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  • 1.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Barmparas, Galinos
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Ley, Eric J.
    Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Does beta-blockade reduce the risk of depression in patients with isolated severe extracranial injuries?2017In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 7, p. 1801-1806Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Approximately half of trauma patients develop post-traumatic depression. It is suggested that beta-blockade impairs trauma memory recollection, reducing depressive symptoms. This study investigates the effect of early beta-blockade on depression following severe traumatic injuries in patients without significant brain injury.

    METHODS: Patients were identified by retrospectively reviewing the trauma registry at an urban university hospital between 2007 and 2011. Severe extracranial injuries were defined as extracranial injuries with Abbreviated Injury Scale score ≥3, intracranial Abbreviated Injury Scale score <3 and an Injury Severity Score ≥16. In-hospital deaths and patients prescribed antidepressant therapy ≤1 year prior to admission were excluded. Patients were stratified into groups based on pre-admission beta-blocker status. The primary outcome was post-traumatic depression, defined as receiving antidepressants ≤1 year following trauma.

    RESULTS: Five hundred and ninety-six patients met the inclusion criteria with 11.4% prescribed pre-admission beta-blockade. Patients receiving beta-blockers were significantly older (57 ± 18 vs. 42 ± 17 years, p < 0.001) with lower Glasgow Coma Scale score (12 ± 3 vs. 14 ± 2, p < 0.001). The beta-blocked cohort spent significantly longer in hospital (21 ± 20 vs. 15 ± 17 days, p < 0.01) and intensive care (4 ± 7 vs. 3 ± 5 days, p = 0.01). A forward logistic regression model was applied and predicted lack of beta-blockade to be associated with increased risk of depression (OR 2.7, 95% CI 1.1-7.2, p = 0.04). After adjusting for group differences, patients lacking beta-blockers demonstrated an increased risk of depression (AOR 3.3, 95% CI 1.2-8.6, p = 0.02).

    CONCLUSIONS: Pre-admission beta-blockade is associated with a significantly reduced risk of depression following severe traumatic injury. Further investigation is needed to determine the beneficial effects of beta-blockade in these instances.

  • 2.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Matthiessen, Peter
    School of Medical Sciences, Örebro University, Örebro, Sweden; Division of Colorectal Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    The Relationship Between Severe Complications, Beta-Blocker Therapy and Long-Term Survival Following Emergency Surgery for Colon Cancer2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 10, p. 2527-2535Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency surgery for colon cancer carries significant morbidity, and studies show more than doubled mortality when comparing elective to emergency surgery. The relationship between postoperative complications and survival has been outlined. Beta-blocker therapy has been linked to improved postoperative outcomes. This study aims to assess the impact of postoperative complications on long-term survival following emergency surgery for colon cancer and to determine whether beta-blockade can reduce complications.

    STUDY DESIGN: This cohort study utilized the prospective Swedish Colorectal Cancer Registry to identify adults undergoing emergency colon cancer surgery between 2011 and 2016. Prescription data for preoperative beta-blocker therapy were collected from the national drug registry. Cox regression was used to evaluate the effect of beta-blocker exposure and complications on 1-year mortality, and Poisson regression was used to evaluate beta-blocker exposure in patients with major complications.

    RESULTS: A total of 3139 patients were included with a mean age of 73.1 [12.4] of which 671 (21.4%) were prescribed beta-blockers prior to surgery. Major complications occurred in 375 (11.9%) patients. Those suffering major complications showed a threefold increase in 1-year mortality (adjusted HR = 3.29; 95% CI 2.75-3.94; p < 0.001). Beta-blocker use was linked to a 60% risk reduction in 1-year mortality (adjusted HR = 0.40; 95% CI 0.26-0.62; p < 0.001) but did not show a statistically significant association with reductions in major complications (adjusted IRR = 0.77; 95% CI 0.59-1.00; p = 0.055).

    CONCLUSION: The development of major complications after emergency colon cancer surgery is associated with increased mortality during one year after surgery. Beta-blocker therapy may protect against postoperative complications.

  • 3.
    Asklid, Daniel
    et al.
    Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro & Institute of Molecular Medicine and Surgery, Örebro University, Örebro, Sweden; University Hospital, Karolinska Institute, Stockholm, Sweden.
    Xu, Yin
    Örebro University, School of Medical Sciences.
    Gustafsson, Ulf O
    Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Risk Factors for Anastomotic Leakage in Patients with Rectal Tumors Undergoing Anterior Resection within an ERAS Protocol: Results from the Swedish ERAS Database2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, no 6, p. 1630-1641Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Research on risk factors for anastomotic leakage (AL) alone within an Enhanced Recovery After Surgery (ERAS) protocol has not yet been conducted. The aim of this study was to identify risk factors for AL and study short-term outcome after AL in patients operated with anterior resection (AR).

    METHODS: All prospectively and consecutively recorded patients operated with AR in the Swedish part of the international ERAS® Interactive Audit System (EIAS) between January 2010 and February 2020 were included. The cohort was evaluated regarding risk factors for AL and short-term outcomes, including uni- and multivariate analysis. Pre-, intra- and postoperative compliance to ERAS®Society guidelines was calculated and evaluated.

    RESULTS: Altogether 1900 patients were included, 155 (8.2%) with AL and 1745 without AL. Male gender, obesity, peritoneal contamination, year of surgery 2016-2020, duration of primary surgery and age remained significant predictors for AL in multivariate analysis. There was no significant difference in overall pre- and intraoperative compliance to ERAS®Society guidelines between groups. Only preadmission patient education remained as a significant ERAS variable associated with less AL. AL was associated with longer length of stay (LOS), higher morbidity rate and higher rate of reoperations.

    CONCLUSION: Male gender, obesity, peritoneal contamination, duration of surgery, surgery later in study period, age and preadmission patient education were associated with AL in patients operated on with AR. Overall pre- and intraoperative compliance to the ERAS protocol was high in both groups and not associated with AL.

  • 4.
    Bass, G. A.
    et al.
    Örebro University, School of Medical Sciences. Division of Traumatology, Emergency Surgery & Surgical Critical Care, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
    Gillis, Amy E.
    Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Patients over 65 years with Acute Complicated Calculous Biliary Disease are Treated Differently: Results and Insights from the ESTES Snapshot Audit2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, no 7, p. 2046-2055Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Accrued comorbidities are perceived to increase operative risk. Surgeons may offer operative treatments less often to their older patients with acute complicated calculous biliary disease (ACCBD). We set out to capture ACCBD incidence in older patients across Europe and the currently used treatment algorithms.

    METHODS: The European Society of Trauma and Emergency Surgery (ESTES) undertook a snapshot audit of patients undergoing emergency hospital admission for ACCBD between October 1 and 31 2018, comparing patients under and ≥ 65 years. Mortality, postoperative complications, time to operative intervention, post-acute disposition, and length of hospital stay (LOS) were compared between groups. Within the ≥ 65 cohort, comorbidity burden, mortality, LOS, and disposition outcomes were further compared between patients undergoing operative and non-operative management.

