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Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery: A Review
Örebro University, School of Medical Sciences. Department of Surgery.ORCID iD: 0000-0003-2636-4745
Department of Anaesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, the Netherlands.
Surgical Services, NHS [National Health Service] Lothian, Edinburgh, United Kingdom.
Department of Anaesthesia and Pain Medicine, Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom.
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2021 (English)In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 56, no 8, p. 775-784Article, review/survey (Refereed) Published
Abstract [en]

Importance: Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion.

Observations: Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low- and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS.

Conclusions and Relevance: To date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

Place, publisher, year, edition, pages
American Medical Association , 2021. Vol. 56, no 8, p. 775-784
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Surgery
Identifiers
URN: urn:nbn:se:oru:diva-91352DOI: 10.1001/jamasurg.2021.0586ISI: 000644322900006PubMedID: 33881466Scopus ID: 2-s2.0-85105241358OAI: oai:DiVA.org:oru-91352DiVA, id: diva2:1546400
Available from: 2021-04-22 Created: 2021-04-22 Last updated: 2023-12-08Bibliographically approved

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Ljungqvist, Olle

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