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Batchelor, T. J. P. & Ljungqvist, O. (2019). A surgical perspective of ERAS guidelines in thoracic surgery. Current Opinion in Anaesthesiology, 32(1), 17-22
Open this publication in new window or tab >>A surgical perspective of ERAS guidelines in thoracic surgery
2019 (English)In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 32, no 1, p. 17-22Article in journal (Refereed) Published
Abstract [en]

PURPOSE OF REVIEW: Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization.

RECENT FINDINGS: Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications.

SUMMARY: The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-72046 (URN)10.1097/ACO.0000000000000685 (DOI)30589662 (PubMedID)2-s2.0-85059237383 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-12Bibliographically approved
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2019). Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery. British Journal of Surgery, 106(4), 477-483
Open this publication in new window or tab >>Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
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2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 4, p. 477-483Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-69119 (URN)10.1002/bjs.10988 (DOI)000459801800023 ()30259967 (PubMedID)
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2019-03-13Bibliographically approved
Currie, A., Soop, M., Demartines, N., Fearon, K., Kennedy, R. & Ljungqvist, O. (2019). Enhanced Recovery After Surgery Interactive Audit System: 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database. Clinics in Colon and Rectal Surgery, 32(1), 75-81
Open this publication in new window or tab >>Enhanced Recovery After Surgery Interactive Audit System: 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database
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2019 (English)In: Clinics in Colon and Rectal Surgery, ISSN 1531-0043, E-ISSN 1530-9681, Vol. 32, no 1, p. 75-81Article, review/survey (Refereed) Published
Abstract [en]

The Enhanced Recovery After Surgery (ERAS) is a managed care program that has shown the ability to reduce complications following elective colorectal surgery. In 2006, the ERAS (R) Society developed the ERAS (R) Interactive Audit System (EIAS), which has allowed centers in over 20 countries to enter perioperative patient data to benchmark against international practice within the audit system and act as a stimulus for quality improvement. The de-identified patient data are coded in SQL (a relational database), stored on secure servers, and data governance aspects have been secured in all involved countries. A collaborative approach is undertaken within involved units toward research questions with published cohort data from the audit system having demonstrated the importance of overall compliance on improving patient outcomes and less cost of care. The EIAS has shown that collaborative clinical effort can drive quality improvement in a short time frame in an international context.

Place, publisher, year, edition, pages
Thieme Medical Publishers, 2019
Keywords
surgery, audit, perioperative care, outcomes
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:oru:diva-71678 (URN)10.1055/s-0038-1673357 (DOI)000455134200013 ()30647549 (PubMedID)2-s2.0-85059774143 (Scopus ID)
Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-01-23Bibliographically approved
Batchelor, T. J. P., Rasburn, N. J., Abdelnour-Berchtold, E., Brunelli, A., Cerfolio, R. J., Gonzalez, M., . . . Naidu, B. (2019). Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). European Journal of Cardio-Thoracic Surgery, 55(1), 91-115
Open this publication in new window or tab >>Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)
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2019 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 55, no 1, p. 91-115Article in journal (Refereed) Published
Abstract [en]

Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-69583 (URN)10.1093/ejcts/ezy301 (DOI)30304509 (PubMedID)2-s2.0-85059248778 (Scopus ID)
Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2019-01-08Bibliographically approved
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., . . . Ljungqvist, O. (2019). Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery, 43(3), 659-695
Open this publication in new window or tab >>Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018
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2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 3, p. 659-695Article in journal (Refereed) Published
Abstract [en]

Background: This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol.

Methods: A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

Results: All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly.

Conclusions: The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Identifiers
urn:nbn:se:oru:diva-70174 (URN)10.1007/s00268-018-4844-y (DOI)000457455400001 ()30426190 (PubMedID)2-s2.0-85056655176 (Scopus ID)
Available from: 2018-11-15 Created: 2018-11-15 Last updated: 2019-02-19Bibliographically approved
Low, D. E., Allum, W., De Manzoni, G., Ferri, L., Immanuel, A., Kuppusamy, M., . . . Ljungqvist, O. (2019). Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World Journal of Surgery, 43(2), 299-330
Open this publication in new window or tab >>Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations
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2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 2, p. 299-330Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure.

METHODS: A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system.

RESULTS: Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure.

CONCLUSIONS: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-69212 (URN)10.1007/s00268-018-4786-4 (DOI)000455555600001 ()30276441 (PubMedID)2-s2.0-85054487928 (Scopus ID)
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2019-01-29Bibliographically approved
Nelson, G., Bakkum-Gamez, J., Kalogera, E., Glaser, G., Altman, A., Meyer, L. A., . . . Dowdy, S. C. (2019). Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. International Journal of Gynecological Cancer, Article ID ijgc-2019-000356.
Open this publication in new window or tab >>Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update
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2019 (English)In: International Journal of Gynecological Cancer, ISSN 1048-891X, E-ISSN 1525-1438, article id ijgc-2019-000356Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.