    RESULTS: The median age of the 338 admitted patients was 67 years; 185 patients (54.7%) of these were the age of 65 or over. Significantly fewer patients ≥ 65 underwent surgical treatment (37.8% vs. 64.7%, p < 0.001). Surgical complications were more frequent in the ≥ 65 cohort than younger patients, and the mean postoperative LOS was significantly longer. Postoperative mortality was seen in 2.2% of patients ≥ 65 (vs. 0.7%, p = 0.253). However, operated elderly patients did not differ from non-operated in terms of comorbidity burden, mortality, LOS, or post-discharge rehabilitation need.

    CONCLUSIONS: Few elderly patients receive surgical treatment for ACCBD. Expectedly, postoperative morbidity, LOS, and the requirement for post-discharge rehabilitation are higher in the elderly than younger patients but do not differ from elderly patients managed non-operatively. With multidisciplinary perioperative optimization, elderly patients may be safely offered optimal treatment.

    TRIAL REGISTRATION: ClinicalTrials.gov (Trial # NCT03610308).

  • 5.
    Blomgren, Lena
    Department of Surgery, St. Göran Hospital, Stockholm, Sweden.
    Perforated peptic ulcer: long-term results after simple closure in the elderly1997In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 21, no 4, p. 412-414; discussion 414Article in journal (Refereed)
    Abstract [en]

    The relative incidence of peptic ulcer perforation in the elderly is rising, and the optimal surgical treatment has yet to be defined. To evaluate the long-term result after simple closure a follow-up study was initiated at a Swedish community hospital. During 1983-1992 a total of 151 patients were admitted with perforated peptic ulcer; 92 were elderly (i.e., 70 years or older), 63 of whom were operated with simple closure. Mortality at 30 days was 27% (17/63) and the total in-hospital mortality 30% (19/63). After a mean follow-up of 79 months, 14 of the 44 survivors are still alive. So far only three of the survivors have required additional hospitalization for complications of peptic ulcer disease. Because the rate of serious recurrences is low (14%, 6/44), it is concluded that simple closure is an adequate surgical treatment for peptic ulcer perforation in the elderly.

  • 6.
    Drakeford, Paul Andrew
    et al.
    Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Novena, Singapore.
    Tham, Shu Qi
    Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Novena, Singapore.
    Kwek, Jia Li
    Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Novena, Singapore.
    Lim, Vera
    Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Novena, Singapore.
    Lim, Chien Joo
    Clinical Research & Innovation Office, Tan Tock Seng Hospital, Novena, Singapore.
    How, Kwang Yeong
    Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 1, p. 19-33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We aimed to determine the prevalence, risk factors, and outcomes of acute kidney injury (AKI) within an ERAS program for colorectal surgery (CRS).

    METHODS: This is a retrospective case-control study conducted from March 2016 to September 2018 at a single tertiary hospital in Singapore. All adult patients requiring CRS within our ERAS program were considered eligible. Exclusions were stage 5 chronic kidney disease or patients requiring a synchronous liver resection. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. Secondary outcomes included mortality, major complications, and hospital length of stay. Patient, surgical, and anaesthesia-related data were analysed to determine factors associated with AKI.

    RESULTS: A total of 575 patients were eligible for the study. Twenty patients were excluded from the study leaving 555 patients for analysis. Mean age was 67.8 (SD 11.4) years. Seventy-four patients met the criteria for AKI (13.4%: stage 1-11.2%, stage 2-2.0%, stage 3-0.2%). One patient required renal replacement therapy (RRT). Patients with AKI had a longer length of stay (median [IQR], 11.0 [5.0-17.0] days vs 6.0 [4.0-8.0] days; P < .001), more major complications (OR, 6.55; 95% CI, 3.00-14.35, P < .001), and a trend towards higher mortality at one year (OR, 1.44; 95% CI 0.48-4.30; p = 0.511. After multivariable regression analysis, factors associated with AKI were preoperative creatinine (OR, 1.01 per 10 µmol/l; 95% CI, 1.03-1.22; P = 0.01), robotic surgery vs open surgery (OR, 0.15; 95% CI, 0.06-0.39; P < 0.001), anaesthesia duration (OR, 1.38 per hour; 95% CI, 1.22-1.55; P < 0.001), and major complications (OR, 5.55; 95% CI, 2.63-11.70; P < 0.001).

    CONCLUSIONS: Within the present cohort, the implementation of an ERAS program for CRS was associated with a low prevalence of moderate to severe AKI despite a balanced intravenous fluid regimen. Patients having open surgery, longer procedures, and major complications are at increased risk of AKI.

  • 7.
    Elias, Kevin M.
    et al.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Stone, Alexander B.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    McGinigle, Katharine
    University of North Carolina School of Medicine, Chapel Hill, USA.
    Tankou, Jo'An I.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Scott, Michael J.
    Virginia Commonwealth University Health System, Richmond, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
    Fawcett, William J.
    Royal Surrey County Hospital, Guilford, UK; University of Surrey, Guilford, UK.
    Demartines, Nicolas
    Lausanne University Hospital CHUV, Lausanne, Switzerland.
    Lobo, Dileep N
    Nottingham Digestive Diseases Centre, Nottingham, UK; National Institute for Health Research (NIHR), Nottingham, UK; Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Queen’s Medical Centre, University of Nottingham, Nottingham, UK.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences.
    Urman, Richard D.
    Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Eras, Society
    The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 1, p. 1-8Article in journal (Refereed)
    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.

  • 8.
    Francis, Nader K.
    et al.
    Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, UK; Faculty of Science, University of Bath, Bath, UK.
    Walker, Thomas
    Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, UK.
    Carter, Fiona
    South West Surgical Training Network, ERAS-UK, Yeovil, UK.
    Hübner, Martin
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Balfour, Angela
    NHS Lothian Western General Hospital, Edinburgh, UK.
    Jakobsen, Dorthe Hjort
    Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark.
    Burch, Jennie
    Head of Gastrointestinal Nurse Education, Academic Institute, St Mark's Hospital, London, UK.
    Wasylak, Tracy
    Strategic Clinical Networks, Alberta Health Services, Edmonton AB, Canada; Faculty of Nursing, University of Calgary, Calgary AB, Canada.
    Demartines, Nicolas
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Lobo, Dileep N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; Queen's Medical Centre, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR), London, UK.
    Addor, Valerie
    Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 7, p. 1919-1928Article in journal (Refereed)
    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.

  • 9.
    Gustafsson, U. O.
    et al.
    Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Scott, M. J.
    Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, USA; Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA.
    Hubner, M.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Nygren, J.
    Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Demartines, N.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Francis, N.
    Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, UK; University of Bath, Wessex House Bath, UK.
    Rockall, T. A.
    Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK.
    Young-Fadok, T. M.
    Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, USA.
    Hill, A. G.
    Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand.
    Soop, M.
    Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK.
    de Boer, H. D.
    Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands.
    Urman, R. D.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Chang, G. J.
    Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, USA.
    Fichera, A.
    Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA.
    Kessler, H.
    Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA.
    Grass, F.
    Department of Visceral Surgery, CHUV, Lausanne, Switzerland.
    Whang, E. E.
    Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA.
    Fawcett, W. J.
    Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK.
    Carli, F.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
    Lobo, D. N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Rollins, K. E.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK.
    Balfour, A.
    Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK.
    Baldini, G.
    Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
    Riedel, B.
    Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University and University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 20182019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 3, p. 659-695Article, review/survey (Refereed)
    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.

