Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology – A systematic review and meta-analysis.

Bisch, Steven; Jago, C.A.; Kalogera, Eleftheria; Ganshorn, Heather; Meyer, Larissa A.; Ramírez, Pedro T.; Dowdy, Sean C.; Nelson, Gregg

doi:10.1016/j.ygyno.2020.12.035

Cited by 131 publications

(84 citation statements)

References 51 publications

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“…Although evidence supports ERAS practice changes 1 and previous research has demonstrated the benefits of systemwide expansion of ERAS within a single surgical area, 2,5,6 none to our knowledge have reported the impact of systemwide expansion of ERAS across multiple sites and disciplines. Pickens et al 24 examined the results of multidisciplinary audit of ERAS programs at a single institution. They studied clinical outcome improvements in aggregate and within specific surgical pathways (liver, pancreas, colorectal, and urology).…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to know why this occurred other than to speculate that pancreatic surgery is especially complex and to date several studies have failed to find benefit with ERAS implementation. Pickens et al 24 found no change in LOS in their ERAS pancreatic surgery cohort but in fact found a 12% increase in 30-day complications. Roulin et al 35 concluded that implementation of ERAS in pancreatoduodenectomy is challenging, particularly in the postoperative period.…”

Section: Jama Network Open | Surgerymentioning

confidence: 90%

“…A recent meta-analysis 34 of ERAS programs in liver surgery found that ERAS was associated with a 2-day reduction in LOS and 29% reduction in complications; however, the included studies were noted to be heterogeneous. Not all studies have found benefit with ERAS in liver surgery, including the study by Pickens et al, 24 which found no improvement in LOS or complications. This finding may be attributed to the fact that no clinically significant increase in ERAS liver protocol adherence was reported in their study.…”

Section: Jama Network Open | Surgerymentioning

confidence: 99%

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Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

et al. 2021

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IMPORTANCE Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. OBJECTIVE To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. INTERVENTIONS Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. MAIN OUTCOMES AND MEASURES Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. RESULTS A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Surgerymentioning

confidence: 90%

Section: Jama Network Open | Surgerymentioning

confidence: 99%

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Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

et al. 2021

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“…e enhanced recovery after surgery (ERAS) model is an important tool in medical application [1,2]. Yazdchi et al [3] performed a ERAS cardiac surgery for a propensity-matched analysis.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Predictors of Prolonged Hospital Stay in Accelerated Rehabilitation for Patients Undergoing Orthopedic Surgery

Huang

Xie

Huang

et al. 2021

Bioinorganic Chemistry and Applications

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In this study, we performed a retrospective and prospective study of preoperative predictors of the length of stay (LOS) in three groups of surgical patients and conducted a clinical retrospective study of the current research status of preoperative predictors of LOS prolongation in three groups of patients under ERAS (enhanced recovery after surgery) mode, such as patient characteristics and comorbidities. Information such as patients’ exercise preferences, exercise time, frequency and duration, footwear, location of knee osteoarthritis, whether there is a past history of knee injury, and smoking and drinking history was collected, and the research data of 312 patients undergoing the three operations were analyzed by SPSS. Meniscal injury-knee arthroscopy sample included a total of 104 people. Surgical sample for anterior cruciate ligament reconstruction included a total of 100 subjects. Knee osteoarthritis-knee replacement surgery sample included 148 people who were divided into two groups in a ratio of 1 : 1: one group used Mailuo Shutong pills during hospitalization (intervention group) and the other group did not (control group). The research conclusions are as follows. Meniscal Knee Arthroscopy. (1) Samples from different causes of injury showed significant differences for all injured sites. (2) Samples with different smoking and drinking histories all showed significant differences for the causes of injury. (3) Exercise hobby, exercise frequency, duration of each exercise and duration of exercise, and warm-up time before exercise all showed positive correlation. Anterior Cruciate Ligament Reconstruction Surgery. (4) Samples from different causes of injury showed significant differences for all the injured sites. (5) Age has a significant negative influence on the wearing of shoes at ordinary times. (6) Exercise hobby: the warm-up time before exercise had a significant negative influence on the injured area. (7) Two groups of analysis items of exercise frequency, exercise duration and exercise duration, preexercise warm-up time, and exercise hobby were typically positively correlated. Total Knee Arthroplasty. (8) There was a significant difference of 0.01 between the hospitalization days of the intervention group and the control group ( p < 0.01 ), and the hospitalization days of the intervention group were significantly lower than those of the control group. These results indicated that Mailuo Shutong pills were of great significance for the treatment of orthopedic patients during the operation period in that it could effectively shorten the hospital stay of all orthopedic patients and strengthen the accelerated rehabilitation. (9) There was a significant positive correlation between the history of knee joint surgery and the use time of Mailuo Shutong pills. (10) There was a markable positive correlation between occupation and sports hobbies, sports time, frequency and duration, and footwear. There was a significant negative correlation between occupation and preexercise warm-up. (11) Exercise time, frequency, and duration have significant positive influence on BMI.

