos tradicionales estuvieron en ayunas entre 3-12 horas y se reanudó la ingesta de alimentos progresivamente. Conclusiones: los grupos fast-track presentaron BR temprana (p < 0,01), los tradicionales tuvieron más infecciones, muertes y un HS más larga. Se observó gran variabilidad en las NI, pero había un punto común: ingesta temprana. A pesar de que se observó una recuperación del paciente, se necesitan futuros estudios con características de la NI más detalladas. Se debe evaluar el NS para poder reconocer el estado nutricional para un mayor reconocimiento del impacto NI. AbstractBackground and aim: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in fast-track protocols for colorectal cancer surgery and assess morbidity-mortality and patient´s recovery. Method: Systematic review of scientifi c literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientifi c Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: "colorectal surgery", "fast-track", "perioperative care", "nutrition therapy" and "enhanced recovery programme". Filters: "humans", adult (19+ years) and "clinical trial". Variables POSTOP outcomes: bowel recovery (BR), hospital s...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Articles Selectionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

“…In the preoperative stage between 3 and 12 hours before surgery was given nil by mouth (6,8,9,12,15,16,(18)(19)(20)(21)(22)28,30) the rest of author didn't reported its duration.…”

Section: Nutritional Intervention Traditional Groupmentioning

confidence: 99%

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Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

et al. 2016

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Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality

Sauro,

Smith,

Ibadin

et al. 2024

JAMA Netw Open

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ImportanceA comprehensive review of the evidence exploring the outcomes of enhanced recovery after surgery (ERAS) guidelines has not been completed.ObjectiveTo evaluate if ERAS guidelines are associated with improved hospital length of stay, hospital readmission, complications, and mortality compared with usual surgical care, and to understand differences in estimates based on study and patient factors.Data SourcesMEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central were searched from inception until June 2021.Study SelectionTitles, abstracts, and full-text articles were screened by 2 independent reviewers. Eligible studies were randomized clinical trials that examined ERAS-guided surgery compared with a control group and reported on at least 1 of the outcomes.Data Extraction and SynthesisData were abstracted in duplicate using a standardized data abstraction form. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Risk of bias was assessed in duplicate using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool estimates for each outcome, and meta-regression identified sources of heterogeneity within each outcome.Main Outcome and MeasuresThe primary outcomes were hospital length of stay, hospital readmission within 30 days of index discharge, 30-day postoperative complications, and 30-day postoperative mortality.ResultsOf the 12 047 references identified, 1493 full texts were screened for eligibility, 495 were included in the systematic review, and 74 RCTs with 9076 participants were included in the meta-analysis. Included studies presented data from 21 countries and 9 ERAS-guided surgical procedures with 15 (20.3%) having a low risk of bias. The mean (SD) Reporting on ERAS Compliance, Outcomes, and Elements Research checklist score was 13.5 (2.3). Hospital length of stay decreased by 1.88 days (95% CI, 0.95-2.81 days; I2 = 86.5%; P &lt; .001) and the risk of complications decreased (risk ratio, 0.71; 95% CI, 0.59-0.87; I2 = 78.6%; P &lt; .001) in the ERAS group. Risk of readmission and mortality were not significant.Conclusions and RelevanceIn this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications. Future studies should aim to improve implementation of ERAS and increase the reach of the guidelines.

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Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Dort

Farwell

Findlay

et al. 2017

JAMA Otolaryngol Head Neck Surg

395

257

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Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

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Implementing Fast‐Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial

Cited by 60 publications

References 36 publications

Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

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