Tagged research

Research: Provincial ERAS Implementation – Alberta’s experience

Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience

World J Surg (2016) 40:1092–1103

Gregg Nelson, Lawrence N. Kiyang, Ellen T. Crumley, Anderson Chuck, Thanh Nguyen, Peter Faris, Tracy Wasylak, Carlota Basualdo-Hammond, Susan McKay, Olle Ljungqvist, Leah M. Gramlich

Background

Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system.

Methods

We compared pre- and post-guideline implementation in consecutive elective colorectal patients, C18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts.  Read more

Research: Impact of 24-hour post-discharge telephone follow-up

Call to Care: The impact of 24-hour post-discharge telephone follow-up in the treatment of surgical daycare patients

Shay-Anne Daniels, Amanda Kelly, M.Sc., Deborah Bachand, R.N., B.A., Elizabeth Simeoni, R.N., Christine Hall, M.D., M.Sc., F.R.C.P.C., Scott M. Hofer, Ph.D., Allen Hayashi, M.D., M.Sc., F.R.C.S.C. (January 2016)

Background

Patient satisfaction and effective management of post-operative complaints are important factors in determining the success of outpatient surgery programs.

Methods

In September 2013 a 24-hour post-discharge telephone follow-up (TFU) call, was initiated by surgical day care nurses at the Royal Jubilee Hospital in Victoria, B.C. The study group was contacted to evaluate the effectiveness of the TFU in identifying and addressing post-operative complaints and determining the level of satisfaction with discharge instructions and care. Read more

Research: ERAS protocols for radical cystectomy

Enhanced Recovery After Surgery protocols for radical cystectomy surgery: review of current evidence and local protocols.

Mir MC, Zargar H, Bolton DM, et al. (March 2015)

BACKGROUND:

Radical cystectomy (RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery (ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra-operative and post-operative setting of care for RC patients and to propose ERAS evidence-based protocol for patients undergoing RC in the Australian and New Zealand environment.

PREOPERATIVE:

Patient’s medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high-energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC.

INTRA-OPERATIVE:

Epidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC, despite encouraging results from high-volume centres, high-level evidence in this field are lacking (ongoing clinical trials). Standardized anaesthetic protocols with particular emphasis on perioperative fluid management are essential components of ERAS protocols.

POST-OPERATIVE:

Avoidance of routine nasogastric tube placement, early mobilization and multifaceted approach to optimization of gut function and elimination of post-operative ileus are the cornerstones of post-operative care in the setting of ERAS in RC patients.

ANZ J Surg. 2015 Mar 17. doi: 10.1111/ans.13043

Research: Chewing gum after surgery to help recovery of the digestive system

Cochrane Review

Short V, Herbert G, Perry R, et al. (2015)

Conclusions:

This review identified some evidence for the benefit of postoperative CG in improving recovery of GI function. However, the research to date has primarily focussed on CS and CRS, and largely consisted of small, poor quality trials. Many components of the ERAS programme also target ileus, therefore the benefit of CG alongside ERAS may be reduced, as we observed in this review. Therefore larger, better quality RCTS in an ERAS setting in wider surgical disciplines would be needed to improve the evidence base for use of CG after surgery.

Read More:

http://www.cochrane.org/CD006506/COLOCA_chewing-gum-after-surgery-to-help-recovery-of-the-digestive-system

 

Research: Attitudes of patients and care providers to ERAS programs after major abdominal surgery

Hughes M, Coolsen MM, Aahlin EK, et al. (2015)

BACKGROUND:

Enhanced recovery after surgery (ERAS) is a well-established pathway of perioperative care in surgery in an increasing number of specialties. To implement protocols and maintain high levels of compliance, continued support from care providers and patients is vital. This survey aimed to assess the perceptions of care providers and patients of the relevance and importance of the ERAS targets and strategies.

MATERIALS AND METHODS:

Pre- and post-operative surveys were completed by patients who underwent major hepatic, colorectal, or oesophagogastric surgery in three major centers in Scotland, Norway, and The Netherlands. Anonymous web-based and article surveys were also sent to surgeons, anesthetists, and nurses experienced in delivering enhanced recovery protocols. Each questionnaire asked the responder to rate a selection of enhanced recovery targets and strategies in terms of perceived importance.

RESULTS:

One hundred nine patients and 57 care providers completed the preoperative survey. Overall, both patients and care providers rated the majority of items as important and supported ERAS principles. Freedom from nausea (median, 10; interquartile range [IQR], 8-10) and pain at rest (median, 10; IQR, 8-10) were the care components rated the highest by both patients and care providers. Early return of bowel function (median, 7; IQR, 5-8) and avoiding preanesthetic sedation (median, 6; IQR, 3.75-8) were scored the lowest by care providers.

CONCLUSIONS:

ERAS principles are supported by both patients and care providers. This is important when attempting to implement and maintain an ERAS program. Controversies still remain regarding the relative importance of individual ERAS components.

J Surg Res. 2015 Jan;193(1):102-10. doi: 10.1016/j.jss.2014.06.032. Epub 2014 Jun 23.