ERAS Society sessions in Shanghai viewed over 50,000 times

The ERAS Society cooperated in arranging the OCAP2020 (Oriental Congress of Anesthesiology and Perioperative Medicine) congress in Shanghai in October. This congress was huge success with more than 4,000 delegates in place at the venue in Shanghai and with more than 50,000 delegates attending the ERAS Society day long session on line. In this session speakers from the ERAS Society alongside experts from inside and outside China delivered up to date presentations about ERAS.

We are grateful to Professor Miao the main host of the congress and his excellent team for a very nice and fruitful collaboration and we look forward to working with our Chinese colleagues to further spread ERAS in China and Asia.

In due course, members of the ERAS Society will be able to watch the presentations via the website.

You can join the society via our membership page 

ERAS® Society 10th anniversary World day – 14th Nov 2020

 

 

Join colleagues from around the world for the ERAS® Society 10th anniversary World day.

This global webinar will take place on the 14th November, 2020

Clinical experts in the ERAS® Society from around the world will deliver a series of short lectures and discuss key ERAS® papers. Join the free webinar from wherever you are!

ERAS Society Webinar Programme and Speaker Biographies 14 Nov 2020

Register for the time zone that suits you by clicking on the links below:

Asia and Australia 

Time Zone 1 https://us02web.zoom.us/webinar/register/WN_yrNyHf6tTjKX4kSqjftBaA

Africa and Europe

Time Zone 2  https://us02web.zoom.us/webinar/register/WN_nk0Kwrz8Q2mcu87IUlcZ9Q

Latin America and USA 

Time Zone 3 https://us02web.zoom.us/webinar/register/WN_iDqRqE2IQNqPTTU5gDtbrQ

If you are an ERAS® Society member, the webinars will also be available to view afterwards. To join the ERAS® Society click here

 

Following the three webinars, the ERAS Society USA Chapter, invites you to join them for their virtual conference “ERAS Updates and Future Directions”. Please find below the link to ERAS® USA Program and how to register

https://erasusa.org/meetings/virtual/2020/program/

 

Stopping opioid-related addiction, harm and accidents after surgery – international experts come together to publish guidance

The opioid crisis, in which addiction and harm are related to pain-relieving opioid drugs, has been well documented. It has been concentrated in the USA but is now affecting most Western nations and increasingly, developing countries also. In some cases, this addiction and subsequent harm begins when the patient is given these drugs for pain relief after surgery.

To help confront this, an international group of global experts including anaesthetists, surgeons and other healthcare professionals have come together to publish a consensus statement on the prevention of opioid-related harm in adult surgical patients. The consensus statement is published in Anaesthesia (a journal of the Association of Anaesthetists).

“Opioids are effective medicines that form an integral component of balanced multimodal painkilling strategies for the management of acute pain in postoperative patients,” explain the statement co-authors, who include Professor Dileep Lobo, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK. “However, over the past decade it has been increasingly appreciated that, in efforts to improve pain relief after surgery, doctors prescribing these drugs to help pain relief during and after surgery have unwittingly contributed to persistent postoperative opioid use, abuse and harm in some patients.”

They add: “In addition to the social and economic costs of opioid misuse, there are personal costs, with many people dying from opioid overdose, or in accidents caused, for example, by driving under the influence of opioids.”

Ways to reduce possible harm begin before surgery, since the strongest predictor of persistent postoperative opioid use post-surgery is pre-existing chronic opioid use. The incidence of persistent postoperative opioid use can be up to 10 times higher in those taking opioids long- term before surgery than in patients who have never used opioids.

The main points from the consensus statement are:

  • All patients undergoing surgery should be assumed to be at risk of developing persistent postoperative opioid use/addiction and may need interventions to mitigate those risks. However, some patients are at particularly high-risk of opioid related respiratory impairment, including older patients; those with sleep-disordered breathing; obesity; kidney disease; respiratory, cardiac and neurological diseases; diabetes; tolerance to opioids; and genetic variations in opioid metabolism.
  • Healthcare teams must consider optimising management of pre-operative pain and psychological risk-factors before surgery, including weaning patients off opioids they are already taking where possible. They should ensure realistic expectations of postoperative pain control, both in hospital and after discharge.
  • Provision of opioid painkillers should be guided by functional outcomes, rather than just a rating of the patient’s pain using existing scales.
  • Multiple methods of pain management should be optimised, and patients educated about the use of non-pharmacological and non-opioid painkilling strategies to reduce the amount and duration of opioids required to restore function
  • Long-acting opioids should not be used routinely for acute postoperative pain. (e.g. modified-release oxycodone, transdermal fentanyl patches)
  • A patient-centred approach should be used to limit the number of tablets and the duration of usual discharge opioid prescriptions, typically to less than a week. (Post-discharge prescriptions of opioids, if necessary, should be limited to less than a week’s duration. A small number of patients may need repeat prescriptions, but these should not be automatic. GPs should see patients and assess them before re-prescribing opioids).
  • Automated post-discharge repeat prescriptions for opioids should be avoided. Doctors, including those in outpatient clinics and general practice, should perform a patient review if more opioids are requested. Research has shown each additional repeat prescription has been found to increase the risk of opioid misuse (encompassing diagnoses of opioid dependence; abuse; or overdose) by 40%, with each additional week of opioids taken raising the risk of misuse by 20%. (A small number of patients may need repeat prescriptions, but these should not be automatic. GPs should see patients and assess them before re-prescribing opioids).
  • Patients should be advised on safe storage and disposal of unused opioids and directed to avoid opioid diversion to other individuals (e.g. sharing with friends and family). Addiction surveys have shown that around 50% of adults who misuse opioids obtain them from friends and family. This also avoids accidental deaths. Paediatric mortality from unintentional opioid overdose has increased three-fold in the last 20 years and has followed a similar time trend to adult overdose deaths

The authors also highlight the dangers of driving under the influence of opioids, that can impair driving skills and cognitive reasoning in a similar manner to alcohol. “Driving under the influence of drugs, including prescribed opioids, is now recognised to be a major cause of motor vehicle collisions and subsequent fatalities, particularly if the person commenced the opioid within the previous 30 days,” explain the authors, who add that many countries have established laws making driving under the influence of opioids illegal.

They conclude: “While the use of opioids during and after surgery has the capacity to promote recovery after life-saving or life-enhancing surgery, their use can be associated with harm from persistent postoperative opioid use; opioid-induced respiratory impairment; opioid diversion to people they were not originally prescribed for; and driving under the influence of prescription opioids. Strict control of opioid use within hospitals (stewardship) is required to minimise the risk of opioid-related harm. This will require the multidisciplinary involvement of anaesthetists; surgeons; pain specialists; pharmacists; nursing staff; physiotherapists; primary care clinicians; hospital management; and patients to adopt the recommendations from this consensus statement to local practice.”

Click here for the article

Professor Dileep Lobo, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK. +44-7545966471) dileep.lobo@nottingham.ac.uk

Co-author Dr Kariem El-Boghdadly, Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK. Please e-mail first to arrange interview. T) +44 7958 904883 E) editor-kariem@anaesthetists.org

Co-author and expert on pain medicine and addiction: Dr Jane Quinlan, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. T) +44 7545 995 615 E) jane.quinlan@ouh.nhs.uk

Call for papers focussing on Nursing and Allied Health Professional research in ERAS

There is an open call for papers focussing on Nursing and Allied Health Professional research in ERAS.

The journal Medicina has an open Special Issue titled “Nursing and Allied Health Professional Focused Research on Enhanced Recovery after Surgery (ERAS)”. It is calling for articles that highlight the innovative work undertaken by nurses and allied health professionals within ERAS pathways across all surgical specialties.

Research led by or involving nurses, operating department practitioners, physiotherapists, occupational therapists, dieticians, pharmacists, radiographers, healthcare assistants, or any other non-medical professionals involved in ERAS is being welcomed. This includes research from work conducted at the pre-operative, intra-operative, post-operative, and post-discharge stage.

For more details click here

ERAS® Society USA Chapter and Office of National Drug Control Policy Webinar – Recording Now Available

Webinar on Enhanced Recovery After Surgery (ERAS): Medical education engagement to support safe prescribing for patients needing surgery

This webinar, which included prominent ERAS leaders including ERAS® USA President-Elect Dr. Michael Scott and ERAS® USA Past President Dr. Tonia Young-Fadok, was designed for health care leaders to learn about the National Drug Control Strategy and how the surgical community has an important role in optimal surgical outcomes as well as safe prescribing education, prevention, and referral to addiction services. The Office of National Drug Control Policy (ONDCP) with the assistance of ERAS USA have organized this webinar. The Public Health, Education and Treatment team hopes to utilize this webinar as an opportunity to communicate the Administration’s support for safe prescribing practices and the role of the entire health care community in leading the path in both prevention as well as treatment for those who need surgical care.