METHODS: A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

RESULTS: All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.

CONCLUSIONS: The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
Enhanced Recovery After Surger, intraoperative care, postoperative care, preoperative care, surgery
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-73189 (URN)10.1136/ijgc-2019-000356 (DOI)30877144 (PubMedID)
Available from: 2019-03-19 Created: 2019-03-19 Last updated: 2019-03-19Bibliographically approved
Elias, K. M., Stone, A. B., McGinigle, K., Tankou, J. I., Scott, M. J., Fawcett, W. J., . . . Eras, S. (2019). The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies. World Journal of Surgery, 43(1), 1-8
Open this publication in new window or tab >>The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies
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2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 1, p. 1-8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Enhanced recovery after surgery (ERAS) programs are multimodal care pathways designed to minimize the physiological and psychological impact of surgery for patients. Increased compliance with ERAS guidelines is associated with improved patient outcomes across surgical types. As ERAS programs have proliferated, an unintentional effect has been significant variation in how ERAS-related studies are reported in the literature.

METHODS: Society launched an effort to create an instrument to assist authors in manuscript preparation. Criteria to include were selected by a combination of literature review and expert opinion. The final checklist was refined by group consensus.

RESULTS: The Societies present the Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist. The tool contains 20 items including best practices for reporting clinical pathways, compliance auditing, and formatting guidelines.

CONCLUSIONS: The RECOvER Checklist is intended to provide a standardized framework for the reporting of ERAS-related studies. The checklist can also assist reviewers in evaluating the quality of ERAS-related manuscripts. Authors are encouraged to include the RECOvER Checklist when submitting ERAS-related studies to peer-reviewed journals.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-68520 (URN)10.1007/s00268-018-4753-0 (DOI)000454846000001 ()30116862 (PubMedID)2-s2.0-85051787555 (Scopus ID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-01-17Bibliographically approved
Martin, D., Roulin, D., Grass, F., Addor, V., Ljungqvist, O., Demartines, N. & Hübner, M. (2018). A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program. Clinical Nutrition, 37(6 Pt. A), 2172-2177
Open this publication in new window or tab >>A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program
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2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6 Pt. A, p. 2172-2177Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS: The existence of enhanced recovery specific guidelines (ERAS) is not enough to change patient management practice since many barriers exist to successful ERAS implementation. The present survey aimed to analyse motivations for implementation as well as encountered difficulties and challenges. Further, relevance and importance of perioperative care items and postoperative recovery targets were assessed.

METHODS: A multicentre qualitative study was conducted between August and December 2016 among surgeons, anaesthesiologists and nurses from implemented ERAS centres in Switzerland (n = 16) and Sweden (n = 14). An online survey (31 closed questions) was sent by email, with reminders at 4, 8 and 12 weeks.

RESULTS: Seventy-seven out of 146 experts completed the survey (response rate 52.7%). Main motivations to implement ERAS were the expectation to reduce complications (91%), higher patient satisfaction (73%) and shorter hospital stay (62%). The application of ERAS program represented major changes in clinical practice for 57% of participants without significant differences between various specialities (surgeons: 63%, nurses: 63%, anaesthesiologists: 36%, p = 0.185). The most important barriers for straightforward implementation were time restraints (69%), opposing colleagues (68%) and logistical reasons (66%). The 3 most frequently cited patient-related barriers to adopt ERAS were opposing personality (52%), co-morbidities (49%) and language barriers (31%).

CONCLUSIONS: Implementing ERAS care into practice was challenging and required important changes in clinical practice for all involved specialities. Main reasons for implementation were the expectation to reduce complications and hospital stay with improved patients' satisfaction. Main barriers were time restraints, reluctance to change and logistics.

Place, publisher, year, edition, pages
Churchill Livingstone, 2018
Keywords
Enhanced recovery after surgery, implementation, qualitative study
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-64350 (URN)10.1016/j.clnu.2017.10.017 (DOI)000455069400046 ()29129637 (PubMedID)2-s2.0-85033398511 (Scopus ID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2019-01-23Bibliographically approved
McQueen, K., Oodit, R., Derbew, M., Banguti, P. & Ljungqvist, O. (2018). Authors' Reply: Enhanced Recovery After Surgery for Low and Middle-Income Countries [Letter to the editor]. World Journal of Surgery, 42(12), 4126-4126
Open this publication in new window or tab >>Authors' Reply: Enhanced Recovery After Surgery for Low and Middle-Income Countries
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2018 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 12, p. 4126-4126Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-67024 (URN)10.1007/s00268-018-4652-4 (DOI)000452385600042 ()29717348 (PubMedID)2-s2.0-85046152736 (Scopus ID)
Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-01-07Bibliographically approved
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