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Enhanced Recovery After Surgery (ERAS): Concept and Purpose

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The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases

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Abstract

Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative started by a group of European surgeons who challenged the evidence surrounding several historical perioperative practices including prolonged fasting (NPO after midnight), and mechanical bowel preparation. With the goal to minimize the stress response to surgery and bring evidence-based practice mainstream, the ERAS® Society was formed, and has now published numerous perioperative practice guidelines including those for pancreatic and liver surgery. This chapter will provide an overview of (i) the philosophy of ERAS, (ii) the pathophysiology and basis of several core ERAS practices, with special attention to those relevant to Hepato-Pancreato-Biliary (HPB) disease, (iii) clinical and financial outcomes associated with ERAS, and (iv) important considerations when starting an ERAS implementation program.

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References

  1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–8.

    Article  Google Scholar 

  2. https://erassociety.org/. Accessed 25 Aug 2020.

  3. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–77.

    Article  CAS  Google Scholar 

  4. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS) society recommendations: 2018. World J Surg. 2019;43(3):659–95.

    Article  CAS  Google Scholar 

  5. Thorell A, MacCormick AD, Awad S, et al. Guidelines for perioperative care in bariatric surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(9):2065–83.

    Article  CAS  Google Scholar 

  6. Melloul E, Lassen K, Roulin D, et al. Guidelines for perioperative care for pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019. World J Surg. 2020;44(7):2056–84.

    Article  Google Scholar 

  7. Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg. 2016;40(10):2425–40.

    Article  Google Scholar 

  8. Sorensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Arch Surg. 2012;147(4):373–83. https://doi.org/10.1001/archsurg.2012.5.

    Article  PubMed  Google Scholar 

  9. Eisenberg JD, Rosato EL, Lavu H, et al. Delayed gastric emptying after pancreaticoduodenectomy: an analysis of risk factors and cost. J Gastrointest Surg. 2015;19(9):1572–80.

    Article  Google Scholar 

  10. Aoki S, Miyata H, Konno H, et al. Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan. J Hepatobiliary Pancreat Sci. 2017;24(5):243–51.

    Article  Google Scholar 

  11. Oppedal K, Moller AM, Pedersen B, et al. Preoperative alcohol cessation prior to elective surgery. Cochrane Database Syst Rev. 2012;7:CD008343.

    Google Scholar 

  12. Gianotti L, Besselink MG, Sandini M, et al. Nutritional support and therapy in pancreatic surgery: a position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2018;164(5):1035–48.

    Article  Google Scholar 

  13. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;2003(4):CD004423.

    Google Scholar 

  14. American Society of Anesthesiologists Committee. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. 2011;114(3):495–511.

    Article  Google Scholar 

  15. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556–69.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  17. Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014;2014(8):CD009161.

    Google Scholar 

  18. Rollins KE, Lobo DN. The controversies of mechanical bowel and oral antibiotic preparation in elective colorectal surgery. Ann Surg. 2021;273(1):e13–5.

    Article  Google Scholar 

  19. Lavu H, Kennedy EP, Mazo R, et al. Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy. Surgery. 2010;148:278–84.

    Article  Google Scholar 

  20. Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg. 2005;92:673–80.

    Article  CAS  Google Scholar 

  21. Kunstman JW, Klemen ND, Fonseca AL, et al. Nasogastric drainage may be unnecessary after pancreaticoduodenectomy: a comparison of routine vs selective decompression. J Am Coll Surg. 2013;217(3):481–8.

    Article  Google Scholar 

  22. Pessaux P, Regimbeau JM, Dondero F, et al. Randomized clinical trial evaluating the need for routine nasogastric decompression after elective hepatic resection. Br J Surg. 2007;94:297–303.

    Article  CAS  Google Scholar 

  23. Gerritsen A, Besselink MG, Gouma DJ, et al. Systematic review of five feeding routes after pancreatoduodenectomy. Br J Surg. 2013;100(5):589–98.

    Article  CAS  Google Scholar 

  24. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg. 2015;261(6):1153–9.

    Article  Google Scholar 

  25. Pisarska M, Torbicz G, Gajewska N, et al. Compliance with the ERAS protocol and 3-year survival after laparoscopic surgery for nonmetastatic colorectal cancer. World J Surg. 2019;43:2552–60.

    Article  Google Scholar 

  26. Savaridas T, Serrano-Pedraza I, Khan SK, et al. Reduced medium-term mortality following primary total hip and knee arthroplasty with an enhanced recovery program. A study of 4,500 consecutive procedures. Acta Orthop. 2013;84:40–3.

    Article  Google Scholar 

  27. Roulin D, Melloul E, Wellg BE, et al. Feasibility of an enhanced recovery protocol for elective pancreatoduodenectomy: a multicenter international cohort study. World J Surg. 2020;44(8):2761–9.

    Article  Google Scholar 

  28. Noba L, Rodgers S, Chandler C, et al. Enhanced recovery after surgery (ERAS) reduces hospital costs and improve clinical outcomes in liver surgery: a systematic review and meta-analysis. J Gastrointest Surg. 2020;24(4):918–32.

    Article  CAS  Google Scholar 

  29. Ljungqvist O, Thanh NX, Nelson G. ERAS-value based surgery. J Surg Oncol. 2017;116(5):608–12.

    Article  Google Scholar 

  30. Thanh NX, Nelson A, Wang X, et al. Return on investment of the enhanced recovery after surgery (ERAS) multi-guideline multi-site implementation in Alberta. Canada Can J Surg. 2020;63(6):E542–50.

    Article  Google Scholar 

  31. Joliat GR, Hübner M, Roulin D, et al. Cost analysis of enhanced recovery programs in colorectal, pancreatic, and hepatic surgery: a systematic review. World J Surg. 2020;44(3):647–55.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. University of Calgary, Calgary, AB, Canada

    Gregg Nelson

  2. Örebro University, Örebro, Sweden

    Olle Ljungqvist

Authors
  1. Gregg Nelson
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  2. Olle Ljungqvist
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Correspondence to Gregg Nelson .

Editor information

Editors and Affiliations

  1. Emeritus Professor, The University of Tokyo, Tokyo, Japan

    Masatoshi Makuuchi

  2. National Center for Global Health and Medicine, The University of Tokyo, Tokyo, Japan

    Norihiro Kokudo

  3. “Dan Setlacec” Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania

    Irinel Popescu

  4. Emeritus Professor University Paris Cité, Paris, France

    Jacques Belghiti

  5. Department of Surgery, Seoul National University College of Medicine Seoul National University Bundang Hospital, Seoul, Korea (Republic of)

    Ho-Seong Han

  6. Nagahama City Hospital Network, Shiga, Japan

    Kyoichi Takaori

  7. Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Dan G. Duda

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© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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Nelson, G., Ljungqvist, O. (2022). Enhanced Recovery After Surgery (ERAS): Concept and Purpose. In: Makuuchi, M., et al. The IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases. Springer, Singapore. https://doi.org/10.1007/978-981-19-0063-1_27

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  • DOI: https://doi.org/10.1007/978-981-19-0063-1_27

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-0062-4

  • Online ISBN: 978-981-19-0063-1

  • eBook Packages: MedicineMedicine (R0)

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