K K Jensen1, T L Brondum2, H Harling2, H Kehlet3, L N Jorgensen2. 1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. mail@kristiankiim.dk. 2. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. 3. Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Abstract
PURPOSE: Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC). METHODS: Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC. RESULTS: A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls. CONCLUSIONS: The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.
PURPOSE:Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC). METHODS: Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC. RESULTS: A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls. CONCLUSIONS: The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.
Authors: Jan M Dieleman; Arno P Nierich; Peter M Rosseel; Joost M van der Maaten; Jan Hofland; Jan C Diephuis; Ronald M Schepp; Christa Boer; Karel G Moons; Lex A van Herwerden; Jan G Tijssen; Sandra C Numan; Cor J Kalkman; Diederik van Dijk Journal: JAMA Date: 2012-11-07 Impact factor: 56.272
Authors: T Bisgaard; H Kehlet; M B Bay-Nielsen; M G Iversen; P Wara; J Rosenberg; H F Friis-Andersen; L N Jorgensen Journal: Br J Surg Date: 2009-12 Impact factor: 6.939
Authors: John P Fischer; Ari M Wes; Jason D Wink; Jonas A Nelson; Benjamin M Braslow; Stephen J Kovach Journal: Plast Reconstr Surg Date: 2014-01 Impact factor: 4.730
Authors: Henrik Husted; Troels H Lunn; Anders Troelsen; Lissi Gaarn-Larsen; Billy B Kristensen; Henrik Kehlet Journal: Acta Orthop Date: 2011-11-09 Impact factor: 3.717
Authors: F K Azar; T C Crawford; K E Poruk; N Farrow; P Cornell; O Nadra; S C Azoury; K C Soares; C M Cooney; F E Eckhauser Journal: Hernia Date: 2017-02-08 Impact factor: 4.739
Authors: Jeremy A Warren; Caroline Stoddard; Ahan L Hunter; Anthony J Horton; Carlyn Atwood; Joseph A Ewing; Steven Pusker; Vito A Cancellaro; Kevin B Walker; William S Cobb; Alfredo M Carbonell; Robert R Morgan Journal: J Gastrointest Surg Date: 2017-08-14 Impact factor: 3.452
Authors: Evan Stearns; Margaret A Plymale; Daniel L Davenport; Crystal Totten; Samuel P Carmichael; Charles S Tancula; John Scott Roth Journal: Surg Endosc Date: 2017-12-21 Impact factor: 4.584
Authors: S T Adams; N H Bedwani; L H Massey; A Bhargava; C Byrne; K K Jensen; N J Smart; C J Walsh Journal: Hernia Date: 2022-01-13 Impact factor: 2.920
Authors: Mark R Jones; Ethan Y Brovman; Amy E Wagenaar; Samuel P Ang; Edward E Whang; Alan D Kaye; Richard D Urman Journal: Psychopharmacol Bull Date: 2020-10-15
Authors: Eva van der Meij; Hidde P van der Ploeg; Baukje van den Heuvel; Boudewijn J Dwars; W J H Jeroen Meijerink; H Jaap Bonjer; Judith A F Huirne; Johannes R Anema Journal: BMC Surg Date: 2017-05-12 Impact factor: 2.102