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“…Recently, enhanced recovery protocols have been introduced in general settings for gynecological surgeries [12][13][14][15]. However, to date, no clinical studies have focused on ERAS protocol compliance for benign hysterectomy, particularly patient self-assessment and satisfaction.…”

Section: Introductionmentioning

confidence: 99%

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

Shen

Min

et al. 2021

BMC Anesthesiol

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Background Enhanced recovery after surgery (ERAS) pathways have been shown to improve clinical outcomes after surgery. Considering the importance of patient experience for patients with benign surgery, this study evaluated whether improved compliance with ERAS protocol modified for gynecological surgery which recommended by the ERAS Society is associated with better clinical outcomes and patient experience, and to determine the influence of compliance with each ERAS element on patients’ outcome after benign hysterectomy. Methods A prospective observational study was performed on the women who underwent hysterectomy between 2019 and 2020. A total of 475 women greater 18 years old were classified into three groups according to their per cent compliance with ERAS protocols: Group I: < 60% (148 cases); Group II:≥60 and < 80% (160 cases); Group III: ≥80% (167 cases). Primary outcome was the 30-day postoperative complications. Second outcomes included QoR-15 questionnaire scores, patient satisfaction on a scale from 1 to 7, and length of stay after operation. After multivariable binary logistic regression analyse, a nomogram model was established to predict the incidence of having a postoperative complication with individual ERAS element compliance. Results The study enrolled 585 patients, and 475 completed the follow-up assessment. Patients with compliance over 80% had a significant reduction in postoperative complications (20.4% vs 41.2% vs 38.1%, P < 0.001) and length of stay after surgery (4 vs 5 vs 4, P < 0.001). Increased compliance was also associated with higher patient satisfaction and QoR-15 scores (P < 0.001),. Among the five dimensions of the QoR-15, physical comfort (P < 0.05), physical independence (P < 0.05), and pain dimension (P < 0.05) were better in the higher compliance groups. Minimally invasive surgery (MIS) (P < 0.001), postoperative nausea and vomiting (PONV) prophylaxis (P < 0.001), early mobilization (P = 0.031), early oral nutrition (P = 0.012), and early removal of urinary drainage (P < 0.001) were significantly associated with less complications. Having a postoperative complication was better predicted by the proposed nomogram model with high AUC value (0.906) and sensitivity (0.948) in the cohort. Conclusions Improved compliance with the ERAS protocol was associated with improved recovery and better patient experience undergoing hysterectomy. MIS, PONV prophylaxis, early mobilization, early oral intake, and early removal of urinary drainage were of concern in reducing postoperative complications. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019178. Registered on 30/10/2018.

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Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology – A systematic review and meta-analysis.

Cited by 131 publications

References 51 publications

Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

Preoperative Predictors of Prolonged Hospital Stay in Accelerated Rehabilitation for Patients Undergoing Orthopedic Surgery

Impact of enhanced recovery after surgery protocol compliance on patients’ outcome in benign hysterectomy and establishment of a predictive nomogram model

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