Beyond surgery: clinical and economic impact of Enhanced Recovery After Surgery programs

Gaëtan-Romain Joliat, Olle Ljungqvist, Tracy Wasylak, Oliver Peters, Nicolas Demartines, Gaëtan-Romain Joliat, Olle Ljungqvist, Tracy Wasylak, Oliver Peters, Nicolas Demartines

Abstract

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

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

Keywords: Enhanced recovery; Implementation; Surgery.

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

OL and ND are members of the ERAS Society Executive Committee. OL is a founder and shareholder of Encare AB, Sweden, that holds IT tools for implementation of ERAS.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg. 2009;144:961–969. doi: 10.1001/archsurg.2009.170.
    1. Gustafsson UO, Oppelstrup H, Thorell A, et al. Adherence to the ERAS protocol is associated with 5-year survival after colorectal Cancer surgery: a retrospective cohort study. World J Surg. 2016;40:1741–1747. doi: 10.1007/s00268-016-3460-y.
    1. Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–1541. doi: 10.1007/s00268-013-2416-8.
    1. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB. 2014;16:699–706. doi: 10.1111/hpb.12245.
    1. Joliat G-R, Labgaa I, Petermann D, et al. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg. 2015;102:1676–1683. doi: 10.1002/bjs.9957.
    1. Savaridas T, Serrano-Pedraza I, Khan SK, et al. Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures. Acta Orthop. 2013;84:40–43. doi: 10.3109/17453674.2013.771298.
    1. Sikka R, Morath JM, Leape L. The quadruple aim: care, health, cost and meaning in work. BMJ Qual Saf. 2015;24:608–610. doi: 10.1136/bmjqs-2015-004160.
    1. Xiong J, Szatmary P, Huang W, et al. Enhanced recovery after surgery program in patients undergoing Pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine. 2016;95:e3497. doi: 10.1097/MD.0000000000003497.
    1. Ni T-G, Yang H-T, Zhang H, et al. Enhanced recovery after surgery programs in patients undergoing hepatectomy: a meta-analysis. World J Gastroenterol. 2015;21:9209–9216. doi: 10.3748/wjg.v21.i30.9209.
    1. Joliat G-R, Labgaa I, Hübner M, et al. Cost-benefit analysis of the implementation of an enhanced recovery program in liver surgery. World J Surg. 2016;40:2441–2450. doi: 10.1007/s00268-016-3582-2.
    1. Roulin D, Donadini A, Gander S, et al. Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg. 2013;100:1108–1114. doi: 10.1002/bjs.9184.
    1. Nelson G, Kiyang LN, Crumley ET, et al. Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg. 2016;40:1092–1103. doi: 10.1007/s00268-016-3472-7.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery. A Review JAMA Surg. 2017;152:292–298. doi: 10.1001/jamasurg.2016.4952.
    1. Zureikat AH, Postlewait LM, Liu Y, et al. A multi-institutional comparison of perioperative outcomes of robotic and open Pancreaticoduodenectomy. Ann Surg. 2016;264:640–649. doi: 10.1097/SLA.0000000000001869.
    1. Baker EH, Ross SW, Seshadri R, et al. Robotic pancreaticoduodenectomy: comparison of complications and cost to the open approach. Int J Med Robot Comput Assist Surg. 2016;12:554–560. doi: 10.1002/rcs.1688.
    1. Khan S, Wilson T, Ahmed J, et al. Quality of life and patient satisfaction with enhanced recovery protocols. Color Dis. 2010;12:1175–1182. doi: 10.1111/j.1463-1318.2009.01997.x.
    1. Hughes M, Coolsen MME, Aahlin EK, et al. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery. J Surg Res. 2015;193:102–110. doi: 10.1016/j.jss.2014.06.032.
    1. Modesitt SC, Sarosiek BM, Trowbridge ER, et al. Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization. Obstet Gynecol. 2016;128:457–466. doi: 10.1097/AOG.0000000000001555.
    1. Hübner M, Addor V, Slieker J, et al. The impact of an enhanced recovery pathway on nursing workload: a retrospective cohort study. Int J Surg. 2015;24:45–50. doi: 10.1016/j.ijsu.2015.10.025.
    1. Sjetne IS, Krogstad U, Ødegård S, et al. Improving quality by introducing enhanced recovery after surgery in a gynaecological department: consequences for ward nursing practice. Qual Saf Health Care. 2009;18:236–240. doi: 10.1136/qshc.2007.023382.
    1. Varadhan KK, Neal KR, Dejong CHC, et al. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–440. doi: 10.1016/j.clnu.2010.01.004.
    1. Coolsen MME, van Dam RM, van der Wilt AA, et al. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37:1909–1918. doi: 10.1007/s00268-013-2044-3.
    1. Fujikuni N, Tanabe K, Tokumoto N, et al. Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy. World J Gastrointest Surg. 2016;8:382–388. doi: 10.4240/wjgs.v8.i5.382.
    1. Tanaka R, Lee S-W, Kawai M, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer. 2017. 10.1007/s10120-016-0686-1.
    1. Chen Z-X, A-HJ L, Cen Y. fast-track program vs traditional care in surgery for gastric cancer. World J Gastroenterol. 2014;20:578–583. doi: 10.3748/wjg.v20.i2.578.
    1. Yu Z, Zhuang C-L, Ye X-Z, et al. Fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Langenbeck's Arch Surg. 2014;399:85–92. doi: 10.1007/s00423-013-1148-4.
    1. Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology. Gynecol Oncol. 2014;135:586–594. doi: 10.1016/j.ygyno.2014.10.006.
    1. Tyson MD, Chang SS. Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes. Eur Urol. 2016;70:995–1003. doi: 10.1016/j.eururo.2016.05.031.
    1. Azhar RA, Bochner B, Catto, et al. enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol. 2016;70:176–187. doi: 10.1016/j.eururo.2016.02.051.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere