BACKGROUND AND AIMS: Enhanced recovery after surgery (ERAS) has been shown to improve outcomes for patients following gastrointestinal surgery. Data on protocol adherence and how this impacts on outcome are limited. This study examines how protocol adherence changes over time and determines how this impacts on outcome across a large-volume gastrointestinal surgical service. MATERIALS AND METHODS: A prospective review of patients eligible for colorectal, liver and oesophagogastric ERAS over two 3-month periods in 2010 and 2011 was performed. End points included: length of stay (LOS), overall protocol adherence, individual modality adherence, reason for pathway deviation and patient outcomes. RESULTS: 172 patients (110 colorectal, 31 liver and 31 oesophagogastric) were evaluated. For each sub-speciality, the introduction of ERAS led to significant reductions in LOS that were sustained for the duration of the study. Adherence was achieved across 60% (colorectal), 75% (liver) and 88% (oesophagogastric) of individual pathway modalities. The major causes of pathway deviation were: post-operative nausea and vomiting (colorectal), pain (liver) and pulmonary complications (oesophagogastric). CONCLUSIONS: Large-scale implementation of ERAS at a high-volume centre is feasible and offers many of the benefits demonstrated in controlled trials, but adherence may diminish over time.
BACKGROUND AND AIMS: Enhanced recovery after surgery (ERAS) has been shown to improve outcomes for patients following gastrointestinal surgery. Data on protocol adherence and how this impacts on outcome are limited. This study examines how protocol adherence changes over time and determines how this impacts on outcome across a large-volume gastrointestinal surgical service. MATERIALS AND METHODS: A prospective review of patients eligible for colorectal, liver and oesophagogastric ERAS over two 3-month periods in 2010 and 2011 was performed. End points included: length of stay (LOS), overall protocol adherence, individual modality adherence, reason for pathway deviation and patient outcomes. RESULTS: 172 patients (110 colorectal, 31 liver and 31 oesophagogastric) were evaluated. For each sub-speciality, the introduction of ERAS led to significant reductions in LOS that were sustained for the duration of the study. Adherence was achieved across 60% (colorectal), 75% (liver) and 88% (oesophagogastric) of individual pathway modalities. The major causes of pathway deviation were: post-operative nausea and vomiting (colorectal), pain (liver) and pulmonary complications (oesophagogastric). CONCLUSIONS: Large-scale implementation of ERAS at a high-volume centre is feasible and offers many of the benefits demonstrated in controlled trials, but adherence may diminish over time.
Authors: Elisabeth C McLemore; John T Paige; Simon Bergman; Yumi Hori; Erin Schwarz; Timothy M Farrell Journal: Surg Endosc Date: 2015-09-03 Impact factor: 4.584
Authors: Donald E Low; William Allum; Giovanni De Manzoni; Lorenzo Ferri; Arul Immanuel; MadhanKumar Kuppusamy; Simon Law; Mats Lindblad; Nick Maynard; Joseph Neal; C S Pramesh; Mike Scott; B Mark Smithers; Valérie Addor; Olle Ljungqvist Journal: World J Surg Date: 2019-02 Impact factor: 3.352
Authors: Katie Benton; Iain Thomson; Elisabeth Isenring; B Mark Smithers; Ekta Agarwal Journal: Support Care Cancer Date: 2018-01-24 Impact factor: 3.603
Authors: Alexander T Hawkins; Timothy M Geiger; Adam B King; Jonathan P Wanderer; Vikram Tiwari; Roberta L Muldoon; Molly M Ford; Roger R Dmochowski; Warren S Sandberg; Barbara Martin; M Benjamin Hopkins; Matthew D McEvoy Journal: Surg Endosc Date: 2018-10-17 Impact factor: 4.584
Authors: Emad Ali Ahmed; Roberto Montalti; Daniele Nicolini; Paolo Vincenzi; Martina Coletta; Andrea Vecchi; Federico Mocchegiani; Marco Vivarelli Journal: Medicine (Baltimore) Date: 2016-07 Impact factor: 1.889
Authors: Matthew D McEvoy; Jonathan P Wanderer; Adam B King; Timothy M Geiger; Vikram Tiwari; Maxim Terekhov; Jesse M Ehrenfeld; William R Furman; Lorri A Lee; Warren S Sandberg Journal: Perioper Med (Lond) Date: 2016-02-05
Authors: Damian D Bragg; Helena Edis; Sian Clark; Simon L Parsons; Binoy Perumpalath; Dileep N Lobo; Charles A Maxwell-Armstrong Journal: World J Gastrointest Surg Date: 2017-09-27