The Surgical clinics of North America
-
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.
-
Surg. Clin. North Am. · Dec 2018
ReviewEnhanced Recovery After Surgery and Its Effects on Patient Reported Outcomes.
Enhanced recovery programs were developed as a means for improving patient recovery after surgery with a multifaceted approach including several interventions in the perioperative period. There is now sufficient evidence in the literature that enhanced recovery programs have actually shortened hospital length of stay after colorectal surgery. Nonetheless, the impact of these successful programs on patient-reported outcomes like functional recovery and return to baseline quality of life is not known.
-
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.
-
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.
-
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.