ERAS
GTPase ERas precursor (EC 3.6.5.2) (E-Ras) (Embryonic stem cell-expressed Ras) [HRAS2] [HRASP]
PublicationsПравить
The incorporation of enhanced recovery after surgery (ERAS) fundamentals into perioperative medicine has improved the patient care experience and hastened recovery time while reducing hospital costs. Research studies have shown that incorporating ERAS principles in the adult or geriatric acute care surgery populations minimizes time to resumption of preoperative activity and reduces hospital length of stay. ERAS principles are widely applicable to these patient cohorts and may be applicable in trauma patients. Increased physician and nursing education to promote widespread utilization of enhanced recovery protocols will further improve quality of health care administered in the twenty-first century.
MeSH Terms
- Adult
- Aged
- Clinical Protocols
- Critical Care
- Geriatrics
- Humans
- Length of Stay
- Perioperative Care
- Postoperative Complications
- Recovery of Function
- Wounds and Injuries
Keywords
- Elderly
- Enhanced recovery
- Perioperative care
- Urgent surgery
To describe prospective application of an implementation framework to guide and evaluate a quality improvement (QI) project to improve adherence to evidence-based postoperative diet guidelines (consistent with Enhanced Recovery After Surgery, ERAS) in older surgical patients. A hybrid mixed methods study guided by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework was used. A pre-implementation audit identified gaps in nutrition-related care practices against ERAS guidelines for older surgical patients. Qualitative interviews explored barriers to practice change, informing development of the facilitated implementation strategy. Iterative facilitation interventions were identified by field notes and classified using i-PARIHS facilitator's tool-kit. Post-implementation audit measured implementation outcomes, and clinical processes and outcomes using controlled before-after comparative study. Implementation involved 17 discrete facilitation activities. Early postoperative diet upgrade was acceptable, well adopted (79%) and appropriate for 89% of patients. Fidelity (i.e. protocol delivered as intended) was 59%, with loss of fidelity primarily because of incorrect diet codes. Clinical processes and outcome evaluation (n = 155) compared data pre-implementation (intervention: n = 45, control: n = 27; mean age 73 (SD 6) years, 60% male) and post-implementation (intervention: n = 47, control: n = 36; mean age 74 (SD 6) years, 57% male). Patients on the intervention ward had higher odds of receiving early nutrition post-implementation (adjusted odds ratio [95% CI]: 6.5 [1.9-22.4], P = 0.01). Prospective application of an implementation framework supported planning and successful implementation in this QI project. Multi-level evaluation of facilitation strategies, implementation outcomes, and clinical processes and outcomes helps to understand areas of success and continuing challenges.
MeSH Terms
- Aged
- Aged, 80 and over
- Diet
- Enteral Nutrition
- Evidence-Based Medicine
- Female
- Geriatrics
- Health Services Research
- Humans
- Male
- Postoperative Care
- Practice Guidelines as Topic
- Prospective Studies
- Quality Improvement
Keywords
- evaluation studies
- evidence-based practice
- facilitation
- implementation
- knowledge translation
- postoperative care
Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate. We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients. Primary outcomes were postoperative complications, mortality, hospital length of stay and readmission rates. Eighteen studies were included. The majority of patients were older than 70. Elderly patients had fewer postoperative complications and a reduced hospitalization with ERAS compared to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery. ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative complications, hospitalization and readmission rates. There is evidence to suggest that ERAS is feasible and beneficial for geriatric emergency patients.
MeSH Terms
- Aging
- Critical Care
- Critical Pathways
- Feasibility Studies
- Geriatrics
- Humans
- Length of Stay
- Patient Readmission
- Perioperative Care
- Postoperative Care
- Postoperative Complications
- Recovery of Function
- Treatment Outcome
Keywords
- ERAS
- elderly
- emergencysurgery
Perioperative application of multimodal rehabilitation pathways represents the anticipated evolution of a concept that has arisen in recent decades, initially named fast-track surgery and known today as enhanced recovery after surgery (ERAS). This concept refers to the use of standardised perioperative care protocols that are supported by evidence-based medicine and aim to reduce surgical trauma and stress. Although application of such protocols to emergency surgery has produced favourable results, the use of ERAS in the geriatric emergency surgery setting has not been widely applied, and no studies have produced results that support its use in this setting. However, ERAS could help improve outcomes in this group of patients, who already have high surgical morbidity and mortality rates. Material and In preparation for a lecture presented at the 18th European Congress of Trauma and Emergency Surgery (Bucharest, May 2017), the authors performed a literature search using the terms "ERAS", "fast-track", "emergency surgery", "emergency medicine", "multimodal rehabilitation" and "elderly patient" to gather scientific evidence with which to present suggestions in support of their opinion that ERAS could be applied successfully to improve postoperative outcomes for geriatric emergency patients. Urgent surgical treatment of elderly patients is associated with morbidity and mortality rates higher than those of younger patients, and there is room for improvement. A multimodal rehabilitation program seems to be a good working model for achieving this goal.
MeSH Terms
- Aged
- Aging
- Emergencies
- Evidence-Based Medicine
- Geriatrics
- Humans
- Perioperative Care
- Postoperative Care
- Postoperative Complications
- Treatment Outcome
Keywords
- elderlypatient
- emergencysurgery
- fast-track
- multimodalrehabilitation
ERAS program applied to colorectal laparoscopic surgery is well known to reduce hospitalization improving short terms outcomes and minimizing the Surgical Stress Response. However its effectiveness in elderly population is yet to be demonstrated. The primary aim of this study is to compare the level of immune and nutritional serum indexes across surgery in patients aged over 70 years old undergoing elective colorectal laparoscopic surgery within an ERAS protocol or according to a Standard program. 83 patients undergoing colorectal laparoscopic surgery were enrolled and randomized in two groups (ERAS Group 40, Standard Group 43) within a larger randomized trial on a general population. Surgical stress parameters were collected preoperatively, 1, 3 and 5 days after surgery. Nutritional parameters were collected preoperatively, 1 and 5 days after surgery. Short Term Outcomes were also prospectively assessed. IL-6 levels were lower in the EG on 1, 3, and 5 days post-operatively (p 0.05). IL-6 levels in the Enhanced group returned to pre operative level 3 days after surgery. C-reactive protein level was lower in the Enhanced group on day 1, 3, and 5 (p 0.05). There was no difference in Cortisol and Prolactin levels between groups. Prealbumin serum level was higher on day 5 (p 0.05) compared to standard group. Postoperative outcomes in terms of normal bowel function and length of hospital stay were significantly improved in the ERAS group. Colorectal laparoscopic surgery within an ERAS prototcol in elderly patients affects Surgical Stress Response, decreasing IL-6 and CRP levels postoperatively and improving Prealbumin post operative synthesis.
MeSH Terms
- Aged
- Aged, 80 and over
- Aging
- Biomarkers, Tumor
- C-Reactive Protein
- Colorectal Neoplasms
- Elective Surgical Procedures
- Female
- Humans
- Interleukin-6
- Laparoscopy
- Length of Stay
- Male
- Perioperative Care
- Prospective Studies
- Treatment Outcome