Large-scale implementation of enhanced recovery programs after surgery. A francophone experience

Véziant, Julie; Raspado, O.; Entremont, A.; Joris, Jean; Pereira, Bruno; Slim, K.

doi:10.1016/j.jviscsurg.2016.08.009

Cited by 22 publications

(22 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16 Adherence to the individual items that make up an ERP in the perioperative period has been associated with improvements in postoperative outcomes, 10,17 including with reductions in postoperative complications and LOS. 18,19 Although there is evidence that demonstrates the effectiveness of the ERP, 12 to our knowledge, there are no large case series of patients showing better postoperative outcomes in centers that perform ERP successfully compared with centers that have the same adherence rates to individual components that make up an ERP as a whole, even though a predefined ERP is not performed. Moreover, there is uncertainty regarding the relative benefit from each component of an ERP.…”

mentioning

confidence: 99%

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. OBJECTIVE To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. EXPOSURES Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. MAIN OUTCOMES AND MEASURES The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. RESULTS Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates.

show abstract

mentioning

confidence: 99%

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In the ERAS concept, pain management is one of the most important constituents. Postoperative pain not only prolongs the LOS, but also reduces the subjective willingness of patients to take early rehabilitation exercises, and therefore resulting in decreased joint function [17, 18]. The traditional procedure is to give appropriate measures when the patient complains unbearable pain.…”

Section: Discussionmentioning

confidence: 99%

“…For elderly patients, early rehabilitation exercise is very important, ERAS concept emphasizes early functional rehabilitation which increases intestinal peristalsis and lung capacity, promotes lower limb muscle strength recovery, maintains hip activity, accelerates the blood circulation at the incision site, promotes incision healing and lower limb venous reflux, and prevents the formation of deep venous thrombosis after operation [13–17]. Although the local nerve block anesthesia using the small dosage and lower concentration can achieve the maximal analgesic effect, the lower limb muscle strength may be affected after the femoral nerve block, and therefore delay the early mobilization [19].…”

Section: Discussionmentioning

confidence: 99%

“…Some investors predicted that any further decreases in the LOS would correspond with increases in postoperative complications [5]. To date, no research has shown that decreases in LOS after treatment of intertrochanteric fracture can be achieved in combination with the reduction of postoperative complications, readmissions, and therefore mortality [15–17].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome

et al. 2019

View full text Add to dashboard Cite

Background Enhanced recovery after surgery (ERAS) has rapidly gained popularity among hip or knee arthroplasty area which can decrease hospital length of stay (LOS). However, limited data exist regarding its safety and efficacy among intertrochanteric fracture patients. The purpose of this study was to determine if LOS associated with intertrochanteric fracture patients can be improved following an existing orthopedic ERAS procedure. Methods We reviewed the outcomes of all patients who had been treated with the PFNA intramedullary fixation at our institution. Open fractures, metastatic pathological fractures, patients unable to walk independently before fracture and patients with Alzheimer's disease were excluded. A quasi-experimental study was adopted between patients treated in an ERAS after intramedullary fixation with those rehabilitated on a traditional pathway. Clinical and demographic data were collected among the two pathway cohorts including LOS, Harris hip scores (HHS), visual analog scale (VAS), and activity of daily living scale (ADL). Results A total of 100 intertrochanteric fracture patients (ERAS pathway 50 cases, traditional care pathway 50 cases) were selected between January 2016 and December 2017 met the inclusion criteria. ERAS procedure was associated with shorter LOS, lower postoperative VAS scores, reduced opioid consumption, earlier mobilization, significant improvement in the mean HHS scores at 3 months postoperatively, lower risk of complications, lower rates of readmission, and reoperation and higher likelihood of being discharged home. The mean LOS decreased from 8.21 ± 0.83 days to 5.82 ± 0.64 days after implementation of the evidence-based orthopedic ERAS pathway ( p < 0.05). Conclusions This series of intertrochanteric fracture patients treated with the orthopedic ERAS procedure demonstrated that the procedure is capable of reducing LOS and preserving hip function without compromising functional outcome. This improvement was possible without a concomitant increase in postoperative complications and readmission rates. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…Recuperação cirúrgica precoce ou aprimorada após a cirurgia é um caminho multimodal, desenvolvido para superar os efeitos deletérios do estresse envolvido no perioperatório, após a cirurgia, para redução de complicações perioperatória, da permanência e dos custos hospitalares (MELLOUL et al, 2016;MESSENGER et al, 2016;VEZIANT et al, 2016).…”

Section: Período Perioperatório: a Recuperação Cirúrgicaunclassified

Processo de recuperação cirúrgica em pacientes submetidos à prostatectomia radical: estudo longitudinal de variáveis sociodemográficas, clínicas e psicológicas

Romanzini¹

View full text Add to dashboard Cite

show abstract

Large-scale implementation of enhanced recovery programs after surgery. A francophone experience

Abstract: This study shows that large-scale ERPs are feasible and safe in French-speaking countries. Nonetheless, although encouraging, these preliminary results highlight that implementation must be improved in specialties such as bariatric surgery and that more complete data collection is needed.

Cited by 22 publications

References 21 publications

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

Enhanced recovery after surgery (ERAS) in elective intertrochanteric fracture patients result in reduced length of hospital stay (LOS) without compromising functional outcome

Processo de recuperação cirúrgica em pacientes submetidos à prostatectomia radical: estudo longitudinal de variáveis sociodemográficas, clínicas e psicológicas

Contact Info

Product

Resources

About