  • 10. Gustafsson, U. O.
    et al.
    Scott, M. J.
    Schwenk, W.
    Demartines, N.
    Roulin, D.
    Francis, N.
    McNaught, C. E.
    Macfie, J.
    Liberman, A. S.
    Soop, M.
    Hill, A.
    Kennedy, R. H.
    Lobo, D. N.
    Fearon, Ken
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS(®)) society recommendations2013In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, no 2, p. 259-284Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

    METHODS: Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

    RESULTS: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (quality of evidence and recommendations according to the GRADE system).

    CONCLUSIONS: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolism (ESPEN) present a comprehensive evidence-based consensus review of perioperative care for colonic surgery.

  • 11.
    Gustafsson, Ulf O.
    et al.
    Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Oppelstrup, Henrik
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Thorell, Anders
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Nygren, Jonas
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study2016In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, no 7, p. 1741-1747Article in journal (Refereed)
    Abstract [en]

    Background: Surgical stress can influence oncological outcome and survival. The enhanced recovery after surgery (ERAS) protocol is designed to reduce perioperative stress and has been shown to reduce postoperative morbidity. We studied if adherence to ERAS is associated with increased long-term survival.

    Methods: Between the years 2002 and 2007, 911 consecutive patients, operated with major colorectal cancer surgery at Ersta Hospital, Stockholm, Sweden were analyzed. The histopathological reports of the resected specimen, date, and cause of death of the patients as well as postoperative CRP levels were obtained. The relation between the rate of adherence to the ERAS protocol at the time of surgery, and the short-term outcomes in relation to 5-year overall and colorectal cancer-specific survival was determined in this retrospective cohort study.

    Results: In patients with ≥70 % adherence to ERAS interventions (N = 273,), the risk of 5-year cancer-specific death was lowered by 42 %, HR 0.58 (0.39-0.88, cox regression) compared to all other patients (<70 % adherence). Significant independent perioperative predictors of increased 5-year survival were avoiding overload of intravenous fluids, HR 0.53 (0.32-0.86); oral intake on the day of operation, HR 0.55 (0.34-0.78); and low CRP levels on postoperative day 1.

    Conclusion: High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery.

  • 12.
    Gustafsson, Ulf O.
    et al.
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Centre for Gastrointestinal Disease, Ersta Hospital, Stockholm, Sweden.
    Tiefenthal, Marit
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Thorell, Anders
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Institute of Molecular Medicine and surgery, Karolinska Institutet, Stockholm, Sweden.
    Nygrens, Jonas
    Department of Surgery, Ersta Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Laparoscopic-assisted and open high anterior resection within an ERAS protocol2012In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 36, no 5, p. 1154-1161Article in journal (Refereed)
    Abstract [en]

    Background: Due to potentially superior short-term outcomes compared with open colorectal surgery, laparoscopic surgery is currently being implemented in clinical practice worldwide. In parallel, enhanced recovery after surgery (ERAS) programs are shown to improve postoperative recovery in open colorectal surgery. This study reports outcomes in laparoscopic versus open surgery in conjunction with compliance to the ERAS protocol.

    Methods: The association between surgical approach (laparoscopic or open surgery), compliance to the ERAS protocol, postoperative symptoms, complications, and length of stay after surgery was studied. Between January 2007 to December 2010, 114 consecutive patients underwent elective high anterior resection with laparoscopic-assisted (n = 55) or open resection (n = 59). All clinical data (114 variables) were prospectively recorded.

    Results: The overall preoperative ERAS-protocol compliance was 77% for both the laparoscopic and open group. Laparoscopic surgery resulted in shorter total length of stay (median 4 vs. 6 days, p = 0.04), earlier pain control (median 2 vs. 3 days, p = 0.008), shorter need for intravenous infusions, improved mobilization on the first postoperative day (POD1), and lower inflammatory response (CRP (POD1) 54 +/- 24 vs. 67 +/- 31 mg/l, p = 0.017) compared with open resection. The trends in fewer postoperative complications (9.1 vs. 16.9%; odds ratio (OR) 0.55; 95% confidence interval (CI) 0.17-1.81) and overall postoperative symptoms delaying recovery (20 vs. 30.5%; OR 0.63; 95% CI 0.22-1.34) in laparoscopic surgery were not statistically significant.

    Conclusions: The use of laparoscopy in colorectal surgery within an ERAS protocol results in faster recovery compared with open resection.

  • 13.
    Inabnet, William B.
    et al.
    Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA.
    Palazzo, Fausto
    Hammersmith Hospital and Imperial College, London, UK.
    Sosa, Julie Ann
    University of California, San Francisco, CA, USA.
    Kriger, Joshua
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Aspinall, Sebastian
    Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
    Barczynski, Marcin
    Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
    Doherty, Gerard
    Brigham and Women's Hospital, Boston, MA, USA.
    Iacobone, Maurizio
    University of Padua, Padua, Italy.
    Nordenström, Erik
    Lund University, Lund, Sweden.
    Scott-Coombes, David
    University Hospital of Wales, Cardiff, UK.
    Wallin, Göran
    Örebro University, School of Medical Sciences.
    Williams, Lauren
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Bray, Rachel
    Columbia University Mailman School of Public Health, New York, NY, USA.
    Bergenfelz, Anders
    Lund University, Lund, Sweden.
    Correlating the Bethesda System for Reporting Thyroid Cytopathology with Histology and Extent of Surgery: A Review of 21,746 Patients from Four Endocrine Surgery Registries Across Two Continents2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 2, p. 426-435Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Bethesda system for cytopathology (TBSRTC) is a 6-tier diagnostic framework developed to standardize thyroid cytopathology reporting. The aim of this study was to determine the risk of malignancy (ROM) for each Bethesda category.

    METHODS: Thyroidectomy-related data from 314 facilities in 22 countries were entered into the following outcome registries: CESQIP (North America), Eurocrine (Europe), SQRTPA (Sweden) and UKRETS (UK). Demographic, cytological, pathologic and extent of surgery data were mapped into one dataset and analyzed.

