Long-term experience with a modified ERAS protocol for urogynaecology day procedures

Gupta, Sandhya; Rane, Ajay; Vengavati, Venkat; Achari, Mugundan; Mubeen, Anusheh; Gupta, Umesh Kumar

doi:10.1080/01443615.2021.1983784

Cited by 3 publications

(7 citation statements)

References 8 publications

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“…2,14–17 The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. 3–5,19,32,33…”

Section: Discussionmentioning

confidence: 99%

“…2,[14][15][16][17] The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. [3][4][5]19,32,33 A significant obstacle to overcome was a lack of ambulatory staff familiarity with enhanced recovery concepts. This was surmounted via frequent communications and education at staff meetings, posting of pertinent ERP publications, and displaying dynamic data as the project progressed.…”

Section: Discussionmentioning

confidence: 99%

“…Dumestre et al 3 showed that using ERAS protocols allowed safe ambulatory breast reconstruction surgery. Similarly, Alfonso et al 3 and Gupta et al 4 demonstrated that ERAS protocols promoted ambulatory efforts for oncologic and urogynecology surgeries. There appear to be no published studies of ERAS in the pediatric ambulatory setting.…”

Section: Available Knowledgementioning

confidence: 95%

“…1 While initially focused on patients undergoing complex procedures, beneficial impacts of ERAS practices in adult ambulatory surgery have recently been reported. [2][3][4] ERAS guidelines have had slowed implementation in the pediatric population due to limited evidence of benefit. In 2018, the first World Congress for Pediatric ERAS brought together experts in standardized perioperative pediatric care to develop this needed evidence.…”

mentioning

confidence: 99%

“…1 While initially focused on patients undergoing complex procedures, beneficial impacts of ERAS practices in adult ambulatory surgery have recently been reported. 2–4…”

mentioning

confidence: 99%

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Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Martin

Chiem

Hansen

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence. Center-wide efforts involving all ambulatory surgical patients and procedures have not previously been described. METHODS: A comprehensive assessment and gap analysis of ERAS elements in our ambulatory center identified 11 of 19 existing elements. The leadership committed to implementing an Enhanced Recovery Program (ERP) to improve existing elements and close as many remaining gaps as possible. A quality improvement (QI) team was launched to improve 5 existing ERP elements and to introduce 6 new elements (target 17/19 ERP elements). The project plan was broken into 1 preparation phase to collect baseline data and 3 implementation phases to enhance existing and implement new elements. Statistical process control methodology was used. Team countermeasures were based on available evidence. A consensus process was used to resolve disagreement. Monthly meetings were held to share real-time data, gather new feedback, and modify countermeasure plans as needed. The primary outcome measure selected was mean postanesthesia care unit (PACU) length of stay (LOS). Secondary outcomes measures were mean maximum pain score in PACU and patient/family satisfaction scores. RESULTS: The team had expanded the pool of active ERP elements from 11 to 16 of 19. The mean PACU LOS demonstrated significant reduction (early in phase 1 and again in phase 3). No change was seen for the mean maximum pain score in PACU or surgical complication rates. Patient/family satisfaction scores were high and sustained throughout the period of study (91.1% ± 5.7%). Patient/family and provider engagement/compliance were high. CONCLUSIONS: This QI project demonstrated the feasibility of pediatric ERP in an ambulatory surgical setting. Furthermore, a center-wide approach was shown to be possible. Additional studies are needed to determine the relevance of this project to other institutions.

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“…2,14–17 The application of enhanced recovery protocols in the ambulatory surgical setting is rare, and thus far appears to be limited to adult centers. 3–5,19,32,33…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Available Knowledgementioning

confidence: 95%

mentioning

confidence: 99%

“…1 While initially focused on patients undergoing complex procedures, beneficial impacts of ERAS practices in adult ambulatory surgery have recently been reported. 2–4…”

mentioning

confidence: 99%

See 3 more Smart Citations

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Martin

Chiem

Hansen

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

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Nonhome Discharge in Patients Undergoing Pelvic Reconstructive Surgery: A National Analysis

Ross

Wood

Simmons

et al. 2023

UROGC

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Importance Discharge to home after surgery has been recognized as a determinant of long-term survival and is a common concern in the elderly population. Objective The aim of the study was to determine the incidence and risk factors for nonhome discharge in patients undergoing major surgery for pelvic organ prolapse. Study Design We performed a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program Database from 2010 to 2018. We included patients who underwent sacrocolpopexy, vaginal colpopexy, and colpocleisis. We compared perioperative characteristics in patients who were discharged home versus those who were discharged to a nonhome location. Stepwise backward multivariate logistic regression was then used to control for confounding variables and identify independent predictors of nonhome discharge. Results A total of 38,012 patients were included in this study, 209 of whom experienced nonhome discharge (0.5%). Independent predictors of nonhome discharge included preoperative weight loss (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 1.3–27.5), dependent health care status (aOR, 5.0; 95% CI, 2.6–9.5), abdominal hysterectomy (aOR, 2.3; 95% CI, 1.4–3.7), American Society of Anesthesiologists class 3 or greater (aOR, 2.0; 95% CI, 1.5–2.7), age (aOR, 1.1; 95% CI, 1.05–1.09), operative time (aOR, 1.005; 95% CI, 1.003–1.006), laparoscopic hysterectomy (aOR, 0.6; 95% CI, 0.4–1.0), and laparoscopic sacrocolpopexy (aOR, 0.5; 95% CI, 0.3–0.8). Conclusions In patients undergoing surgery for pelvic organ prolapse, nonhome discharge is associated with various indicators of frailty, including age, health care dependence, and certain comorbidities. An open surgical approach increases the risk of nonhome discharge, while a laparoscopic approach is associated with lower risk.

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ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol

Rezaee,

Mahon,

Trock

et al. 2024

BMJ Open

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IntroductionTransurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an ‘incision-free’ and ‘well-tolerated’ operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed.Methods and analysisThis is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups.Ethics and disseminationThe trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication.Trial registration numberNCT05905276

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Long-term experience with a modified ERAS protocol for urogynaecology day procedures

Cited by 3 publications

References 8 publications

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative

Nonhome Discharge in Patients Undergoing Pelvic Reconstructive Surgery: A National Analysis

ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol

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