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Yuan CD, Zhou BZ, Wang NY, Wan QQ, Hu ZZ. Evidence-based control of stress response on intraoperative physiological indexes and recovery of patients undergoing gastrointestinal surgery. World J Gastroenterol 2025; 31:102331. [DOI: 10.3748/wjg.v31.i8.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/11/2024] [Accepted: 01/14/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery (ERAS) provide recommendations for ERAS in gastrointestinal surgery, the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the complex factors contributing to patient stress responses. Moreover, stress responses are more severe in older adult patients. Therefore, precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.
AIM To establish an evidence-based ERAS model based on stress response nursing care and demonstrate nursing benefits through clinical practice.
METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response. Next, 392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based (study group) or conventional (control group) ERAS nursing models, respectively. Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.
RESULTS Among 64 domestic and international studies, the stress responses of older adult patients mainly included emotional anxiety, sleep disorders, gastrointestinal discomfort, physical weakness, pain, and swelling. The appropriate nursing interventions included comprehensive psychological counseling, pre- and postoperative nutritional support, temperature control, pain management, and rehabilitation training. Compared with the control group, the study group showed lower heart rate, mean arterial pressure, blood glucose level, and adrenaline level; shorter duration of drainage tube placement, time to first flatus, time to first ambulation, and postoperative hospital stay; lower anxiety scores on postoperative day 3; and lower incidences of postoperative infection, obstruction, poor wound healing, and gastrointestinal reactions were lower in the study group (all P < 0.05).
CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery, promoted postoperative recovery, and reduced the incidence of complications.
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Affiliation(s)
- Chen-Dong Yuan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Bao-Zhu Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ning-Yan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qing-Qing Wan
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zhen-Zhen Hu
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Bel Diaz J, Barbero Mielgo M, Pérez Garnelo A, Guzmán Carranza R, García Fernández J. Analysis of protocol adherence and outcomes of an enhanced recovery program in colorectal surgery after 5 years of implementation. J Healthc Qual Res 2025:S2603-6479(25)00001-6. [PMID: 39894686 DOI: 10.1016/j.jhqr.2024.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 11/08/2024] [Accepted: 12/31/2024] [Indexed: 02/04/2025]
Abstract
INTRODUCTION Enhanced recovery program (ERAS program) have revolutionized the world of surgery by reducing postoperative complications and hospital stays. Greater adherence to the protocol results in better outcomes; however, adherence often declines over time. The main objective of this study is to analyze the adherence rate to ERAS strategies and the outcomes of an ERAS colorectal (CRC) program five years after its implementation. METHODOLOGY This is a descriptive observational study comparing two groups of patients undergoing scheduled CRC surgery under an ERAS program at University Hospital. The first group (ERAS) includes patients operated on during the period immediately following the implementation of the protocol (January 2017-June 2018), while the second group (ERAS 5) includes patients operated on five years after the implementation (January 2022-June 2022). RESULTS An increase in the adherence rate to ERAS strategies was observed (88.2% in ERAS vs. 84.2% in ERAS 5, p 0.003), as well as a reduction in healthcare-associated infections (HAIs) (9% in ERAS vs. 25.2% in ERAS 5, p 0.001) and surgical site infections (6% in ERAS vs. 18.2% in ERAS 5, p 0.002). No differences were found in other postoperative complications, functional recovery, average length of stay, and readmission rates. CONCLUSIONS After five years of implementing an ERAS protocol for CRC in our hospital, we have managed to maintain a high adherence rate to ERAS strategies. There has been a significant reduction in HAIs and surgical site infections.
