Abstract

Enhanced Recovery After Surgery (ERAS^Ò) is a multimodal protocol applied to perioperative care. These protocols are implemented by a multidisciplinary patient-centered team, incorporating outpatient clinical staff, nurses, anesthesiologists, post-operative recovery staff, nutrition staff, physical therapists, social workers, and surgeons.

Regardless of the surgical subspecialty, all ERAS^Ò protocols share the same objectives: preoperative optimization of the patient, reduction of perioperative stress, maintenance of post-operative physiological function, and accelerated recovery time after surgery. ERAS^Ò protocols are designed to reduce the response to surgical stress, facilitate the maintenance of body composition and organ function to achieve early recovery.

Keywords: ERAS^Ò Protocol; Enhancer Recovery After Surgery; Multimodal Rehabilitation; Perioperative Nutrition; Review Article

References

1. Miller TE., et al. “Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol”. Anesthesia and Analgesia 5 (2014): 1052-1061.
2. Schicker T., et al. Physiology and pathophysiology of ERAS. Enhanced Recovery After Surgery (ERAS). “A complete guide to optimizing outcomes”. ERAS Society. 2020 Springer Nature Switzerlan O. Ljungqvist., et al. (eds.) (2020).
3. Krinsley JS. “Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients”. Mayo Clinic Proceedings 78 (2003): 1471-1478.
4. McAlister FA., et al. “Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes”. Diabetes Care 26 (2003): 1518-1524.
5. Kiran RP., et al. “The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control?” Annals of Surgery 258 (2013): 599-604.
6. Umpierrez GE., et al. “Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes”. The Journal of Clinical Endocrinology and Metabolism 87 (2002): 978-982.
7. Schicker T and Lattermann R. “Strategies to attenuate the catabolic response to surgery and improve perioperative outcomes”. Canadian Journal of Anesthesia 54 (2007): 414-419.
8. Ljungqvist O., et al. “Enhanced Recovery After Surgery. A Review”. JAMA Surgery (2017): E1-E7.
9. Gustafsson UO., et al. “Guidelnes for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations”. World Journal of Surgery (2018).
10. Sorensen LT., et al. “Abstinence from smoking reduces incisional wound infection: a randomized controlled trial”. Annals of Surgery1 (2003): 1-5.
11. Brady M., et al. “Preoperative fasting for adults to prevent perioperative complications”. Cochrane Database of Systematic Reviews 4 (2003): CD004423.
12. Ljungqvist O and Soreide E. “Preoperative fasting”. British Journal of Surgery4 (2003): 400-406.
13. American Society of Anesthesiologist Task Force on Preoperative Fasting. “Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting”. Anesthsiology 3 (1999): 896-905.
14. Smith I., et al. “Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology”. European Journal of Anaesthesiology 8 (2011): 556-569.
15. Feldheiser A., et al. “Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: Consensus statement for anaesthesia practice”. Acta An­aesthesiologica Scandinavca3 (2016): 289-334.
16. Weimann A., et al. “ESPEN guidelines: Clinical nutrition in surgery”. Clinical Nutrition (2017): 623-650.
17. Sugisawa N., et al. “phase II study of an enhanced recovery after surgery protocol in gastric cancer surgery”. Gastric Cancer3 (2015): 961-967.
18. Lassen K., et al. “Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced recovery after surgery (ERAS) Society recommendatios”. World Journal of Surgery 2 (2013): 240-258.
19. Kwon S., et al. “Perioperative pharmacologic prophylaxis for venous thromboembolism in colorectal surgery”. Journal of the American College of Surgeons 5 (2011): 596-603.
20. Gustafsson UO., et al. “Guideines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations”. World Journal of Surgery 37 (2013): 259-284.
21. Darouiche RO., et al. “Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis”. The New England Journal of Medicine1 (2010): 18-26.
22. Chandrakantan A and Glass PS. “Multimodal therapies for postoperative nausea and vomiting, and pain”. British Journal of Anaesthesia 1 (2013): i27-i40.
23. Charlton S., et al. “Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery”. Cochrane Database of Systematic Reviews 12 (2010): CD007705.
24. Varadhan KK and Lobo DN. “A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right”. Proceedings of the Nutrition 4 (2010): 488-498.
25. Giglio MT., et al. “Goal directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials”. British Journal of Anaesthesia 5 (2009): 637-646.
26. Petrowsky H., et al. “Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses”. Annals of Surgery 6 (2004): 1074-1084.
27. Nygren J., et al. “Preoperative oral carbohydrate therapy”. Current Opinion in Anesthesiology 3 (2015): 364-369.
28. Ljungqvist O., et al. “Insulin resistance and enhanced recovery after surgery”. Journal of Parenteral and Enteral Nutrition 4 (2012): 389-398.
