BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with increased postoperative complications and a prolonged length of stay (LOS). We report on our experience following implementation of an Enhanced Recovery After Surgery (ERAS) program for CRS and HIPEC. METHODS: Patients were divided into pre- and post-ERAS groups. Modifications in the ERAS group included routine use of transversus abdominis plane blocks, intra- and postoperative fluid restriction, and minimizing the use of narcotics, drains, and nasogastric tubes. RESULTS: Of a total of 130 procedures, 49 (38%) were in the pre-ERAS group and 81 (62%) were in the ERAS group. Mean LOS was reduced from 10.3 ± 8.9 days to 6.9 ± 5.0 days (p = 0.007) and the rate of grade III/IV complications was reduced from 24 to 15% (p = 0.243) following ERAS implementation. The ERAS group received less intravenous fluid during hospitalization (19.2 ± 18.7 L vs. 32.8 ± 32.5 L, p = 0.003) and used less opioids than the pre-ERAS group (median of 159.7 mg of oral morphine equivalents vs. 272.6 mg). There were no significant changes in the rates of 30-day readmission or acute kidney injury between the two groups (p = non-significant). On multivariable analyses, ERAS was significantly associated with a reduction in LOS (- 2.89 days, 95% CI - 4.84 to - 0.94) and complication rates (odds ratio 0.22, 95% CI 0.08-0.57). CONCLUSIONS: Implementation of an ERAS program for CRS and HIPEC is associated with a reduction in overall intravenous fluids, postoperative narcotic use, complication rates, and LOS.
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been associated with increased postoperative complications and a prolonged length of stay (LOS). We report on our experience following implementation of an Enhanced Recovery After Surgery (ERAS) program for CRS and HIPEC. METHODS:Patients were divided into pre- and post-ERAS groups. Modifications in the ERAS group included routine use of transversus abdominis plane blocks, intra- and postoperative fluid restriction, and minimizing the use of narcotics, drains, and nasogastric tubes. RESULTS: Of a total of 130 procedures, 49 (38%) were in the pre-ERAS group and 81 (62%) were in the ERAS group. Mean LOS was reduced from 10.3 ± 8.9 days to 6.9 ± 5.0 days (p = 0.007) and the rate of grade III/IV complications was reduced from 24 to 15% (p = 0.243) following ERAS implementation. The ERAS group received less intravenous fluid during hospitalization (19.2 ± 18.7 L vs. 32.8 ± 32.5 L, p = 0.003) and used less opioids than the pre-ERAS group (median of 159.7 mg of oral morphine equivalents vs. 272.6 mg). There were no significant changes in the rates of 30-day readmission or acute kidney injury between the two groups (p = non-significant). On multivariable analyses, ERAS was significantly associated with a reduction in LOS (- 2.89 days, 95% CI - 4.84 to - 0.94) and complication rates (odds ratio 0.22, 95% CI 0.08-0.57). CONCLUSIONS: Implementation of an ERAS program for CRS and HIPEC is associated with a reduction in overall intravenous fluids, postoperative narcotic use, complication rates, and LOS.
Authors: Patrick B Schwartz; Christopher C Stahl; Roberto J Vidri; Glen E Leverson; Yana Puckett; Syed N Zafar; Patrick Varley; Sean M Ronnekleiv-Kelly; Ahmed Al-Niaimi; Sharon M Weber; Daniel E Abbott Journal: Ann Surg Oncol Date: 2022-06-07 Impact factor: 4.339
Authors: Iris H Wei; Emmanouil P Pappou; J Joshua Smith; Maria Widmar; Garrett M Nash; Martin R Weiser; Philip B Paty; Jose G Guillem; Anoushka Afonso; Julio Garcia-Aguilar Journal: Clin Surg Date: 2020-08-10
Authors: Russell G Witt; Timothy E Newhook; Laura R Prakash; Morgan L Bruno; Elsa M Arvide; Whitney L Dewhurst; Naruhiko Ikoma; Jessica E Maxwell; Michael P Kim; Jeffrey E Lee; Matthew H G Katz; Ching-Wei D Tzeng Journal: J Surg Res Date: 2022-03-17 Impact factor: 2.417
Authors: Patrick B Schwartz; Christopher C Stahl; Kara A Vande Walle; Courtney J Pokrzywa; Linda M Cherney Stafford; Taylor Aiken; James Barrett; Alexandra W Acher; Glen Leverson; Sean Ronnekleiv-Kelly; Sharon M Weber; Daniel E Abbott Journal: Ann Surg Oncol Date: 2020-05-15 Impact factor: 5.344
Authors: Annika Kurreck; Felix Gronau; Miguel Enrique Alberto Vilchez; Wiltrud Abels; Philipp Enghard; Andreas Brandl; Roland Francis; Bettina Föhre; Christian Lojewski; Johann Pratschke; Peter Thuss-Patience; Dominik Modest; Beate Rau; Linda Feldbrügge Journal: Ann Surg Oncol Date: 2021-08-04 Impact factor: 5.344