The Surgical clinics of North America
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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.
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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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Value in health care is defined as the best outcome that matters to the patient at the lowest cost. Therefore, a valuable intervention is one that either results in better outcomes at the same cost, the same outcomes at lower cost, or in the best-case scenario, better outcomes at lower cost. ⋯ ERPs do not increase overall costs, even when implementation and maintenance costs are considered. More research on patient-reported outcomes and other downstream effects of ERPs is required to fully characterize their true value.
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Enhanced recovery after surgery programs were developed as a type of standardized evidence-based perioperative care protocols. The necessity and benefit of clinical care pathways is not a new phenomenon in urology and have been a big part of the evolution of care for urology patients, especially in terms of urologic oncology. This article discusses the key components of evidence-based perioperative care in key urologic procedures. These protocols have been shown to decrease length of stay, decrease complications, and reduce cost.
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Surg. Clin. North Am. · Dec 2018
ReviewOverview of Enhanced Recovery After Surgery: The Evolution and Adoption of Enhanced Recovery After Surgery in North America.
Enhanced Recovery is broadly defined as the application of evidence based perioperative care elements for improved surgical outcomes. Demonstration of decreasing surgical stress with innovation of surgical technique, in combination with pressure to drive down health care costs, have coalesced into a unique version of perioperative medicine in the United States. The US government has failed to show interest; there are no performance metrics, no participation requirements, and certainly no monetary incentives for implementation of best perioperative practices. When considering the term, Enhanced Recovery is, in its broadest sense, an amalgam of industry, innovation, patient-focused care, cost-effective strategies, and collaboration with a goal of best perioperative outcomes.