Skip to main content

Techniques of Enhanced Recovery in Post Operative Care

  • 171 Accesses

Abstract

Patients undergoing major surgery are exposed to surgical stress leading to a decrease in functional capacity resulting in delayed postoperative recovery. Enhanced Recovery after Surgery (ERAS) protocol of perioperative care consists of inclusion of certain clinical practices and exclusion of certain traditional practices to facilitate earlier post operative recovery of surgical patients. Implementation of ERAS protocol is associated with decreased length of hospital stay, decrease in rates of postoperative complications, decreased morbidity and cost saving with improved patient satisfaction and quality of life. The main components include preoperative patient counselling, prehabilitation, reduced preoperative fasting, preoperative bowel preparation with oral antibiotics, maintenance of euvolemia, perioperative normoglycemia, normothermia, early initiation of oral intake, early postoperative ambulation, multimodal analgesia and early discharge.

Keywords

  • Enhanced recovery after surgery
  • Prehabilitation
  • Perioperative care

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-94110-9_7
  • Chapter length: 12 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   149.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-94110-9
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   199.99
Price excludes VAT (USA)
Fig. 7.1
Fig. 7.2

References

  1. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.

    CAS  PubMed  CrossRef  Google Scholar 

  2. Schneider S, Armbrust R, Spies C, du Bois A, Sehouli J. Prehabilitation programs and ERAS protocols in gynecological oncology: a comprehensive review. Arch Gynecol Obstet. 2020;301(2):315–26.

    CAS  PubMed  CrossRef  Google Scholar 

  3. Schmidt S, Vilagut G, Garin O, et al. Reference guidelines for the 12-item short-form health survey version 2 based on the Catalan general population. Med Clin. 2012;139:613–25.

    CrossRef  Google Scholar 

  4. Baitar A, Van Fraeyenhove F, Vandebroek A, De Droogh E. Groningen frailty indicator and the G-8 questionnaire as screening tools for frailty in older patients with cancer. J Geriatr Oncol. 2013;4(1):32–8.

    PubMed  CrossRef  Google Scholar 

  5. Phillips SM, Chevalier S, Leidy HJ. Protein “requirements” beyond the RDA: implications for optimizing health. Appl Physiol Nutr Metab. 2016;41(5):565–72.

    CAS  PubMed  CrossRef  Google Scholar 

  6. Halaszynski TM, Juda R, Silverman DG. Optimizing postoperative outcomes with efficient preoperative assessment and management. Crit Care Med. 2004;32(4 Suppl):S76–86.

    PubMed  CrossRef  Google Scholar 

  7. Kumar AS, Kelleher DC, Sigle GW. Bowel preparation before elective surgery. Clin Colon Rectal Surg. 2013;26(3):146–52.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  8. Pineda CE, Shelton AA, Hernandez-Boussard T, et al. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 2008;12:2037–44.

    PubMed  CrossRef  Google Scholar 

  9. Slim K, Vicaut E, Launay-Savary M-V, et al. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249:203–9.

    PubMed  CrossRef  Google Scholar 

  10. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015;28:364–9.

    CAS  PubMed  CrossRef  Google Scholar 

  11. Matsuo K, Yessaian AA, Lin YG, et al. Predictive model of venous thromboembolism in endometrial cancer. Gynecol Oncol. 2013;128:544–51.

    PubMed  CrossRef  Google Scholar 

  12. Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine. 1999;78:285–91.

    CAS  PubMed  CrossRef  Google Scholar 

  13. Mokri B, Mariani A, Heit JA, et al. Incidence and predictors of venous thromboembolism after debulking surgery for epithelial ovarian cancer. Int J Gynecol Cancer. 2013;23:1684–91.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  14. Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:2189–204.

    CAS  PubMed  CrossRef  Google Scholar 

  15. Golemi I, Salazar Adum JP, Tafur A, Caprini J. Venous thromboembolism prophylaxis using the Caprini score. Dis Mon. 2019;65(8):249–98.

    PubMed  CrossRef  Google Scholar 

  16. Bell BR, Bastien PE, Douketis JD, Canada T. Prevention of venous thromboembolism in the enhanced recovery after surgery (ERAS) setting: an evidence-based review. Can J Anaesth. 2015;62(2):194–202.

    PubMed  CrossRef  Google Scholar 

  17. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14:73–156.

    CrossRef  Google Scholar 

  18. Johnson MP, Kim SJ, Langstraat CL, et al. Using bundled interventions to reduce surgical site infection after major gynecologic cancer surgery. Obstet Gynecol. 2016;127:1135–44.

    PubMed  CrossRef  Google Scholar 

  19. Wong PF, Kumar S, Bohra A, et al. Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg. 2007;94:421–6.

    CAS  PubMed  CrossRef  Google Scholar 

  20. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2. J Clin Oncol. 2009;27(32):5331–6.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  21. Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379(20):1895–904.

    PubMed  CrossRef  Google Scholar 

  22. Sneyd JR, Carr A, Byrom WD, et al. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 1998;15:433–45.

    CAS  PubMed  CrossRef  Google Scholar 

  23. Blaudszun G, Lysakowski C, Elia N, et al. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012;116:1312–22.

    CAS  PubMed  CrossRef  Google Scholar 

  24. Futier E, Constantin J-M, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med Overseas Ed. 2013;369:428–37.

    CAS  CrossRef  Google Scholar 

  25. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112(6):1392–402.

