Guidelines for perioperative care in gynecologic/oncology – 2019 update

The ERAS Society is delighted to announce that the “Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update” have just been published in the International Journal of Gynecological Cancer (IJGC). The guidelines are FREE to download and are available here.

They are also listed on our guideline page with all of the other ERAS Guidelines.

The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery

ERAS Society Scientific Chair: Professor Dileep Lobo

ERAS Society guidelines have recommended that mechanical bowel preparation (MBP) should not be used for patients undergoing colonic surgery and that it should be used selectively for patients undergoing rectal surgery. This has been based on the fact that mechanical bowel preparation on its own did not impact on morbidity and mortality in these patients when compared with no bowel preparation or rectal enema alone.

This new meta-analysis has looked at the impact of oral luminal antibiotic preparation (OAB) on outcome in patients undergoing colorectal surgery. It has analysed data from both cohort studies (12 studies, 63,080 participants) and randomised controlled studies (28 studies, 6,437 patients). Although the addition of cohort studies may be considered to weaken the strengths of the conclusions, there have been a number of recent large cohort studies and these cannot be ignored. One of the strengths of this analysis is that it includes only one of the many NSQIP studies that have used the same database with overlapping cohorts of patients. Separate analyses have been presented for cohort and randomised controlled studies.
The meta-analysis has shown that a combination of MBP+OAB versus MBP alone was associated with a significant reduction in surgical site infection rates, anastomotic leak, 30-day mortality, overall morbidity and development of postoperative ileus, with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. The study also found that there is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation and OAB versus MBP. Whilst evidence arising from large retrospective cohort and database studies suggests a strong positive benefit, these are tempered when evidence arising from randomised controlled trials alone is considered. However, the evidence from randomised controlled trials suggests a benefit from OAB preparation in terms of SSI, which represents a major source of morbidity and increased healthcare costs.

The study suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery, and perhaps, this may need revisiting the ERAS guideline recommendations.

Click here for the article.

Professor Dileep Lobo
University of Nottingham, UK


Recovery after surgery: time to break with tradition

Nurses Section Chair: Angie Balfour, RN

A new article has just been published in the Nursing Standard featuring ERAS Society Nurse Section Chair, Angie Balfour.

Pearce ,L.(2018).Recovery after surgery: time to break with tradition. Nursing Standard, 33(6), 70-72.doi:10.7748/ns.33.6.70.s27

Click here for the full article

Report from the SwERAS Conference 2018

The second annual SwERAS conference was successfully held in November 2018, with 110 participants from a variety of professions and medical specialties. Twentyfour different hospitals, from three countries, were represented.
The sessions included a broad variety of topics. There was an in depth discussion after a large survey concerning practical implementation of the ERAS program for colorectal surgery. There were two inspiring examples from ERAS – hospitals in Sweden and Norway. The University Hospital of Sahlgrenska in Gothenburg presented there work with enhanced recovery after pancreas surgery. Östfolds hospital in Norway had a presentation of there way to achieve low complicationrate, short length of stay and high compliance to ERAS.
One session highlighted the importance of identifying, and special preoperative workup, for the high risk patients. With the Swedish SPOR registry as a base we had a number of lectures concerning the danger of surgery in a metabolic, respiratory, cardiac and mentally perspective.
Validation of the EIAS database is vital for extraction of correct data. Both for benchmarking within each hospital and for future research. SwERAS is therefore planning for a national validation program, during 2019, of each Swedish hospital that participates in an ERAS program.
One highlight of the two days was our guest speaker professor Nicolas Dermartines, University Hospital of Lausanne, Switzerland. He addressed the challenges of ERAS in liver and pancreas surgery on the first day of the conference, and both a historical and futuristic view on the subject: From surgical technique to ERAS, on the second day.
There was also plenty of time at coffee breaks and at lunch to network with other colleagues and get practical tips and tricks how to implement and how to maintain the ERAS spirit.
The 3rd SwERAS conference will be held in Stockholm on the 21 – 22 of November 2019. Welcome!
Lars Johansen

ERAS® Society & ERAS® Society Latin America sign partnership with the Brazilian Society of Anesthesiology and São Paulo State Society of Anesthesiology

From left to right: Dr. Othon Bastos (President of São Paulo Society of Anesthesiologists), Dr. Sérgio Logar, (President of Brazilian Society of Anesthesiologists), Dr. Hans de Boer (Treasurer of ERAS® Society) and Dr. Adrian Alvarez (President of ERAS® LATAM).