    RESULTS: Out of 41,294 thyroidectomy patient entries from January 1, 2015, to June 30, 2017, 21,746 patients underwent both thyroid FNA and surgery. A comparison of cytology and surgical pathology data demonstrated a ROM for Bethesda categories 1 to 6 of 19.2%, 12.7%, 31.9%, 31.4%, 77.8% and 96.0%, respectively. Male patients had a higher rate of malignancy for every Bethesda category. Secondary analysis demonstrated a high ROM in male patients with Bethesda 3 category aged 31-35 years (52.1%, 95% confidence interval (CI) 37.9-66.2%), aged 36-40 years (55.9%, 95% CI 39.2-72.6%) and aged 41-45 years (46.9%, 95% CI 33-60.9%). Patients with Bethesda 5 and 6 scores were more likely to undergo total thyroidectomy (65.9% and 84.6%); for patients with Bethesda scores 2 and 3, a higher percentage of females underwent total thyroidectomy compared to males in spite of a higher ROM for males.

    CONCLUSIONS: These data demonstrate that Bethesda categories 1-4 are associated with a higher ROM compared to the first edition of TBSRTC, especially in male patients, and validate findings from the second edition of TBSRTC.

  • 14.
    Khalili, Hosseinali
    et al.
    Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Ahl, Rebecka
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska University Hospital,Stockholm, Sweden; .
    Paydar, Shahram
    Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Department of Surgery.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fard, Hossein Abdolrahimzadeh
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Niakan, Amin
    Department of Neurosurgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Hanna, Kamil
    Department of Surgery, University of Arizona College of Medicine, Tucson AZ, USA.
    Joseph, Bellal
    Department of Surgery, University of Arizona College of Medicine, Tucson AZ, USA.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery.
    Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 6, p. 1844-1853Article in journal (Refereed)
    Abstract [en]

    Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.

    Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.

    Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).

    Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.

    Level of evidence: Level II; therapeutic.

    Study type: Therapeutic study.

  • 15. Lassen, Kristoffer
    et al.
    Coolsen, Marielle M. E.
    Slim, Karem
    Carli, Francesco
    de Aguilar-Nascimento, José E.
    Schäfer, Markus
    Parks, Rowan W.
    Fearon, Kenneth C. H.
    Lobo, Dileep N.
    Demartines, Nicolas
    Braga, Marco
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital.
    Dejong, Cornelis H. C.
    Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations2013In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, no 2, p. 240-258Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy.

    METHODS: An international working group constructed within the Enhanced Recovery After Surgery (ERAS(®)) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated "high", "moderate", "low" or "very low". Recommendations were graded as "strong" or "weak".

    RESULTS: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations.

    CONCLUSIONS: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials.

  • 16.
    Lillo-Felipe, Miriam
    et al.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Ahl Hulme, Rebecka
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden .
    Forssten, Maximilian Peter
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bass, Gary Alan
    Örebro University, School of Medical Sciences. Division of Traumatology, Surgical Critical Care & Emergency Surgery, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, USA.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Matthiessen, Peter
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, no 12, p. 3695-3706Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume.

    METHODS: Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien-Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50-150 cases/year) and high-volume centers (> 150 cases/year).

    RESULTS: A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75-1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80-5.31, p = 0.134) for high-volume centers and 2.15 (0.83-5.56, p = 0.116) for medium-volume centers in the second stratification.

    CONCLUSION: This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

  • 17.
    Ljungqvist, Olle
    Örebro University Hospital.
    Guidelines for perioperative care2013In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, no 2, p. 239-239Article in journal (Refereed)
  • 18.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sustainability After Structured Implementation of ERAS Protocols2015In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 39, no 2, p. 534-535Article in journal (Refereed)
  • 19.
    Ljungqvist, Olle
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, Ulf
    Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Solna, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    de Boer, Hans D.
    Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, The Netherlands.
    20 + Years of Enhanced Recovery After Surgery: What's Next2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 5, p. 1087-1089Article in journal (Other academic)
  • 20.
    Ljungqvist, Olle
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Nelson, Gregg
    Department of Oncology, Cumming School of Medicine,University of Calgary, Calgary AB, Canada.
    Demartines, Nicolas
    Department of Visceral Surgery, University Hospital CHUV and University of Lausanne, Lausanne, Switzerland.
    The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 1, p. 3197-3198Article in journal (Refereed)
  • 21.
    Low, Donald E.
    et al.
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Allum, William
    The Royal Marsden Hospitals, London, UK.
    De Manzoni, Giovanni
    University of Verona, Verona, Italy.
    Ferri, Lorenzo
    McGill University Health Centre, Montreal, Canada.
    Immanuel, Arul
    Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
    Kuppusamy, MadhanKumar
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Law, Simon
    Queen Mary Hospital, Hong Kong, China.
    Lindblad, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Maynard, Nick
    Oxford Radcliffe Hospitals, Oxford, UK.
    Neal, Joseph
    Head of Thoracic Surgery and Thoracic Oncology, C6-GS, Virginia Mason Medical Center, Seattle, USA.
    Pramesh, C. S.
    Tata Memorial Centre, Mumbai, India.
    Scott, Mike
    Virginia Commonwealth University Health System, Richmond, USA.
    Mark Smithers, B.
    Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia.
    Addor, Valérie
    Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences.
    Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 2, p. 299-330Article, review/survey (Refereed)
    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.

  • 22.
    McQueen, K.
    et al.
    Department of Anesthesiology, Vanderbilt University, Nashville, South Africa.
    Oodit, R.
    University of Cape Town, Cape Town, South Africa.
    Derbew, M.
    Black Lion Hospital, Addis Ababa, Ethiopia.
    Banguti, P.
    Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences.
    Enhanced Recovery After Surgery for Low- and Middle-Income Countries2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 4, p. 950-952Article in journal (Refereed)
  • 23.
    McQueen, Kelly
    et al.
    Department of Anesthesiology, Vanderbilt University, Nashville, South Africa.
    Oodit, Ravi
    University of Cape Town, Cape Town, South Africa.
    Derbew, Miliard
    Black Lion Hospital, Addis Ababa, Ethiopia.
    Banguti, Paulin
    Department of Anesthesiology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences.
    Authors' Reply: Enhanced Recovery After Surgery for Low and Middle-Income Countries2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 12, p. 4126-4126Article in journal (Refereed)
  • 24.
    Meehan, Adrian David
    et al.
    Örebro University, School of Medical Sciences. Department of Geriatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Kardell, Mathias
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Landén, Mikael
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden: Sahlgrenska University Hospital, Gothenburg, Sweden.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lithium-Associated Hypercalcemia: Pathophysiology, Prevalence, Management2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 2, p. 415-424Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Lithium-associated hypercalcemia (LAH) is an ill-defined endocrinopathy. The aim of the present study was to determine the prevalence of hypercalcemia in a cohort of bipolar patients (BP) with and without concomitant lithium treatment and to study surgical outcomes for lithium-associated hyperparathyroidism.

    METHODS: Retrospective data, including laboratory results, surgical outcomes and medications, were collected from 313 BP treated with lithium from two psychiatric outpatient units in central Sweden. In addition, data were collected from 148 BP without lithium and a randomly selected control population of 102 individuals. Logistic regression was used to compare odds of hypercalcemia in these respective populations.

