ERAS in Emergency Surgery

Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients.

Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients (2016) Wisely JC, Barclay KL. ANZ J Surg. 2016 Nov;86(11):883-888.

 

What is already known:
The majority of ERAS research has been focussed, quite rightly, on improving outcomes in elective surgery. However emergency surgery has high rates of morbidity and mortality and a lot more interest more recently has been directed at how ERAS elements could affect outcomes in this high-risk group.

What this paper adds:
In this retrospective review the authors compared 2 groups of patients undergoing emergency major abdominal surgery before and after an ERAS program had been introduced for their elective colorectal surgery patients. A total of 370 patients were included. The two groups were similar in age, co-morbidities and ASA scores. The post-ERAS group underwent significantly more left sided procedures. Hospital length of stay was similar in both groups [median 8 days], but the post-ERAS group received significantly less intravenous fluid, both intra-operatively and post-operatively. Significantly fewer patients in the post-ERAS group had a urinary catheter or PCA for more than 2 days. There were also fewer abdominal drains used in the post-ERAS group. This resulted in significantly reduced major post-operative complications in particular chest infections. Suggesting that ERAS elements could have a place in both elective and emergency surgery.

Chris Jones, Guildford.


ERAS in Emergency Surgery

Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes?

Quiney N, Aggarwal G, Scott M, Dickinson M (2016)Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes? World J Surg. 2016 Jun;40(6):1283-7 

 

What is already known:

Emergency general surgical operations carry a very high mortality rate, and it is estimated that they are at least ten times higher than many similar elective procedures. Roughly 55,000 emergency operations are carried out each year and it is estimated that will result in 8,000 deaths.

What this paper adds:

In this interesting paper the authors examine the evidence behind the ERAS elements and how they can be applied to emergency surgery. In particular they examine the delays can affect outcomes, in particular delays in diagnosis, resuscitation, antibiotics and definitive care. They also examine how inadequate postoperative care can affect outcomes.

Chris Jones, Guildford.


ERAS for Head and Neck Surgery

Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference?

Bater M, King W, Teare J, D’Souza J.Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? Br J Oral Maxillofac Surg. 2017 Dec;55(10):1024-1029

What is already known:
Head and neck surgery is one of the newest specialities to embrace ERAS, but at present there are very few studies published in this area. Despite this the ERAS society have published consensus guidelines available here, based mostly on extrapolation from other surgical specialities.

What this paper adds:
This is one of the first papers to specifically describe an ERAS programme for head and neck surgery and compare it to a traditional care model. They compared 100 consecutive patients undergoing their ERAS programme and compared with 40 from a historical control group. Overall they demonstrated a 4 day reduction in length of stay (10 vs 14 days, p=0.003), with no change in morbidity or readmission rates. Suggesting that ERAS is safe and effective for this group of patients.

Chris Jones, Guildford.


ERAS for Neurosurgery

Hagan KB, Bhavsar S, Raza SM, Arnold B, Arunkumar R, Dang A, Gottumukkala V, Popat K, Pratt G, Rahlfs T, Cata JP. Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016 Feb;24:10-6.

What is already known:

The principles of ERAS have been applied to many new specialities over the recent years. One of the newest specialities is Neurosurgery. This group from the US explored how ERAS principles of ERAS could be applied to oncological craniotomies.

What this paper adds:

The authors should be congratulated for this interesting systematic review of the literature on ERAS for neurosurgery. They reviewed how each element could be applied to neurosurgery, including specific concepts such as scalp blocks and minimally invasive craniotomies. And whilst there is insufficient evidence at present for recommending a specific protocol it does support pursuing future research in this area.

Chris Jones, Guildford.