At the recent 65th annual Congress of the Brazilian Society of Anesthesiologist in Belem, Brazil, a memorandum of understanding was signed between the Brazilian Society of Anesthesiology, São Paulo State Society of Anesthesiology, the ERAS® Society and the ERAS® Society Latin America.

Dr. Othon Bastos (President of São Paulo Society of Anesthesiologists) and Dr. Sérgio Logar, (President of Brazilian Society of Anesthesiologists) signed on behalf of their societies.
The objective of this collaboration is to define joint strategies in order to promote perioperative care in Brazil in line with the best scientific evidence-based medicine practices according to the ERAS® Society methodology.

Furthermore, we have agreed to extend collaboration between the societies in the field of education and scientific research according to the operational guidelines of the ERAS® Society.
We are looking forward to this new international collaboration.

Adrian Alvarez, ERAS® Society Latam Chapter
Hans de Boer, Eras® Society

New Textbook – Analgesia in Major Abdominal Surgery

A new textbook edited by Prof Michael Scott and Dr Anton Krige presents the current evidence in an Enhanced Recovery Programme context, and provides a common sense approach to using the array of available analgesia techniques appropriately in major abdominal surgery. Current pain relief options are discussed, many of which have been described only in the last ten years. Topics covered range from the now widespread use of portable ultrasound machines to an appreciation of the value of some older drugs in a new context. Analgesia for Major Abdominal Surgery is aimed at anesthetists, acute pain teams, and acute pain nurses, as well as colorectal, hepatobiliary, urological and gynecological surgeons.

Click here to see more details on the Springer website

ERAS in Mexico

Last August 11th, 2018 we received at the National Cancer Institute, Mexico, Dr. Adrián Álvarez and Nurse Gabriela Sánchez from Hospital Italiano de Buenos Aires. The objective was to start our training to implement ERAS in our Digestive Tract Tumors Department.  We counted with the presence of the Associate Medical General Director of our Institution, Dr. Ángel Herrera Gómez, and Vice-Director of Surgery, Dr. Aarón González Enciso.

For the implementation of this program we created a team in each area that this program will be implemented, the Colorectal team, coordinated by the Head of the Department, Dr. Horacio López Basave and the Pancreatic surgery team coordinated by Dr. Javier Melchor Ruan.  With a total of 20 attendants the training started in the morning discussing the goals of the ERAS program and stating which is the necessary process for its implementation. Doubts about how to manage changes in the perioperative process of the patient were clarified and each team set its short- term goals. We had the first contact with EIAS system and we defined activities for the first two months.

With great enthusiasm we started our training counting with the active presence of Nurse Mariana Perales; authorities of the Nurse Department of the Institution as well as representatives of the Anesthesia and Nutrition Departments, associate physicians and residents.

Dr. Javier Melchor Ruan- ERAS INCAN Program Coordinator

Top Row – left to right: Crisenry Brito Baños- Anesthesiologist, Luis Cuellar- Head of Anesthesia Department, Abraham Fabela- Anesthesiologist, Luis Orozco Rosas- Surgery resident, Maura Judith Tomas- Anesthesiologist, Sergio Aguilar- Oncologic Surgery resident, Gerardo Miranda: Pancreatic Associate surgeon, Aarón González Enciso: Surgery Vice Director, Javier Melchor : ERAS Program Coordinator, Itzel Vela Sarmiento: Associate Colorectal Surgeon, Mariana Perales: ERAS Program Nurse Coordinator, María Josefina, Flores: Nutritionist, Anabel Labana – Nutritionist, Alberto León : Associate Colorectal Surgeon
Bottom row – left to right: Emma Ávila García: Surgery Nurse Supervisor, Inés Mendoza Santos: Head Nurse, National Cancer Institute, Horacio López Basave: Head of Digestive Tract Tumor Department, Adrián Álvarez, Juan Manuel Ruiz: Surgical Coordinator, Erika Gonzalez Soriano: Surgery Head Nurse