    RESULTS: The prevalence of lithium-associated hypercalcemia was 26%. Mild hypercalcemia was detected in 87 out of 563 study participants. The odds of hypercalcemia were significantly higher in BP with lithium treatment compared with BP unexposed to lithium (adjusted OR 13.45; 95% CI 3.09, 58.55; p = 0.001). No significant difference was detected between BP without lithium and control population (adjusted OR 2.40; 95% CI 0.38, 15.41; p = 0.355). Seven BP with lithium underwent surgery where an average of two parathyroid glands was removed. Parathyroid hyperplasia was present in four patients (57%) at the initial operation. One patient had persistent disease after the initial operation, and six patients had recurrent disease at follow-up time which was on average 10 years.

    CONCLUSION: The high prevalence of LAH justifies the regular monitoring of calcium homeostasis, particularly in high-risk groups. If surgery is necessary, bilateral neck exploration should be considered in patients on chronic lithium treatment. Prospective studies are needed.

  • 25.
    Meehan, Adrian David
    et al.
    Örebro University, School of Medical Sciences. Department of Geriatrics.
    Wallin, Göran
    Örebro University, School of Medical Sciences. Department of Surgery.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Characterization of Calcium Homeostasis in Lithium-Treated Patients Reveals Both Hypercalcaemia and Hypocalcaemia2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 2, p. 517-525Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Prevalence studies demonstrate that a significant proportion of lithium-treated patients develop hypercalcaemia (3-30%). Lithium-associated hyperparathyroidism (LHPT) is poorly defined, and calcium homeostasis may be affected in a more complicated fashion than purely by elevated PTH secretion. The current study aims to examine in detail calcium homeostasis principally with regard to lithium duration.

    METHODS: Medical records of 297 lithium-treated patients (193 women, 104 men; median age 58 years) were examined, and information on gender, age, lithium treatment duration and calcium homeostasis was obtained. The median treatment duration with lithium was 16 (1.5-45) years.

    RESULTS: A total of 8504 calcium values were retrieved. Before initiation of lithium treatment, serum calcium was on average 2.33 mmol/l (2.02-2.60). During the treatment period, 178 patients (60%) remained normocalcaemic, 102 (34%) developed hypercalcaemia or were strongly suspected of LHPT, 17 (6%) had 3 or more intermittent episodes of hypocalcaemia. Forty-one per cent of patients with suspected or confirmed LHPT had low (<4 mmol) 24-h urine calcium levels. The success rate after 33 parathyroidectomies was 35%, hyperplasia being diagnosed in 75% of extirpated glands.

    CONCLUSIONS: The prevalence of hypercalcaemia during lithium treatment is very high. In addition, hypocalcaemic episodes appear to occur frequently, possibly reflecting a more complicated parathyroid dysfunction than previously known. Long-term surgical results are unsatisfactory. LHPT biochemical profile is different from that of primary hyperparathyroidism and is in some ways similar to familial hypocalciuric hypercalcaemia.

  • 26.
    Mohseni, Shahin
    et al.
    Örebro University Hospital. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden; Department of Surgery, Division of Acute Care Surgery and Trauma, Karolinska University Hospital Solna, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia; Department of Surgery, North Estonia Medical Center, Tallinn, Estonia.
    Thelin, Eric P.
    Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
    Wallin, Göran
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Surgery, Division of Acute Care Surgery, Örebro University Hospital, Örebro, Sweden.
    Riddez, Louis
    Department of Surgery, Division of Acute Care Surgery and Trauma, Karolinska University Hospital Solna, Stockholm, Sweden.
    The Effect of beta-blockade on Survival After Isolated Severe Traumatic Brain Injury2015In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 39, no 8, p. 2076-2083Article in journal (Refereed)
    Abstract [en]

    Several North American studies have observed survival benefit in patients exposed to beta-blockers following traumatic brain injury (TBI). The purpose of this study was to evaluate the effect of beta-blockade on mortality in a Swedish cohort of isolated severe TBI patients.

    The trauma registry of an urban academic trauma center was queried to identify patients with an isolated severe TBI between 1/2007 and 12/2011. Isolated severe TBI was defined as an intracranial injury with an Abbreviated Injury Scale (AIS) a parts per thousand yen3 excluding extra-cranial injuries AIS a parts per thousand yen3. Multivariable logistic regression analysis was used to determine the effect of beta-blocker exposure on mortality. Also, a subgroup analysis was performed to investigate the risk of mortality in patients on pre-admission beta-blocker versus not and the effect of specific type of beta-blocker on the overall outcome.

    Overall, 874 patients met the study criteria. Of these, 33 % (n = 287) were exposed to beta-blockers during their hospital admission. The exposed patients were older (62 +/- A 16 years vs. 49 +/- A 21 years, p < 0.001), and more severely injured based on their admission GCS, ISS, and head AIS scores (GCS a parts per thousand currency sign8: 32 % vs. 28 %, p = 0.007; ISS a parts per thousand yen16: 71 % vs. 59 %, p = 0.001; head AIS a parts per thousand yen4: 60 % vs. 45 %, p < 0.001). The crude mortality was higher in patients who did not receive beta-blockers (17 % vs. 11 %, p = 0.007) during their admission. After adjustment for significant confounders, the patients not exposed to beta-blockers had a 5-fold increased risk of in-hospital mortality (AOR 5.0, CI 95 % 2.7-8.5, p = 0.001). No difference in survival was noted in regards to the type of beta-blocker used. Subgroup analysis revealed a higher risk of mortality in patients naive to beta-blockers compared to those on pre-admission beta-blocker therapy (AOR 3.0 CI 95 % 1.2-7.1, p = 0.015).

    Beta-blocker exposure after isolated severe traumatic brain injury is associated with significantly improved survival. We also noted decreased mortality in patients on pre-admission beta-blocker therapy compared to patients naive to such treatment. Further prospective studies are warranted.

  • 27.
    Nelson, Gregg
    et al.
    Department of Oncology, University of Calgary, Calgary, Canada; Tom Baker Cancer Centre, Calgary AB, Canada.
    Kiyang, Lawrence N.
    Alberta Health Services, , Canada.
    Crumley, Ellen T.
    Alberta Health Services, , Canada.
    Chuck, Anderson
    Institute of Health Economics, Edmonton AB, Canada.
    Nguyen, Thanh
    Institute of Health Economics, Edmonton AB, Canada.
    Faris, Peter
    Alberta Health Services, , Canada.
    Wasylak, Tracy
    Alberta Health Services, , Canada.
    Basualdo-Hammond, Carlota
    Alberta Health Services, , Canada.
    McKay, Susan
    Alberta Health Services, , Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Gramlich, Leah M.
    Department of Medicine, University of Alberta, Edmonton AB, Canada.
    Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience2016In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, no 5, p. 1092-1103Article in journal (Refereed)
    Abstract [en]

    Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system.

    We compared pre- and post-guideline implementation in consecutive elective colorectal patients, a parts per thousand yen18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts.

    A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value < 0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient.

    The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.

