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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
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
Medical and Health Sciences 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)29129637 (PubMedID)2-s2.0-85033398511 (Scopus ID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-12-03Bibliographically 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
Joliat, G.-R., Ljungqvist, O., Wasylak, T., Peters, O. & Demartines, N. (2018). Beyond surgery: clinical and economic impact of Enhanced Recovery After Surgery programs. BMC Health Services Research, 18(1), Article ID 1008.
Open this publication in new window or tab >>Beyond surgery: clinical and economic impact of Enhanced Recovery After Surgery programs
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2018 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, no 1, article id 1008Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a perioperative management based on multimodality and multidisciplinary work. ERAS has been shown to have important clinical and economic benefits, but its spread remains slow worldwide.

DISCUSSION: This manuscript reviews the overall program benefits and focuses on important aspects for implementation well beyond surgery. Implementation of ERAS pathways improves clinical outcomes and induces substantial economic gains. ERAS is the current surgical revolution.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Enhanced recovery, Implementation, Surgery
National Category
Surgery Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-71186 (URN)10.1186/s12913-018-3824-0 (DOI)000454562700006 ()30594252 (PubMedID)2-s2.0-85059279930 (Scopus ID)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-17Bibliographically approved
Oodit, R. L., Ljungqvist, O. & Moodley, J. (2018). Can an Enhanced Recovery After Surgery (ERAS) programme improve colorectal cancer outcomes in South Africa?. South African Journal of Wurgery, 56(1), 8-11
Open this publication in new window or tab >>Can an Enhanced Recovery After Surgery (ERAS) programme improve colorectal cancer outcomes in South Africa?
2018 (English)In: South African Journal of Wurgery, ISSN 0038-2361, E-ISSN 2078-5151, Vol. 56, no 1, p. 8-11Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
South African Medical Association, 2018
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-68339 (URN)10.17159/2078-5151/2018/v56n1a2320 (DOI)000439026800002 ()29638086 (PubMedID)2-s2.0-85045381998 (Scopus ID)
Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-09-14Bibliographically approved
Francis, N. K., Walker, T., Carter, F., Hübner, M., Balfour, A., Jakobsen, D. H., . . . Ljungqvist, O. (2018). Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study. World Journal of Surgery, 42(7), 1919-1928
Open this publication in new window or tab >>Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study
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2018 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 7, p. 1919-1928Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.

METHODS: A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence.

RESULTS: An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working.

CONCLUSIONS: We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Identifiers
urn:nbn:se:oru:diva-64040 (URN)10.1007/s00268-017-4436-2 (DOI)000434470100002 ()29302724 (PubMedID)2-s2.0-85040090064 (Scopus ID)
Available from: 2018-01-12 Created: 2018-01-12 Last updated: 2018-09-12Bibliographically approved
Blixt, C., Ahlstedt, C., Ljungqvist, O., Isaksson, B., Kalman, S. & Rooyackers, O. (2018). Corrigendum to ‘The effect of perioperative glucose control on postoperative insulin resistance’ [Clin Nutr 31 (5) (2012) 676–681]. Clinical Nutrition, 37(3), 1091-1091
Open this publication in new window or tab >>Corrigendum to ‘The effect of perioperative glucose control on postoperative insulin resistance’ [Clin Nutr 31 (5) (2012) 676–681]
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2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 3, p. 1091-1091Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-67204 (URN)10.1016/j.clnu.2018.03.007 (DOI)000432879800054 ()29599083 (PubMedID)2-s2.0-85044278044 (Scopus ID)
Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2018-08-30Bibliographically approved
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2018). Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery. British Journal of Surgery
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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2018 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168Article in journal (Refereed) Epub ahead of print
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, 2018
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-69119 (URN)10.1002/bjs.10988 (DOI)30259967 (PubMedID)
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-02Bibliographically approved
McQueen, K., Oodit, R., Derbew, M., Banguti, P. & Ljungqvist, O. (2018). Enhanced Recovery After Surgery for Low- and Middle-Income Countries. World Journal of Surgery, 42(4), 950-952
Open this publication in new window or tab >>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 4, p. 950-952Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-64847 (URN)10.1007/s00268-018-4481-5 (DOI)000427050900006 ()29383424 (PubMedID)2-s2.0-85041176141 (Scopus ID)
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-04-03Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2636-4745

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