Abstract
Purpose of Review
Enhanced recovery pathways provide a framework outlining the best perioperative care for intra-abdominal surgical procedures. To date, no evidence-based umbrella guidelines exist for all intra-abdominal surgeries.
Recent Findings
PubMed and worldwide web searches were performed with the keywords: “ERAS,” “Enhanced Recovery After Surgery,” +/− “protocol.” Manuscripts addressing intra-abdominal procedures were selected with the date range 2012–2017. The enhanced recovery philosophy is based in the realization that a traditional hospital works in silos that need to be broken to ensure a care protocol that follows and optimizes the journey the patient makes during the perioperative care. Enhanced recovery interventions can be categorized into preoperative, perioperative, and postoperative interventions. By design each intervention is planned and coordinated by a multidisciplinary ERAS team. The interventions discussed in this manuscript should be applied to patients on an individual basis depending on their needs.
Summary
In this review, the most common elements of ERAS protocols in intra-abdominal procedures are reviewed, particularly those which provided the best outcomes and are generalized to all intra-abdominal procedures.
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References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:259–84.
•• Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World J Surg. 2013;37:259–84 Excellent review of ERAS society recommendations for elective colonic surgery.
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149:830–40.
Fearon KCH, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CHC, Lassen K, et al. Enhanced Recovery After Surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24:466–77.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630–41.
Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248:189–98.
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum. 2003;46:851–9.
•• Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 2017;60:761–84 Excellent review of ERAS society recommendations for colonic and rectal surgery.
Danielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Color Dis. 2013;15:e276–83. https://doi.org/10.1111/codi.12197.
Altuntas YE, Kement M, Gezen C, Eker H, Aydin H, Sahin F, et al. The role of group education on quality of life in patients with a stoma. Eur J Cancer Care (Engl). 2012;21:776–81.
Chaudhri S, Brown L, Hassan I, Horgan AF. Preoperative intensive, community-based vs. traditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48:504–9.
Parameters P. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126:376–93.
Thorell A, Efendic S, Gutniak M, Häggmark T, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg. 1994;81:59–63.
Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013;32:34–44.
Smith MD, McCall J, Plank L, Herbison GP, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev 2014:CD009161.
Chen M, Song X, Chen L, Lin Z, Zhang X. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery. Dis Colon Rectum. 2016;59:70–8.
Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011;2011:748031.
•• Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105:1615–28 Excellent guidelines for management of postoperative nausea and vomiting.
Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220:430–43.
Bakker N, Cakir H, Doodeman HJ, Houdijk APJ. Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: impact of measures to improve adherence. Surgery. 2015;157:1130–6.
Forsmo HM, Pfeffer F, Rasdal A, Østgaard G, Mohn AC, Körner H, et al. Compliance with Enhanced Recovery After Surgery criteria and preoperative and postoperative counselling reduces length of hospital stay in colorectal surgery: results of a randomized controlled trial. Color Dis. 2016;18:603–11.
Larson DW, Lovely JK, Cima RR, Dozois EJ, Chua H, Wolff BG, et al. Outcomes after implementation of a multimodal standard care pathway for laparoscopic colorectal surgery. Br J Surg. 2014;101:1023–30.
Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg. 2007;245:867–72.
Thacker JKM, Mountford WK, Ernst FR, Krukas MR, Mythen M. Perioperative fluid utilization variability and association with outcomes. Ann Surg. 2016;263:502–10.
Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.
Hamilton MA, Cecconi M, Rhodes A. A systematic review and Meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392–402.
Grocott MPW, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review. Br J Anaesth. 2013;111:535–48.
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Amir Elhassan, Ihab Elhassan, Amjad Elhassan, Krish D. Sekar, Ryan E. Rubin, and Elyse M. Cornett declare no conflict of interest. Alan D. Kaye serves on the Speakers Bureau of Depomed and Merck. Richard D. Urman received research funding from Medtronic.
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Elhassan, A., Elhassan, I., Elhassan, A. et al. Essential Elements for Enhanced Recovery After Intra-Abdominal Surgery. Curr Pain Headache Rep 23, 35 (2019). https://doi.org/10.1007/s11916-019-0772-2
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DOI: https://doi.org/10.1007/s11916-019-0772-2