  • 28.
    Nilsson, Ulrica
    et al.
    Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 8, p. 1949-1956Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Day surgical procedures are increasing both in Sweden and internationally. Day surgery patients prepare for and handle their recovery on their own at home. The aim of this study was to investigate patients' preoperative mental and physical health and its association with the quality of their recovery after day surgery.

    METHOD: This was a secondary analysis of a randomized controlled trial. Data were collected at four-day surgery units in Sweden. Health-related quality of life was measured using the Short Form 36 (SF-36) Health Survey, and postoperative recovery was assessed using the Swedish web version of the Quality of Recovery (SwQoR) scale.

    RESULT: This study included 756-day surgery patients. A low, compared with a high, preoperative mental component score was associated with poorer recovery as shown by responses to 21/24 and 22/24 SwQoR items, respectively, on postoperative days (PODs) 7 and 14. A low compared with a high preoperative physical component score was associated with poorer recovery in 18/24 SwQoR items on POD 7 and 13/24 on POD 14.

    CONCLUSION: A clear message from this study is for surgeons, anaesthetists and nurses to consider the fact that postoperative recovery largely depends on patients' preoperative mental and psychical status. A serious attempt must be made, as a part of the routine preoperative assessment, to assess and document not only the physical but also the mental status of patients undergoing anaesthesia and surgery.

    TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT0249219.

  • 29. Nygren, J
    et al.
    Thacker, J
    Carli, F
    Fearon, KC
    Norderval, S
    Lobo, DN
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden.
    Soop, M
    Ramirez, J
    Guidelines for perioperative care in elective rectal/pelvic surgery: enhanced recovery after surgery (ERAS(®)) society recommendations2013In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 37, no 2, p. 285-305Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol.

    METHODS: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group.

    RESULTS: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate).

    CONCLUSIONS: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery.

  • 30.
    Oodit, Ravi
    et al.
    Department of Surgery, University of Cape Town, Cape Town, South Africa.
    Biccard, Bruce
    Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
    Brindle, Mary
    Surgery, University of Calgary, Calgary, Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Surgery.
    Nelson, Gregg
    University of Calgary, Calgary, Canada.
    ERAS Society Recommendations for Improving Perioperative Care in Low- and Middle-Income Countries through Implementation of Existing Tools and Programs: An Urgent Need for the Surgical Safety Checklist and Enhanced Recovery After Surgery2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 5, article id 1247Article in journal (Other academic)
  • 31.
    Oodit, Ravi
    et al.
    Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa.
    Biccard, Bruce M.
    Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa.
    Panieri, Eugenio
    Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa.
    Alvarez, Adrian O.
    Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, Beunos Aires, Argentina.
    Sioson, Marianna R. S.
    Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila, Philippines.
    Maswime, Salome
    Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa.
    Thomas, Viju
    Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape, South Africa.
    Kluyts, Hyla-Louise
    Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, Ga-Rankuwa, Pretoria, Gauteng, South Africa.
    Peden, Carol J.
    Keck School of Medicine, University of Southern California, Los Angeles CA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA.
    de Boer, Hans D.
    Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, The Netherlands.
    Brindle, Mary
    Cumming School of Medicine, University of Calgary, London, Canada; Alberta Children’s Hospital, Calgary, Canada; Safe Systems, Ariadne Labs, Stockholm, USA; EQuIS Research Platform, Orebro, Canada.
    Francis, Nader K.
    Division of Surgery and Interventional Science- UCL, London, UK.
    Nelson, Gregg
    Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada.
    Gustafsson, Ulf O.
    Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Danderyd, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 8, p. 1826-1843Article, review/survey (Refereed)
    Abstract [en]

    Background: This is the first Enhanced Recovery After Surgery (ERAS (R)) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care.

    Methods: The ERAS LMIC Guidelines group was established by the ERAS (R) Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS (R) Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS (R) guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus.

    Results: In addition to previously described ERAS (R) Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline.

    Conclusions: These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.

  • 32.
    Oodit, Ravi
    et al.
    Global Surgery Unit, Department of Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
    Biccard, Bruce
    Department of Anesthesia and Perioperative Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.
    Nelson, Gregg
    Departments of Obstetrics and Gynecology and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Brindle, Mary E.
    Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Canada and Safe Surgery and Safe Systems, Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Calgary, Canada.
    ERAS Society Recommendations for Improving Perioperative Care in Low- and Middle-Income Countries Through Implementation of Existing Tools and Programs: An Urgent Need for the Surgical Safety Checklist and Enhanced Recovery After Surgery2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, no 11, p. 3246-3248Article in journal (Refereed)
  • 33.
    Peden, Carol J.
    et al.
    Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA.
    Aggarwal, Geeta
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
    Aitken, Robert J.
    Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
    Anderson, Iain D.
    Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD, UK; University of Manchester, Manchester, UK.
    Balfour, Angie
    Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU, Scotland.
    Foss, Nicolai Bang
    Hvidovre University Hospital, Copenhagen, Denmark.
    Cooper, Zara
    Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA; Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
    Dhesi, Jugdeep K.
    Perioperative Medicine for Older People Undergoing Surgery (POPS), Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK; Research Department of Targeted Intervention, Division of Surgery & Interventional Science, University College London, London, UK.
    French, W. Brenton
    Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
    Grant, Michael C.
    Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
    Hammarqvist, Folke
    Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital Huddinge, Hälsovägen 3. B85, S 141 86, Stockholm, Sweden.
    Hare, Sarah P.
    Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
    Havens, Joaquim M.
    Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
    Holena, Daniel N.
    Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
    Hübner, Martin
    Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
    Johnston, Carolyn
    Department of Anaesthesia, St George's Hospital, Tooting, London, UK.
    Kim, Jeniffer S.
    Kaiser Permanente Research, Department of Research & Evaluation, 100 South Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
    Lees, Nicholas P.
    Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lobo, Dileep N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen's Medical Centre, Nottingham University Hospitals and University of Nottingham, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia; Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
    Quiney, Nial
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
    Sharoky, Catherine
    Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
    Urman, Richard D.
    Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10th Ave, Columbus, OH, 43210, USA.
    Wick, Elizabeth
    Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
    Wu, Christopher L.
    Department of Anesthesiology, Critical Care and Pain Medicine, and Department of Anesthesiology, Weill-Cornell Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
    Young-Fadok, Tonia
    Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 e. Mayo Blvd., Phoenix, AZ, 85054, USA.
    Scott, Michael J.
    Department of Anesthesiology and Critical Care Medicine, and Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA; University College London, London, UK.
    Enhanced Recovery After Surgery (ERAS®) Society Consensus Guidelines for Emergency Laparotomy Part 3: Organizational Aspects and General Considerations for Management of the Emergency Laparotomy Patient2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 8, p. 1881-1898Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care.

    METHODS: Experts in management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations.

    RESULTS: Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process.

