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Pędziwiatr, M., Pisarska, M. & Ljungqvist, O. (2020). Authors' Reply: Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Nonmetastatic Colorectal Cancer [Letter to the editor]. World Journal of Surgery, 44(1), 314-315
Open this publication in new window or tab >>Authors' Reply: Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Nonmetastatic Colorectal Cancer
2020 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 1, p. 314-315Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2020
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-76428 (URN)10.1007/s00268-019-05168-8 (DOI)31502006 (PubMedID)2-s2.0-85072042819 (Scopus ID)
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2020-01-10Bibliographically approved
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2020). β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes. Annals of Surgery, 271(1), 140-146
Open this publication in new window or tab >>β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
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2020 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1, p. 140-146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-74248 (URN)10.1097/SLA.0000000000002970 (DOI)30048321 (PubMedID)2-s2.0-85077036188 (Scopus ID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2020-01-13Bibliographically approved
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
Keywords
enhanced recovery after surgery, lung surgery, perioperative care, thoracic surgery
National Category
Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-72046 (URN)10.1097/ACO.0000000000000685 (DOI)000467342600004 ()30589662 (PubMedID)2-s2.0-85059237383 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-19Bibliographically approved
Lovely, J. K., Hyland, S. J., Smith, A. N., Nelson, G., Ljungqvist, O. & Parrish, R. H. . (2019). Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS (R)) programs. International Journal of Surgery, 63, 58-62
Open this publication in new window or tab >>Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS (R)) programs
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2019 (English)In: International Journal of Surgery, ISSN 1743-9191, E-ISSN 1743-9159, Vol. 63, p. 58-62Article, review/survey (Refereed) Published
Abstract [en]

One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS (R)) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS (R) Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS (R); (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS (R) programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS (R) implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-73499 (URN)10.1016/j.ijsu.2019.01.006 (DOI)000461663800007 ()30665004 (PubMedID)2-s2.0-85061611907 (Scopus ID)
Available from: 2019-04-04 Created: 2019-04-04 Last updated: 2019-04-04Bibliographically approved
Pisarska, M., Torbicz, G., Gajewska, N., Rubinkiewicz, M., Wierdak, M., Major, P., . . . Pędziwiatr, M. (2019). Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer. World Journal of Surgery, 43(10), 2552-2560
Open this publication in new window or tab >>Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer
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2019 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 10, p. 2552-2560Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Enhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results.

OBJECTIVE: The aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer.

MATERIAL AND METHODOLOGY: Between 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan-Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters.

RESULTS: The groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61-6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19-5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23-5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day.

CONCLUSIONS AND RELEVANCE: This study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.

Place, publisher, year, edition, pages
Springer, 2019
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75598 (URN)10.1007/s00268-019-05073-0 (DOI)000483827100024 ()31286185 (PubMedID)2-s2.0-85068878342 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-09-20Bibliographically approved
Wainwright, T. W., Gill, M., McDonald, D. A., Middleton, R. G., Reed, M., Sahota, O., . . . Ljungqvist, O. (2019). Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthopaedica, 1-17
Open this publication in new window or tab >>Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations
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2019 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, p. 1-17Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background and purpose: There is a large volume of heterogeneous studies across all Enhanced Recovery After Surgery (ERAS®) components within total hip and total knee replacement surgery. This multidisciplinary consensus review summarizes the literature, and proposes recommendations for the perioperative care of patients undergoing total hip replacement and total knee replacement with an ERAS program.

Methods: Studies were selected with particular attention being paid to meta-analyses, randomized controlled trials, and large prospective cohort studies that evaluated the efficacy of individual items of the perioperative treatment pathway to expedite the achievement of discharge criteria. A consensus recommendation was reached by the group after critical appraisal of the literature.

Results: This consensus statement includes 17 topic areas. Best practice includes optimizing preoperative patient education, anesthetic technique, and transfusion strategy, in combination with an opioid-sparing multimodal analgesic approach and early mobilization. There is insufficient evidence to recommend that one surgical technique (type of approach, use of a minimally invasive technique, prosthesis choice, or use of computer-assisted surgery) over another will independently effect achievement of discharge criteria.

Interpretation: Based on the evidence available for each element of perioperative care pathways, the ERAS® Society presents a comprehensive consensus review, for the perioperative care of patients undergoing total hip replacement and total knee replacement surgery within an ERAS® program. This unified protocol should now be further evaluated in order to refine the protocol and verify the strength of these recommendations.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:oru:diva-77695 (URN)10.1080/17453674.2019.1683790 (DOI)000493233700001 ()31663402 (PubMedID)
Available from: 2019-11-07 Created: 2019-11-07 Last updated: 2019-11-21Bibliographically 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: 2019-05-13Bibliographically approved
Brindle, M. E., Heiss, K., Scott, M. J., Herndon, C. A., Ljungqvist, O., Koyle, M. A. & Pediatric ERAS, (. R. (2019). Embracing change: the era for pediatric ERAS is here. Pediatric surgery international (Print), 35(6), 631-634
Open this publication in new window or tab >>Embracing change: the era for pediatric ERAS is here
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2019 (English)In: Pediatric surgery international (Print), ISSN 0179-0358, E-ISSN 1437-9813, Vol. 35, no 6, p. 631-634Article in journal (Refereed) Published
Abstract [en]

The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS® in 2018 has set the stage for a new era in pediatric surgical safety.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Care pathways, ERAS, Enhanced recovery after surgery, Outcomes, Quality and safety
National Category
Surgery Pediatrics
Identifiers
urn:nbn:se:oru:diva-73966 (URN)10.1007/s00383-019-04476-3 (DOI)000467501600001 ()31025092 (PubMedID)2-s2.0-85065030131 (Scopus ID)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-06-19Bibliographically approved
Rove, K. O., Brockel, M. A., Brindle, M. E., Scott, M. J., Herndon, C. D., Ljungqvist, O. & Koyle, M. A. (2019). Embracing changed-the time for pediatric enhanced recovery after surgery is now. Journal of Pediatric Urology, 15(5), 491-493
Open this publication in new window or tab >>Embracing changed-the time for pediatric enhanced recovery after surgery is now
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2019 (English)In: Journal of Pediatric Urology, ISSN 1477-5131, E-ISSN 1873-4898, Vol. 15, no 5, p. 491-493Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Pediatrics Urology and Nephrology
Identifiers
urn:nbn:se:oru:diva-78633 (URN)10.1016/j.jpurol.2019.04.005 (DOI)000498927800020 ()31109886 (PubMedID)2-s2.0-85065764701 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2019-12-16Bibliographically 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
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2636-4745

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