ERAS® Society Executive Committee Statement regarding surgery and anaesthesia during the COVID-19 pandemic

The COVID-19 pandemic is sweeping across the world and affecting all of us gravely. It impacts upon surgical practice substantially by necessitating cancellation or postponement of the majority of elective operations to create capacity for the management of patients in need of treatment for COVID-19. Several countries, surgical societies, national associations and journals have published guidelines on how to manage these patients, many of which can be found with a simple internet search using “COVID-19 Guidelines for surgery”. There are also case series soon to be published showing how units have managed their patients during this crisis. The ERAS® Society chooses not to publish guidelines on this topic but rather point to the fact that for the patients who do undergo elective surgery, it is now more important than ever before to implement ERAS® pathways, given the increased importance to avoid complications, intensive care admission and to have patients in a condition to leave the hospital as soon as possible.

It must also be highlighted that at present there is little or no scientific evidence to base recommendations for the treatment of COVID-19 patients undergoing surgery, but at this point in the development of knowledge it is relying on opinion and use of information from other pathogens in different situations that will shape any future guidelines.

Professor Olle Ljungqvist
Professor Gregg Nelson
Dr Hans De Boer
Professor Nicolas Demartines
Professor Dileep Lobo
Professor Michael Scott
Professor William Fawcett
Ms Angie Balfour

Textbook now available to order! ERAS – A Complete Guide to Optimizing Outcomes

The text book “Enhanced Recovery After Surgery A Complete Guide to Optimizing Outcomes” edited by Prof Olle Ljungqvist, Prof Nader Francis, and Prof Richard Urman is now available to order on the Springer website.

The book Provides a broad and comprehensive overview of ERAS with expert opinions from leaders in the field regarding elements of care that are both generic and specific to various surgeries First comprehensive, authoritative book on the subject that covers the patient journey through such a program, commencing with optimization of the patient’s condition, patient education, and conditioning of their expectations Discusses metabolic response to surgery, anaesthetic contributions, and optimal fluid management after surgery, providing examples of ERAS pathways and practical tips on post-operative pain control, feeding, mobilization, and criteria for discharge Helps an existing user of ERAS care and centers with established programs by outlining causes of deviation and failure and suggesting modifications that may be necessary

Save the date – International Surgical Week (ISW) 2021 – Aug 29-Sep 2, 2021, Kuala Lumpur, Malaysia

 

 

 

 

 

Engaging and insightful, the International Surgical Week (ISW) 2021 will be unlike any other meeting. Offering scientific excellence in the field of surgery at an affordable price, the event will bring together many of the world’s leading experts. ISW 2021 will also provide a platform for scientific and clinical working groups where they can collaborate to establish the foundations for future diagnostic and surgical challenges, and discuss novel approaches and standards, facilitating progress towards real-time, patient-oriented solutions.

For more information visit www.isw2021.org or visit The International Society of Surgery website www.iss-sic.com

 

 

Guidelines for Perioperative Care in Cardiac Surgery – Now over 107,000 views/downloads

Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

We are delighted to report that the “Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations” published in JAMA Surgery in August, 2019, have now received over 107,000 views/downloads since its release. Further to this, the manuscript has achieved an Altimetric attention score of 322, which makes it one of the top research outputs scored by this group. JAMA Surgery is the highest impact factor peer reviewed surgical journal, with an impact factor of 10.668, and this article was the most viewed manuscript in 2019.

We are pleased that our contribution has garnered so much attention from our peers in cardiac surgery, cardiac anesthesia, critical care, and nursing. We look forward to continuing to standardize best practice surrounding the perioperative care of cardiac surgical patients through expert consensus, review of the literature, and open communication.

Congratulations to the ERAS® CARDIAC Board of Directors and Authors

Letter from the ERAS Society Chairman – Reviewing 2019 and Previewing 2020

Chairman: Professor Olle Ljungqvist

2019 – Thank you all for another great ERAS® Society year

It is with great happiness and pride that I can summarize that 2019 has been yet another year of great developments for ERAS® and the ERAS® Society.