    CONCLUSIONS: These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

  • 34.
    Peden, Carol J.
    et al.
    Department of Anesthesiology and Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Anesthesiology, University of Pennsylvania, Philadelphia, PA, USA.
    Aggarwal, Geeta
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
    Aitken, Robert J.
    Sir Charles Gardiner Hospital, Nedlands, WA, Australia.
    Anderson, Iain D.
    Salford Royal NHS Foundation Trust, Stott La, Salford, UK; University of Manchester, Manchester, UK.
    Bang Foss, Nicolai
    Hvidovre University Hospital, Copenhagen, Denmark.
    Cooper, Zara
    Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women's Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, Boston, MA, USA.
    Dhesi, Jugdeep K.
    Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, Guy's and St Thomas' NHS Foundation Trust, King's College London, Division of Surgery & Interventional Science, University College London, London, UK.
    French, W. Brenton
    Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.
    Grant, Michael C.
    Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
    Hammarqvist, Folke
    Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Hare, Sarah P.
    Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK.
    Havens, Joaquim M.
    Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, USA.
    Holena, Daniel N.
    Department of Surgery and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
    Hübner, Martin
    Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.
    Kim, Jeniffer S.
    Gehr Family Center for Health Systems Science & Innovation, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
    Lees, Nicholas P.
    Department of General & Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, UK.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Lobo, Dileep N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia; Sección de Cirugía de Trauma Y Emergencias, Universidad del Valle, Cali, Colombia.
    Quiney, Nial
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
    Urman, Richard D.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, USA.
    Wick, Elizabeth
    Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
    Wu, Christopher L.
    Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
    Young-Fadok, Tonia
    Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA.
    Scott, Michael
    Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA.
    Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1-Preoperative: Diagnosis, Rapid Assessment and Optimization2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, p. 1272-1290Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach.

    METHODS: Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1-Preoperative Care and Part 2-Intraoperative and Postoperative management. This paper provides guidelines for Part 1.

    RESULTS: Twelve components of preoperative care were considered. Consensus was reached after three rounds.

    CONCLUSIONS: These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

  • 35.
    Pisarska, Magdalena
    et al.
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Torbicz, Grzegorz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Gajewska, Natalia
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Rubinkiewicz, Mateusz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Wierdak, Mateusz
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
    Major, Piotr
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Budzyński, Andrzej
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Pędziwiatr, Michał
    2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 43, no 10, p. 2552-2560Article in journal (Refereed)
    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.

  • 36.
    Pędziwiatr, Michał
    et al.
    2nd Department of General Surgery, Jagiellonian University, Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
    Pisarska, Magdalena
    2nd Department of General Surgery, Jagiellonian University, Medical College, Kraków, Poland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences.
    Authors' Reply: Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Nonmetastatic Colorectal Cancer2020In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, no 1, p. 314-315Article in journal (Refereed)
  • 37.
    Scott, Michael J.
    et al.
    Department of Anesthesiology and Critical Care Medicine, Leonard Davis Institute for Health Economics, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA; University College London, London, UK.
    Aggarwal, Geeta
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, Surrey, UK.
    Aitken, Robert J.
    Sir Charles Gardiner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
    Anderson, Iain D.
    Salford Royal NHS Foundation Trust, Stott La, Salford, M6 8HD, UK; University of Manchester, Manchester, UK.
    Balfour, Angie
    Western General Hospital, NHS Lothian, Edinburgh, EH4 2XU, Scotland.
    Foss, Nicolai Bang
    Hvidovre University Hospital, Copenhagen, Denmark.
    Cooper, Zara
    Harvard Medical School, Kessler Director, Center for Surgery and Public Health, Brigham and Women's Hospital and Division of Trauma, Burns, Surgical Critical Care, and Emergency Surgery, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
    Dhesi, Jugdeep K.
    School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
    French, W. Brenton
    Department of Surgery, Virginia Commonwealth University Health System, 1200 E. Broad Street, Richmond, VA, 23298, USA.
    Grant, Michael C.
    Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
    Hammarqvist, Folke
    Department of Emergency and Trauma Surgery, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital Huddinge, Hälsovägen 3. B85, 141 86, Stockholm, Sweden.
    Hare, Sarah P.
    Department of Anaesthesia, Perioperative Medicine and Critical Care, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
    Havens, Joaquim M.
    Division of Trauma, Burns and Surgical Critical Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
    Holena, Daniel N.
    Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
    Hübner, Martin
    Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
    Johnston, Carolyn
    Department of Anesthesia, St George's Hospital, Tooting, London, UK.
    Kim, Jeniffer S.
    Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, CA, 9110, USA.
    Lees, Nicholas P.
    Department of General and Colorectal Surgery, Salford Royal NHS Foundation Trust, Scott La, Salford, M6 8HD, UK.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
    Lobo, Dileep N.
    Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery.
    Ordoñez, Carlos A.
    Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cra 98 No. 18 - 49, 760032, Cali, Colombia; Sección de Cirugía de Trauma y Emergencias, Universidad del Valle - Hospital Universitario del Valle, Cl 5 No. 36-08, 760032, Cali, Colombia.
    Quiney, Nial
    Department of Anesthesia and Intensive Care Medicine, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU5 7XX, UK.
    Sharoky, Catherine
    Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA.
    Urman, Richard D.
    Department of Anesthesiology, The Ohio State University and Wexner Medical Center, 410 West 10Th Ave, Columbus, OH, 43210, USA.
    Wick, Elizabeth
    Department of Surgery, University of California San Francisco, 513 Parnassus Ave HSW1601, San Francisco, CA, 94143, USA.
    Wu, Christopher L.
    Department of Anesthesiology, Critical Care and Pain Medicine-Hospital for Special Surgery, Department of Anesthesiology-Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
    Young-Fadok, Tonia
    Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo Clinic Arizona, 5777 e. Mayo Blvd., Phoenix, AZ, 85054, USA.
    Peden, Carol J.
    Department of Anesthesiology Keck School of Medicine, University of Southern California, 2020 Zonal Avenue IRD 322, Los Angeles, CA, 90033, USA; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA.
    Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS®) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care2023In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 47, no 8, p. 1850-1880Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

    METHODS: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL.

    RESULTS: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process.

    CONCLUSIONS: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies.

  • 38.
    Sosa, Julie Ann
    et al.
    Department of Surgery, University of California at San Francisco-UCSF, San Francisco, CA, USA.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    World Journal of Surgery Becomes the Official Publication of the ERAS Society2018In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, no 9, p. 2689-2690Article in journal (Refereed)
  • 39.
    Stenberg, Erik
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Dos Reis Falcão, Luiz Fernando
    Discipline of Anesthesia, Pain and Critical Care Medicine, Federal University of São Paulo, São Paulo, Brazil.
    O'Kane, Mary
    Dietetic Department, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK.
    Liem, Ronald
    Department of Surgery, Groene Hart Hospital, Gouda, Netherlands; Dutch Obesity Clinic, The Hague, Netherlands.
    Pournaras, Dimitri J.
    Department of Upper GI and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, UK.
    Salminen, Paulina
    Department of Surgery, University of Turku, Turku, Finland; Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
    Urman, Richard D.
    Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
    Wadhwa, Anupama
    Department of Anesthesiology, Outcomes Research Institute, Cleveland Clinic, University of Texas Southwestern, Dallas, USA.
    Gustafsson, Ulf O.
    Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Thorell, Anders
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden.
    Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 4, p. 729-751Article, review/survey (Refereed)
    Abstract [en]

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

    METHODS: A principal literature search was performed utilizing the Pubmed, EMBASE, Cochrane databases and ClinicalTrials.gov through December 2020, with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. After critical appraisal of these studies, the group of authors reached consensus regarding recommendations.