29. Scott MJ., et al. “Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations”. Acta Anaesthesiologica Scandinavica10 (2015): 1212-1231.
30. Group EC. “The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry”. Annals of Surgery 6 (2015): 1153-1159.
31. Gustafsson UO., et al. “Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery”. Archives of Surgery5 (2011): 571-577.
32. Habib AS., et al. “The efficacy of the 5-HT3 receptor antagonists combined with droperidol for PONV prophylaxis is similar to their combination with dexamethasone. A meta-analysis of randomized controlled trials”. Canadian Journal of Anesthesia 4 (2004): 311-319.
33. Gan TJ., et al. “Consensus guidelines for the management of postoperative nausea and vomiting”. Anesthesia and Analgesia 1 (2014): 85-113.
34. Nelson R., et al. “Prophylactic nasogastric decompression after abdominal surgery”. Cochrane Database of Systematic Reviews 3 (2007): CD004929.
35. Steenhagen E. “Enhanced Recovery After Surgery. It’s time to change”. Journal of Parenteral and Enteral Nutrition1 (2015): 18-29.
36. Bragg D., et al. “Postoperative ileus: recent developments in pathophysiology and management”. Clinical Nutrition 3 (2015): 367-376.
37. Short V., et al. “Chewing gum for postoperative recovery of gastrointestinal function”. Cochrane Database of Systematic Reviews 2 (2015): CD006506.
38. Su’a BU., et al. “Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis”. International Journal of Surgery 14 (2015): 49-55.
39. Jorgensen H., et al. “Epidural local anesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery”. Cochrane Database of Systematic Reviews 4 (2000): CD001893.
40. Lobo DN., et al. “Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomized controlled trial”. Lancet9320 (2002): 1812-1818.
41. Basse L., et al. “Colonic surgery with accelerated rehabilitation or conventional care”. Diseases of the Colon and Rectum 3 (2004): 271-278.
42. Charoenkwan K and Matovinovic E. “Early versus delayed oral fluids and food for reducing complications after major abdominal gynecologic surgery”. Cochrane Database of Systematic Reviews 12 (2014): CD004508.
43. Schwenk W., et al. “Laparoscopic versus conventional colorectal resection: a prospective randomized study of postoperative ileus and early postoperative feeding”. Langenbeck's Archives of Surgery 1 (1998): 49-55.
44. Lassen K., et al. “Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations”. Archives of Surgery10 (2009): 961-969.
45. Enomoto TM., et al. “Patients requiring perioperative nutritional support”. Medical Clinics of North America 6 (2013): 1181-1120.
46. Buchman AL., et al. “Parenteral nutrition is associated with intestinal morphologic and functional changes in humans”. Journal of Parenteral and Enteral Nutrition6 (1995): 453-460.
47. Doig GS., et al. “Early enteral nutrition reduces mortality in trauma patients requiring intensive care: a meta-analysis of randomized controlled trials”. Injury1 (2011): 50-56. 127.
48. Hotchkiss RS and Karl IE. “The pathophysiology and treatment of sepsis”. The New England Journal of Medicine2 (2003): 138-150.
49. Sands KE., et al. “Epidemiology of sepsis syndrome in 8 academic medical centers”. JAMA 3 (1997): 234-240.
50. Carr CS., et al. “Randomized trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection”. BMJ 7035 (1996): 869-871.
51. Jacobs M., et al. “Minimally invasive colon resection (laparoscopic colectomy)”. Surgical Laparoscopy Endoscopy 3 (1991): 144-150.
52. Phillips EH., et al. “Laparoscopic colectomy”. Annals of Surgery 6 (1992): 703-707.
53. Reissman P., et al. “Is early oral feeding safe after elective colorectal surgery? A prospective randomized trial”. Annals of Surgery1 (1995): 73-77.
54. Han-Geurts IJ., et al. “Randomized clinical trial of the impact of early enteral feeding on postoperative ileus and recovery”. British Journal of Surgery5 (2007): 555-561.
55. Dervenis C., et al. “Benefits and limitations of enteral nutrition in the early postoperative period”. Langenbeck's Archives of Surgery11-12 (2003): 441-449.
56. Wang G., et al. “Fast-track rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial”. World Journal of Gastroenterology5 (2011): 671-676.
57. Hannemann P., et al. “Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries”. Acta Anaesthesiologica Scandinavica 9 (2006): 1152-1160.
58. Lewis SJ., et al. “Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials”. BMJ 7316 (2001): 773-776.
59. Andersen HK., et al. “Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications”. Cochrane Database of Systematic Reviews 4 (2006): CD004080
60. Grass F., et al. Springer Nature Switzerland AG “Enhanced Recovery After Surgery” (2020).

Citation

Citation: Jesús Velázquez Gutiérrez and Morella Vargas Useche. “Enhanced Recovery After Surgery: A Paradigm Shift in Perioperative Care. Review Article". Acta Scientific Gastrointestinal Disorders 5.6 (2022): 43-50.

Copyright

Copyright: © 2022 Jesús Velázquez Gutiérrez and Morella Vargas Useche. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.