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Affiliation(s)
- J Bel Diaz
- Anesthesiology Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
| | - M Barbero Mielgo
- Anesthesiology Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - A Pérez Garnelo
- Anesthesiology Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - R Guzmán Carranza
- Anesthesiology Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - J García Fernández
- Anesthesiology Service, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
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Antoniv M, Nikiforchin A, Sell NM, Bordeianou LG, Francone TD, Ahmed F, Rubin MS, Bleday R. Impact of Multi-Institutional Enhanced Recovery after Surgery Protocol Implementation on Elective Colorectal Surgery Outcomes. J Am Coll Surg 2025; 240:158-166. [PMID: 39812414 DOI: 10.1097/xcs.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols aim to improve surgical patient outcomes, although their effectiveness may vary. This study assessed the impact of multi-institutional ERAS implementation on postoperative morbidity in patients undergoing elective colorectal surgery. STUDY DESIGN We conducted a multicenter retrospective cohort study using the American College of Surgeons NSQIP database from 2012 to 2020. We analyzed patient outcomes before (2012 to 2014) and after (2015 to 2020) ERAS implementation across 4 hospitals. Multivariable logistic regression was used to determine the impact of ERAS program on certain outcomes. RESULTS A total of 8,930 cases were analyzed: 3,573 in the pre-ERAS and 5,357 in the ERAS cohort. The ERAS cohort demonstrated significant reductions in superficial surgical site infection (SSI; 7.5% vs 2.5%, p < 0.001), deep SSI (0.6% vs 0.2%, p = 0.016), urinary tract infection (3.3% vs 1.5%, p < 0.001), pulmonary embolism (0.7% vs 0.4%, p = 0.022), deep vein thrombosis (1.4% vs 0.9%, p = 0.020), sepsis (3.0% vs 2.1%, p = 0.006), and other complications. Median length of stay decreased from 5 to 4 days (p < 0.001), and 30-day readmission rate dropped from 11.3% to 9.8% (p = 0.022). Overall, ERAS implementation was associated with a 35% decrease in the odds of all 30-day complications (odds ratio 0.65, 95% CI 0.59 to 0.73). There was no effect on 30-day (p = 0.962) or overall mortality rates (p = 0.732). CONCLUSIONS A standardized ERAS protocol, used across multiple institutions, significantly improves elective colorectal surgery outcomes, reducing complications, length of hospital stay, and readmissions. These findings support the broader implementation of ERAS to enhance patient care and reduce healthcarecosts.
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Affiliation(s)
- Marta Antoniv
- From the Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Antoniv, Ahmed, Bleday)
| | | | - Naomi M Sell
- Department of Surgery, Winchester Hospital, Winchester, MA (Sell)
| | - Liliana G Bordeianou
- Section of Colon and Rectal Surgery, Department of Surgery, MA General Hospital, Harvard Medical School, Boston, MA (Bordeianou)
| | - Todd D Francone
- Department of Surgery, Newton Wellesley Hospital, Newton, MA (Francone)
| | - Fraz Ahmed
- From the Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Antoniv, Ahmed, Bleday)
| | | | - Ronald Bleday
- From the Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Antoniv, Ahmed, Bleday)
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Ayinde BO, Chokshi P, Adhikari S, Jaimalani A, Yeritsyan A, Surve AV, Khan S. Challenges and Elements Hindering the Adoption of Enhanced Recovery After Surgery (ERAS) Protocols in Colorectal Surgery and Their Resolutions: A Systematic Review. Cureus 2024; 16:e63222. [PMID: 39070469 PMCID: PMC11280001 DOI: 10.7759/cureus.63222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
This systematic review focuses on the various aspects of Enhanced Recovery After Surgery (ERAS) implementations, such as the various barriers, facilitators, and the role of teamwork. A systematic search was performed in PubMed, PubMed Central (PMC), and the Cochrane Library for studies published between the years 2018 and 2023. Inclusion criteria encompassed studies assessing the various factors hindering the implementation of ERAS protocols on patients undergoing colorectal surgery. It collectively highlights the importance of a multidisciplinary approach, continuing education, supervision, and patient involvement in achieving a successful implementation. Important findings include the positive impact of a performance improvement team, audits and feedback, and patient-centered approaches in reducing hospital length of stay, reducing inflammation, and improving patient outcomes. In addition, the study emphasizes the challenges of complete adherence to all ERAS components and suggests a simplified protocol to improve implementation. This paper also seeks to understudy the hurdles encountered during the adoption of the ERAS protocol and studies the various fundamental components of the protocol.