    RESULTS: The quality of evidence for many ERAS interventions remains relatively low in a bariatric setting and evidence-based practices may need to be extrapolated from other surgeries.

    CONCLUSION: A comprehensive, updated evidence-based consensus was reached and is presented in this review by the ERAS® Society.

  • 40.
    W. Thörn, Rose-Marie
    et al.
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Stepniewski, Jan
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hjelmqvist, Hans
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Forsberg, Anette
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Health Sciences. Department of Anesthesiology and Intensive Care.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery.
    Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study2022In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 46, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach.

    METHODS: This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space.

    RESULTS: In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred.

    CONCLUSIONS: Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

  • 41.
    Wanjura, Viktor
    et al.
    Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lundström, Patrik
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Österberg, Johanna
    Department of Surgery, Mora Hospital, Mora, Sweden.
    Rasmussen, Ib
    Department of Surgery, Falun County Hospital, Falun, Sweden.
    Karlson, Britt-Marie
    Department of Surgery, Uppsala University Hospital, Uppsala, Sweden.
    Sandblom, Gabriel
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain2014In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, no 12, p. 3075-3081Article in journal (Refereed)
    Abstract [en]

    Background: Despite the fact that cholecystectomy is a common surgical procedure, the impact on long-term gastrointestinal quality of life is not fully known.

    Methods: All surgical procedures for gallstone disease performed at Mora County Hospital, Sweden, between 2 January 2002 and 2 January 2005, were registered on a standard database form. In 2007, all patients under the age of 80 years at follow-up were requested to fill in a form containing the Gastrointestinal Quality-of-Life Index (GIQLI) questionnaire and a number of additional questions. The outcome was analysed with respect to age, gender, smoking, surgical technique, and original indication for cholecystectomy.

    Results: A total of 627 patients (447 women, 180 men) underwent cholecystectomy, including laparoscopic cholecystectomy (N = 524), laparoscopic cholecystectomy converted to open cholecystectomy (N = 43), and open cholecystectomy (N = 60). The mean time between cholecystectomy and follow-up with the questionnaire was 49 months. The participation rate was 79 %. Using multivariate analysis in the form of generalised linear modelling, the original indication for cholecystectomy in combination with gender (p = 0.0042) was found to predict the GIQLI score. Female gender in combination with biliary colic as indication for cholecystectomy correlated with low GIQLI scores. Female gender also correlated with a higher risk for pain in the right upper abdominal quadrant after cholecystectomy (p = 0.028).

    Conclusions: We found the original indication for cholecystectomy, together with gender, to predict gastrointestinal symptoms and abdominal pain after cholecystectomy. Careful evaluation of symptoms is important before planning elective cholecystectomy.

  • 42.
    Wanjura, Viktor
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery.
    Sandblom, Gabriel
    Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?2016In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, no 1, p. 81-88Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls.

    Methods: A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data.

    Results: The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being.

    Conclusions: In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.

  • 43.
    Wilnerzon Thörn, Rose-Marie
    et al.
    Örebro University, School of Medical Sciences. Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Physiotherapy.
    Stepniewski, Jan
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hjelmqvist, Hans
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Health Sciences. Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Immediate mobilization in post-anesthesia care unit does not increase overall postoperative physical activity after elective colorectal surgery: A randomized, double-blinded controlled trial within an enhanced recovery protocol2024In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The level of post-operative mobilization according to Enhanced Recovery After Surgery (ERAS) guidelines is not always achieved. We investigated whether immediate mobilization increases postoperative physical activity. The objective was to evaluate the effects of immediate postoperative mobilization in the post-anesthesia care unit (PACU) compared to standard care.

    METHODS: This randomized controlled trial, involved 144 patients, age ≥18 years, undergoing elective colorectal surgery. Patients were randomized to mobilization starting 30 min after arrival in the PACU, or to standard care. Standard care consisted of mobilization a few hours later at the ward according to ERAS guidelines. The primary outcome was physical activity, in terms of number of steps, measured with an accelerometer during postoperative days (PODs) 1-3. Secondary outcomes were physical capacity, functional mobility, time to readiness for discharge, complications, compliance with the ERAS protocol, and physical activity 1 month after surgery.

    RESULTS: With the intention-to-treat analysis of 144 participants (median age 71, 58% female) 47% underwent laparoscopic-or robotic-assisted surgery. No differences in physical activity during hospital stay were found between the participants in the intervention group compared to the standard care group (adjusted mean ratio 0.97 on POD 1 [95% CI, 0.75-1.27], p = 0.84; 0.89 on POD 2 [95% CI, 0.68-1.16], p = 0.39, and 0.90 on POD 3 [95% CI, 0.69-1.17], p = 0.44); no differences were found in any of the other outcome measures.

    CONCLUSIONS: Addition of the intervention of immediate mobilization to standard care did not make the patients more physically active during their hospital stay.

    TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NTC 03357497.

  • 44.
    Xu, Yin
    et al.
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fall, Katja
    Örebro University, School of Medical Sciences. Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University and University Hospital, Örebro, Sweden; Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Gustafsson, Ulf O.
    Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Stockholm, Sweden.
    Validity of Routinely Collected Swedish Data in the International Enhanced Recovery After Surgery (ERAS) Database2021In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 45, no 6, p. 1622-1629Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study aims to assess patient coverage, validity and data quality in the Swedish part of the International Enhanced Recovery After Surgery (ERAS) Interactive Audit System (EIAS).

    METHOD: All Swedish ERAS centers that recorded colorectal surgery data in EIAS between January 1, 2017, and December 31, 2017, were included (N = 12). Information registered in EIAS was compared with data from electronic medical records at each hospital to assess the overall coverage of EIAS. Twenty random-selected patients from each of the contributing centers were assessed for accuracy for a set of clinically relevant variables. All patients admitted to the contributing centers were included for the assessment of rate of missing on a selection of key clinical variables.

    RESULTS: Eight hospitals provided complete information for the evaluation, while four hospitals only allowed assessment of coverage and missing data. The eight hospitals had an overall coverage of 98.8% in EIAS (n = 1301) and the four 86.7% (n = 811). The average agreement for the assessed postoperative outcome variables was 96.5%. The accuracy was excellent for 'length of hospital stay,' 'reoperation,' and 'any complications,' but lower for other types of complications. Only a few variables had more than 5% missing data, and missingness was associated with hospital type and size.

    CONCLUSION: This validation of the Swedish part of the international ERAS database suggests high patient coverage in EIAS and high agreement and limited missingness in clinically relevant variables. This validation approach or a modified version can be used for continued validation of the International ERAS database.

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