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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Surgical disparities exist. Certain surgical populations suffer from disproportionately worse access, care, and outcomes in surgery. ⋯ As a result, ERAS provides a uniquely pragmatic model for improving outcomes and reducing disparities in vulnerable surgical populations. The value of ERAS may therefore extend beyond its traditional benefits to the even greater pursuit of health equity.
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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.
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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.