The Surgical clinics of North America
-
Surg. Clin. North Am. · Dec 2018
ReviewPreoperative Preparations for Enhanced Recovery After Surgery Programs: A Role for Prehabilitation.
Preoperative risk assessment is valuable only if subsequent targeted optimization of patient care is allowed. Early assessment of high-risk surgical patients is essential to facilitate appropriate optimization. Preoperative assessment and optimization should not be exclusively focused on patients' comorbidities, but also include nutritional assessment, functional capacity, and promote healthy life style habits that affect surgical outcomes (eg, smoking cessation); it requires a multidisciplinary approach.
-
Surg. Clin. North Am. · Dec 2018
ReviewEnhanced Recovery After Surgery: Intraoperative Fluid Management Strategies.
Ideal fluid management is a critical component of enhanced recovery after surgery protocols and should be considered throughout the perioperative period. The goal of preoperative fluid management is for the patient to arrive to the operating room euvolemic. ⋯ Postoperatively, once patients are tolerant of oral fluid intake, intravenous fluids are not required and should be restarted only if clinically necessary. This article reviews evidence-based, best practices for intraoperative fluid management for patients undergoing surgery within an enhanced recovery after surgery pathway.
-
Surg. Clin. North Am. · Dec 2018
ReviewEnhanced Recovery After Surgery and Effects on Quality Metrics.
Enhanced recovery after surgery (ERAS) is an evidence-based protocol that aims to decrease the physiologic stress response to surgery and maintain postoperative physiologic function. This best practice bundle plays a significant role in improving surgical quality by impacting important quality metrics such as length of stay, hospital-acquired infections, readmissions, and patient experience. Adherence to ERAS as a collective bundle is more important than individual components in improving quality metrics, and this can only be achieved with data-driven information through auditing and interdisciplinary collaboration.
-
Surg. Clin. North Am. · Dec 2018
ReviewEnhanced Recovery After Surgery and Multimodal Strategies for Analgesia.
Enhanced recovery after surgery is an evidence-based, multimodal approach to the perioperative care of a patient undergoing surgery. These pathways seek to attenuate the stress response to surgery facilitating postoperative recovery. ⋯ Traditional analgesic regimens for major surgery rely heavily on opioids to provide analgesia but can cause a wide range of serious side effects, delaying recovery. Enhanced recovery protocols should incorporate multimodal analgesic strategies that minimize opioid use and optimize analgesia.
-
Enhanced recovery after surgery (ERAS) pathways target specific areas within perioperative patient care in a multidisciplinary and evidence-based manner. Because of the subsequent positive outcomes associated with its use, ERAS has expanded to most surgical subspecialties, including hepatopancreatobiliary surgery. Although certain concepts are universal to all ERAS protocols, there are unique areas of emphasis pertaining to the hepatopancreatobiliary specialties, which will be highlighted throughout this article. In addition, some of the less frequently discussed aspects of enhanced recovery, including patient-reported outcomes, recovery assessment, cost, and auditing, will be addressed.