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Affiliation(s)
- Bolaji O Ayinde
- Faculty of Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Priyank Chokshi
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sanjeev Adhikari
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Aniket Jaimalani
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Artashes Yeritsyan
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ashka V Surve
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Vermeulen L, Duhoux A, Karam M. Nurse managers' contribution to the implementation of the enhanced recovery after surgery approach: A qualitative study. Nurs Manag (Harrow) 2024; 55:28-37. [PMID: 38809525 DOI: 10.1097/nmg.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Loïc Vermeulen
- At the Université de Montréal in Quebec, Canada, Loïc Vermeulen is a master's student in Health Services administration, and Arnaud Duhoux and Marlène Karam are professors in the Department of Nursing
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Tolmay S, Rahiri JL, Snoep K, Fewster G, Kee R, Lim Y, Watson B, Richter KK. Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting. ANZ J Surg 2024; 94:910-916. [PMID: 38205533 DOI: 10.1111/ans.18838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) programs have become increasingly popular in the management of patients undergoing colorectal resection. However, the validity of ERAS in rural hospital settings without intensive care facilities has not been primarily evaluated. This study aimed to assess an ERAS protocol in a rural surgical department based in Invercargill New Zealand. METHODS Ten years of prospectively collected data were analysed retrospectively from an ERAS database of all patients undergoing open, converted, or laparoscopic colorectal resections. Data were collected between two time periods: before the implementation of an ERAS protocol, from January 2011 to December 2013; as well as after the implementation of an ERAS protocol, from January 2014 to December 2020. The primary outcome measures were hospital length of stay (LOS) and LOS in the critical care unit (LOS-CCU). Secondary outcomes were compliance with ERAS protocol, mortality, readmission, and reoperation rates. RESULTS A total of 118 and 558 colorectal resections were performed in the pre-ERAS and ERAS groups respectively. A statistically significant reduction in hospital LOS was achieved from a median of 8 to 7 days (P = 0.038) when comparing pre-ERAS to ERAS groups respectively. Furthermore, a significant reduction in re-operation rates was observed (7.6% vs. 3% in the ERAS group, P = 0.033) which was seen without a rise in readmission rates (13.6% vs. 13.6% in the ERAS group). CONCLUSION The implementation of ERAS in a rural surgical setting is feasible, and these initial findings suggest ERAS adds value in optimizing the colorectal patient's surgical journey.
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Affiliation(s)
- Stephen Tolmay
- Department of Surgery, Waitematā District Health Board, Auckland, New Zealand
| | - Jamie-Lee Rahiri
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Kim Snoep
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Gillian Fewster
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Rachel Kee
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Yukai Lim
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Bridget Watson
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
| | - Konrad Klaus Richter
- Department of Surgery, Southland Hospital, Invercargill, New Zealand
- Dunedin School of Medicine, University of Otago, New Zealand
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Byrnes A, Flynn R, Watt A, Barrimore S, Young A. Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review. J Eval Clin Pract 2024; 30:217-233. [PMID: 37957803 DOI: 10.1111/jep.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) is an evidence-based intervention that is well-recognised across multiple surgical specialties as having potential to lead to improved patient and hospital outcomes. Little is known about sustainability of ERAS programmes. AIMS This review aimed to describe available evidence evaluating sustainability of ERAS programmes in gastrointestinal surgery to understand: (a) how sustainability has been defined; (b) examine determinants of sustainability; (c) identify strategies used to facilitate sustainability; (d) identify adaptations to support sustainability; and (e) examine outcomes measured as indicators of sustainability of ERAS programmes. METHODS This scoping review was conducted following the Joanna