Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

Ljungqvist, Olle; Boer, H. de; Balfour, Angie; Fawcett, William; Lobo, Dileep N.; Nelson, Gregg; Scott, Michael J.; Wainwright, Tom; Demartines, Nicolas

doi:10.1001/jamasurg.2021.0586

Cited by 184 publications

(133 citation statements)

References 120 publications

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“…Nevertheless, the implementation of the ERAS protocol in orthopedic practice remains a difficult issue [ 7 ]. Recently, a number of studies on ERAS have reported various obstacles in ERAS implementation, such as reduced compliance and ERAS protocol deviation by providers and patients [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Choi

Kim

Chang

et al. 2022

Knee Surg & Relat Res

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Background With increasing interest in enhanced recovery after surgery (ERAS), the literature on ERAS in orthopedic surgery is also rapidly accumulating. This review article aims to (1) summarize the components of the ERAS protocol applied to orthopedic surgery, (2) evaluate the outcomes of ERAS in orthopedic surgery, and (3) suggest practical strategies to implement the ERAS protocol successfully. Main body Overall, 17 components constituting the highly recommended ERAS protocol in orthopedic surgery were identified. In the preadmission period, preadmission counseling and the optimization of medical conditions were identified. In the preoperative period, avoidance of prolonged fasting, multimodal analgesia, and prevention of postoperative nausea and vomiting were identified. During the intraoperative period, anesthetic protocols, prevention of hypothermia, and fluid management, urinary catheterization, antimicrobial prophylaxis, blood conservation, local infiltration analgesia and local nerve block, and surgical factors were identified. In the postoperative period, early oral nutrition, thromboembolism prophylaxis, early mobilization, and discharge planning were identified. ERAS in orthopedic surgery reduced postoperative complications, hospital stay, and cost, and improved the patient outcomes and satisfaction with accelerated recovery. For successful implementation of the ERAS protocol, various strategies including the standardization of care system, multidisciplinary communication and collaboration, ERAS education, and continuous audit system are necessary. Conclusion The ERAS pathway enhanced patient recovery with a shortened length of stay, reduced postoperative complications, and improved patient outcomes and satisfaction. However, despite the significant progress in ERAS implementation in recent years, it has mainly focused on major surgeries such as arthroplasty. Therefore, further efforts to apply, audit, and optimize ERAS in various orthopedic surgeries are necessary.

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Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Choi

Kim

Chang

et al. 2022

Knee Surg & Relat Res

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“…Enhanced Recovery After Surgery (ERAS) has become the new standard of perioperative care [ 18 , 19 ]. Furthermore, increased compliance to the evidence-based-multimodal system is strongly associated with better outcomes [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of an Operating Room Nurse Preoperative Dialogue on Anxiety, Satisfaction and Early Postoperative Outcomes in Patients Undergoing Major Visceral Surgery—A Single Center, Open-Label, Randomized Controlled Trial

Dias

Clerc

Rodrigues

et al. 2022

JCM

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Background: Anxiety is common before surgery and known to negatively impact recovery from surgery. The aim of this study was to evaluate the impact of a preoperative nurse dialogue on a patient’s anxiety, satisfaction and early postoperative outcomes. Method: This 1:1 randomized controlled trial compared patients undergoing major visceral surgery after a semistructured preoperative nurse dialogue (interventional group: IG) to a control group (CG) without nursing intervention prior to surgery. Anxiety was measured with the autoevaluation scale State-Trait Anxiety Inventory (STAI, Y-form) pre and postoperatively. The European Organization for Research and Treatment of Cancer (EORTC) In-Patsat32 questionnaire was used to assess patient satisfaction at discharge. Further outcomes included postoperative pain (visual analogue scale: VAS 0–10), postoperative nausea and vomiting (PONV), opiate consumption and length of stay (LOS). Results: Over a period of 6 months, 35 participants were randomized to either group with no drop-out or loss to follow-up (total n = 70). The median score of preoperative anxiety was 40 (IQR 33–55) in the IG vs. 61 (IQR 52–68) in the CG (p < 0.001). Postoperative anxiety levels were comparable 34 (IQR 25–46) vs. 32 (IQR 25–44) for IG and CG, respectively (p = 0.579). The IG did not present higher overall satisfaction (90 ± 15 vs. 82.9 ± 16, p = 0.057), and pain at Day 2 was similar (1.3 ± 1.7 vs. 2 ± 1.9, p = 0.077), while opiate consumption, PONV levels and LOS were comparable. Conclusion: A preoperative dialogue with a patient-centered approach helped to reduce preoperative anxiety in patients undergoing major visceral surgery.

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“…Appropriate adoption of technology improves outcomes, but this has to be imbedded in a system that can evaluate the value proposition. 5,7,12 Avoidance of major complications should be the focus. They are miserable for the patient and reduce the quality and quantity of life.…”

Section: Appropriate Adoption Of Technologymentioning

confidence: 99%

COVID-19 and the challenges of the surgery backlog: the greatest healthcare innovation would be to do what we know

Mythen

2021

British Journal of Anaesthesia

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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery

Cited by 184 publications

References 120 publications

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Enhanced recovery after surgery for major orthopedic surgery: a narrative review

Impact of an Operating Room Nurse Preoperative Dialogue on Anxiety, Satisfaction and Early Postoperative Outcomes in Patients Undergoing Major Visceral Surgery—A Single Center, Open-Label, Randomized Controlled Trial

COVID-19 and the challenges of the surgery backlog: the greatest healthcare innovation would be to do what we know

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