    PubMed  CrossRef  Google Scholar 

  26. Joshi GP, Janis JE, Haas EM, Ramshaw BJ, Nihira MA, Dunkin BJ. Surgical site infiltration for abdominal surgery: a novel neuroanatomical-based approach. Plast Reconstr Surg Glob Open. 2016;4(12):e1181.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  27. Gasanova I, Alexander J, Ogunnaike B, Hamid C, Rogers D, Minhajuddin A, Joshi GP. Transversus abdominis plane block versus surgical site infiltration for pain management after open Total abdominal hysterectomy. Anesth Analg. 2015;121(5):1383–8.

    PubMed  CrossRef  Google Scholar 

  28. Wischmeyer PE, Carli F, Evans DC, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg. 2018;126:1883–95.

    PubMed  CrossRef  Google Scholar 

  29. Bakkum-Gamez JN, Langstraat CL, Lemens MA, et al. Accelerating gastrointestinal recovery in women undergoing ovarian cancer debulking: a randomized, double-blind, placebo-controlled trial. Gynecol Oncol. 2016;141:16.

    CrossRef  Google Scholar 

  30. Bernard L, McGinnis JM, Su J, Alyafi M, Palmer D, Potts L, et al. Thirty-day outcomes after gynecologic oncology surgery: a single-center experience of enhanced recovery after surgery pathways. Acta Obstet Gynecol Scand. 2021;100(2):353–61.

    PubMed  CrossRef  Google Scholar 

  31. Sánchez-Iglesias JL, Carbonell-Socias M, Pérez-Benavente MA, Monreal Clua S, Manrique-Muñoz S, et al. PROFAST: a randomised trial implementing enhanced recovery after surgery for highcomplexity advanced ovarian cancer surgery. Eur J Cancer. 2020;136:149–58.

    PubMed  CrossRef  Google Scholar 

  32. Gentry ZL, Boitano TKL, Smith HJ, Eads DK, Russell JF, Straughn JM Jr. The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice. Gynecol Oncol. 2020;156(2):284–7.

    PubMed  CrossRef  Google Scholar 

  33. Harrison RF, Li Y, Guzman A, Pitcher B, Rodriguez-Restrepo A, Cain KE, et al. Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs. Am J Obstet Gynecol. 2020;222(1):66.e1–9.

    CrossRef  Google Scholar 

  34. Wijk L, Udumyan R, Pache B, Altman AD, Williams LL, Elias KM, et al. International validation of enhanced recovery after surgery society guidelines on enhanced recovery for gynecologic surgery. Am J Obstet Gynecol. 2019;221(3):237.e1–237.e11.

    CrossRef  Google Scholar 

  35. Iniesta MD, Lasala J, Mena G, Rodriguez-Restrepo A, Salvo G, Pitcher B, et al. Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery. Int J Gynecol Cancer. 2019;29(9):1417–24.

    PubMed  CrossRef  Google Scholar 

  36. Agarwal R, Rajanbabu A, Nitu PV 5th, Goel G, Madhusudanan L, Unnikrishnan UG. A prospective study evaluating the impact of implementing the ERAS protocol on patients undergoing surgery for advanced ovarian cancer. Int J Gynecol Cancer. 2019;29(3):605–12.

    PubMed  CrossRef  Google Scholar 

  37. Boitano TKL, Smith HJ, Rushton T, Johnston MC, Lawson P, Leath CA 3rd, et al. Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy. Gynecol Oncol. 2018;151(2):282–6.

    PubMed  CrossRef  Google Scholar 

  38. Bisch SP, Wells T, Gramlich L, Faris P, Wang X, Tran DT, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: system-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol. 2018;151(1):117–23.

    CAS  PubMed  CrossRef  Google Scholar 

  39. Bergstrom JE, Scott ME, Alimi Y, Yen TT, Hobson D, Machado KK, et al. Narcotics reduction, quality and safety in gynecologic oncology surgery in the first year of enhanced recovery after surgery protocol implementation. Gynecol Oncol. 2018;149(3):554–9.

    PubMed  CrossRef  Google Scholar 

  40. Dickson EL, Stockwell E, Geller MA, Vogel RI, Mullany SA, Ghebre R, et al. Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service: a randomized controlled trial. Obstet Gynecol. 2017;129(2):355–62.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  41. Myriokefalitaki E, Smith M, Ahmed AS. Implementation of enhanced recovery after surgery (ERAS) in gynaecological oncology. Arch Gynecol Obstet. 2016;294(1):137–43.

    PubMed  CrossRef  Google Scholar 

  42. Bajsová S, Klát J. ERAS protocol in gynecologic oncology. Ceska Gynekol. 2019;84(5):376–85. Summer

    PubMed  Google Scholar 

  43. Tankou JI, Foley O, Falzone M, Kalyanaraman R, Elias KM. Enhanced recovery after surgery protocols improve time to return to intended oncology treatment following interval cytoreductive surgery for advanced gynecologic cancers. Int J Gynecol Cancer. 2021;31(8):1145–53.

    PubMed  CrossRef  Google Scholar 

  44. Elias KM, Stone AB, McGinigle K, et al. The reporting on ERAS compliance, outcomes, and elements research (RECOvER) checklist: a joint statement by the ERAS® and ERAS® USA societies. World J Surg. 2019;43:1–8.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Sharma, S., Gupta, B. (2022). Techniques of Enhanced Recovery in Post Operative Care. In: Singh, K., Gupta, B. (eds) Gynecological Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-94110-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94110-9_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94109-3

  • Online ISBN: 978-3-030-94110-9

  • eBook Packages: MedicineMedicine (R0)