Briggs Institute's methodology. Research databases (PubMed, Embase, CINHAL) and the grey literature were searched (inception to September 2022) for studies reporting sustainability of ERAS programmes in gastrointestinal surgery. Included articles reported an aspect of sustainability (i.e., definition, determinants, strategies, adaptations, outcomes and ongoing use) at ≥2 years following initial implementation. Aspects of sustainability were categorised according to relevant frameworks to facilitate synthesis. RESULTS The search strategy yielded 1852 records; first round screening excluded 1749, leaving 103 articles for full text review. Overall, 22 studies were included in this review. Sustainability was poorly conceptualised and inconsistently reported across included studies. Provision of adequate resources was the most frequently identified enabler to sustainability (n/N = 9/12, 75%); however, relatively few studies (n = 4) provided a robust report of determinants, with no study reporting determinants of sustainability and strategies and adaptations to support sustainability alongside patient and service delivery outcomes. CONCLUSION Improved reporting, particularly of strategies and adaptations to support sustainability is needed. Refinement of ERAS reporting guidelines should be made to facilitate this, and future implementation studies should plan to document and report changes in context and corresponding programme changes to help researchers and clinicians sustain ERAS programmes locally.
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Affiliation(s)
- Angela Byrnes
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rachel Flynn
- Health Information and Standards Directorate, Health Information and Quality Authority, Cork, Ireland
| | - Amanda Watt
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sally Barrimore
- Nutrition and Dietetics Department, Prince Charles Hospital, Chermside, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, Australia
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van Bochove-Waardenburg M, van der Jagt M, de Man-van Ginkel J, Ista E. Sustained adherence to a delirium guideline five years after implementation in an intensive care setting: A retrospective cohort study. Intensive Crit Care Nurs 2023; 76:103398. [PMID: 36731265 DOI: 10.1016/j.iccn.2023.103398] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To explore the level of sustained adherence to a delirium guideline in a university intensive care unit setting five years after cessation of a multifaceted implementation program conducted between April 2012 and February 2015. RESEARCH METHODOLOGY/DESIGN A quantitative retrospective cohort study was conducted using the medical records of all eligible patients admitted to the intensive care unit from November 2019 to February 2020. SETTING Four adult intensive care units in a university hospital. MAIN OUTCOME MEASURES Primary outcome is adherence to seven performance indicators indicated in the guideline being: light sedation days, mobilisation, physical therapy, analgesics use, delirium and sedation screening and avoiding benzodiazepines. Clinical patient outcomes such as Intensive care unit stay and prevalence of delirium were also collected. Data were compared with the results of the original implementation study's using descriptive statistics and Kruskal-wallis and Chi-square tests. RESULTS Data of 236 patients were included. The most notable decrease in adherence concerned 'number of light sedation days' (-28 %). Adherence to three indicators had increased: 'number of days receiving out-of-bed mobilisation' (+11 %); 'number of days receiving physical therapy' (+9%); and 'use of analgesics' (+12 %). Comparison of clinical outcomes showed an increased intensive care unit length-of-stay from 3 to 5 days (P < 0.001). Prevalence of delirium increased over five years from 41 % to 43 % of patients while delirium duration decreased from a median of 3 days to a median of 2 days. CONCLUSION Five years after ceasing of implementation efforts regarding the delirium guideline, partial sustainability has been achieved. The decrease in adherence to 'number of light sedation days' could have contributed to the increased length-of-stay on the intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE After implementation, routine monitoring of performance indicators is required to evaluate the level of sustainment. Further, revisiting reasons for decrease in guideline adherence when contextual changes occur. Reassessment of the perceived barriers and facilitators can guide adaptations to sustain, or even improve, adherence.