This year the ERAS® Society Guidelines surpassed 4,000 citations in PubMed, and when these guidelines are put in use, several reports from different surgeries also show that both short- and long-term outcomes improve. The interest in ERAS® is mirrored by the number of ERAS® publications that are constantly growing; up from around 40 15 years ago to over 600 in the last year. ERAS® makes a big difference in outcomes and this is why ERAS® is a top subject in surgery and anesthesia.

The ERAS® Society is very active in a range of different areas, and I am proud to mention just a few highlights that have been accomplished by a large number of great leaders, experts and collaborators around the globe:

Guidelines: This year ERAS® Society Guidelines broke records in downloads in JAMA Surgery (highest impact journal in surgery) with the Guideline on Cardiac Surgery, and the update of the Colorectal Guideline was a big hit. We were also happy to have just released the Guideline on Hip and Knee replacement surgery on-line. This year the Society also published a guideline for ERAS® Society Guidelines outlining the history behind them and how they have developed into the methodology used currently.

Joining forces: During 2019 we established and strengthened bonds with major Anesthesia Societies – the Brazilian and the European Societies of Anaesthesiology. With these two prominent Societies we will be able to bring the true ERAS® to many more hospitals globally.

Implementation worldwide: Several countries in LATAM are joining the ERAS® Society and ERAS® LATAM, and in countries already with Centers of Excellence present, we are seeing them now training other hospitals in their countries. In Brazil a total of seven new hospitals are engaged in an ERAS® Implementation Program with the ambition to spread it across the country in a collaborative manner with the Brazilian Society of Anesthesiology. In the US, Mayo Clinic and Brigham and Women’s Hospital are now trained as Centers of Excellence and starting to help other units implement ERAS® across the USA. In Asia the first hospital in India is in training, as is the first in Dubai, with more countries joining early next year; Taiwan and Thailand are next in line to follow Singapore, Philippines and Vietnam. In Europe new units across the continent are being trained and in South Africa plans are laid out for spreading ERAS® inside and outside the country.

Congresses and meetings: This year’s main event was the 7th ERAS® World Congress successfully run with ERASUK in Liverpool, UK. An excellent program was held over 3 days with almost 600 delegates from over 70 countries. The 1st ERAS®ASIA congress was held in Singapore to meet the growing interest and demand for ERAS® in this part of the world. More than 200 delegates covering most countries in Asia made this returning event a huge success. In addition, numerous ERAS® sessions and presentations have been part of just about every major international and national congress around the world; many of these presentations are delivered and sessions organized by ERAS® Society members and collaborators. Lastly, in several countries national ERAS® Society Chapters have held congresses and events.

What is in line for 2020?

Next year’s main event will be the 8th ERAS World Congress, in collaboration with ERAS®USA in New Orleans, USA August 26-28. Several local or regional events will take place across the globe – keep an eye on the ERAS® Society website for updates. The ERAS® Society Textbook will be released by Springer, USA during the first quarter of 2020. The title is: Enhanced Recovery After Surgery – A Complete Guide to Optimizing Outcomes. The textbook has 65 chapters written by world leaders in ERAS®, covering all you need to know about ERAS®.

The ERAS® Society will launch a formal membership early next year. Membership will provide a series of benefits in addition to being part of an international multi-professional and multi-disciplinary medical society that is changing the course of surgery and anesthesia: – On line subscriptions to 4 leading journals: World Journal of Surgery, European Journal of Anaesthesiology, Current Opinion in Anesthesiology, and Current Opinion in Critical Care – ERAS® Society textbook: Discounted price on the textbook (released during the 2st quarter of 2019) from Springer – all you need to know about ERAS® – 65 chapters, written by world leading authors. – Congress fee rebate: Reduced registration at the 8th World Congress in New Orleans. Details to be announced on the website shortly.

Guidelines: new and updated guidelines are under way for 2021 Let me thank all of the excellent collaborators and co-workers involved in the ERAS® Society who have made these tremendous successes possible and who have dedicated their precious time and knowledge to help move ERAS® forward with the goal to improve outcomes for patients. I wish all of you the very best for the holidays and the New Year. It has been an honor and privilege to serve as the Chairman of this formidable group of people working for the ERAS®Society.

Sincerely,

Olle Ljungqvist

Chairman ERAS® Society Executive Committee