The Surgical clinics of North America
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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.
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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.
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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.
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Although the utilization of enhanced recovery after surgery (ERAS) pathways has become more prevalent, issues of compliance and implementation remain. Limiting the complexity of new ERAS protocols by maintaining the core elements of ERAS, along with the development of complementary protocols (prehabilitation, the perioperative surgical home, and telemedicine) may improve overall uptake and subsequent patient outcomes. The future directions of ERAS should be centered on improving the dissemination of the practice and ongoing expansion of patient care outside the immediate hospital period.
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Surg. Clin. North Am. · Dec 2018
ReviewEnhanced Recovery After Surgery: Implementation Strategies, Barriers and Facilitators.
Numerous reports have documented the effectiveness of Enhanced Recovery after Surgery (ERAS) pathways in improving recovery and decreasing morbidity and length of stay. However, there is also increasing evidence that ERAS® guidelines are difficult to adopt and require the commitment of all members of the perioperative team. Multiple barriers related to limited hospital resources (financial, staffing, space restrictions, and education), active or passive resistance from members of the perioperative team, and lack of data and/or education have been identified. Thus, ERAS® guidelines require a tailored implementation strategy to increase adherence.