The Surgical clinics of North America
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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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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
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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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.