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Affiliation(s)
- Marlies van Bochove-Waardenburg
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Janneke de Man-van Ginkel
- Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
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Su S, Wang T, Wei R, Jia X, Lin Q, Bai M. The Global States and Hotspots of ERAS Research From 2000 to 2020: A Bibliometric and Visualized Study. Front Surg 2022; 9:811023. [PMID: 35356496 PMCID: PMC8959351 DOI: 10.3389/fsurg.2022.811023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background Enhanced recovery after surgery (ERAS) protocol has been implemented in surgeries for more than 20 years, this study investigated the global states and hotspots of ERAS research. Methods Based on the Web of Science database, a bibliometric and visualized study of original ERAS research from 2000 to 2020 was performed, including the trends of publications and citations; distribution of countries, authors, institutions, sources; study design, level of evidence, served surgeries and surgical disciplines. Hotspots were revealed by research interests and keywords. Results Within the field of original ERAS research, there was a rising trend in annual publications and citations. The USA was the greatest contributor. Kehlet, H, University of Copenhagen were the most influential author and institution, respectively. British Journal of Surgery and Annals of Surgery were the most cited journals. Though there were more prospective designs, more than half of the studies presented level IV evidence and had fewer citations and citation densities compared to that of level II and level III. ERAS protocol was overwhelmingly implemented in colorectal surgeries. Most studies focused on elements of ERAS, the top three research interests were “length of stay,” “pain management,” and “complications.” In recent years, bariatric surgery, compliance with ERAS, and feasibility in the elderly were new hotspots. Conclusion Revealing the global states and hotspots can help researchers better understand the trends in ERAS research. The USA was the greatest contributor to ERAS research. Kehlet, H, was the most influential author in the field. Bariatric surgery, compliance with ERAS, and feasibility in the elderly represent the new trend of ERAS research. Most of the ERAS research had a low evidence levels, studies with high-level evidence are still required in this field.
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Schwenk W, Lang I, Huhn M. [Structured Implementation of a Fast-Track Program - How Does it Work?]. Zentralbl Chir 2021; 146:249-259. [PMID: 33782931 DOI: 10.1055/a-1385-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany. Neither scientific evidence nor reimbursement regulations explain this lack of fast-track acceptance. It seems however that a structured process of change from traditional perioperative medicine to evidence based fast-track therapy is missing in Germany. In other countries, structured programs for fast-track or ERAS implementation have been successful in many hospitals. This article describes structured fast-track implementation divided into three consecutive steps: organisational preparation, clinical implementation and continuous examination of fast-track adherence, functional recovery, morbidity and postoperative length of hospital stay. Due to its complex nature, fast-track implementation should be guided by external fast-track experts.
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Affiliation(s)
- Wolfgang Schwenk
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
| | - Ina Lang
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
| | - Marion Huhn
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
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Etchegary C, Taylor L, Mahoney K, Parfrey O, Hall A. Changing Health-Related Behaviours 5: On Interventions to Change Physician Behaviours. Methods Mol Biol 2021; 2249:613-630. [PMID: 33871867 DOI: 10.1007/978-1-0716-1138-8_33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In many countries, there is a large amount of public money spent on health care. Some patient tests and treatments are not only unnecessary but also may be harmful, leading health researchers to look for the most effective interventions to change physician behaviour. The purpose of this chapter is to describe some of the interventions used to modify physician behaviour and highlight their challenges observed in a Canadian provincial context. We begin with a brief description of the increasing interest in behaviour change interventions in recent years and their theoretical basis. We then describe several interventions used to change physician behaviour ranging from nudges to choice restriction and the available evidence on their effectiveness. We provide examples of interventions and their challenges as we've experienced them in our research program, Quality of Care NL. We conclude with a summary of what the evidence tells us about interventions to change physicians' behaviours.
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Affiliation(s)
- Cheryl Etchegary
- Quality of Care NL, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Lynn Taylor
- Quality of Care NL, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Krista Mahoney
- Quality of Care NL, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Owen Parfrey
- Quality of Care NL, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, NL, Canada
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Correction to "Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital". Can J Surg 2020. [PMID: 33009896 DOI: 10.1503/cjs.2063301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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