Enhanced Recovery after Surgery Protocol Applying in Perioperative Treatment: Current Status and Issues_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CHEGuo-wei , LIULun-xu , SHIYing-kang

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CHEGuo-wei, Email: guowei_che@yahoo.com

Keywords：

Enhanced recovery after surgery; Perioperative care; Multidisciplinary team approach; Recovery

DOI：

10.7507/1007-4848.20160050

Video：

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The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.

Citation： CHEGuo-wei, LIULun-xu, SHIYing-kang. Enhanced Recovery after Surgery Protocol Applying in Perioperative Treatment: Current Status and Issues. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(3): 211-215. doi: 10.7507/1007-4848.20160050 Copy

1.	Steenhagen E. Enhanced recovery after surgery: it's time to change practice! Nutr Clin Pract, 2016, 31(1): 18-29.
2.	Hoffmann H, Kettelhack C. Fast-track surgery--conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res, 2012, 49(1): 24-34.
3.	Cotton P. Fast-track improves CABG outcomes. JAMA, 1993, 270(17): 2023.
4.	Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS). Can J Anaesth, 2015, 62(2): 158-168.
5.	Day RW, Cleeland CS, Wang XS, et al. Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg, 2015, 221(6): 1023-1030.
6.	Galli E, Fagnani C, Laurora I, et al. Enhanced recovery after surgery (ERAS(^®)) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study. Int J Surg, 2015, 23(Pt A): 152-159.
7.	Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
8.	Taniguchi H, Sasaki T, Fujita H, et al. Modified ERAS protocol using preoperative oral rehydration therapy: outcomes and issues. J Anesth, 2014, 28(1): 143-147.
9.	Tiefenthal M, Asklid D, Hjern F, et al. Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an enhanced recovery after surgery (ERAS) protocol. Colorectal Dis, 2016, 18(2): 187-194.
10.	de Groot JJ, van Es LE, Maessen JM, et al. Diffusion of enhanced recovery principles in gynecologic oncology surgery: is active imple-mentation still necessary? Gynecol Oncol, 2014, 134(3): 570-575.
11.	Pędziwiatr M, Kisialeuski M, Wierdak M, et al. Early implementa-tion of enhanced recovery after surgery (ERAS^®) protocol-Comp-liance improves outcomes: A prospective cohort study. Int J Surg, 2015, 21: 75-81.
12.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2):187-196.
13.	Parry S, Denehy L, Berney S, et al. Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study. Physiotherapy, 2014, 100(1): 47-53.
14.	Jin Y, Xie G, Wang H, et al. Incidence and risk factors of postopera-tive pulmonary complications in noncardiac Chinese patients: a multicenter observational study in university hospitals. Biomed Res Int, 2015, 2015: 265165.
15.	鲍珊, 苏建华, 廖虎, 等. 合并慢性阻塞性肺病和手术方式对肺癌患者术后快速康复及治疗费用的影响. 中国胸心血管外科临床杂志, 2014, 21(1): 17-20.
16.	Jones EL, Wainwright TW, Foster JD, et al. A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery. Ann R Coll Surg Engl, 2014, 96(2): 89-94.
17.	Hübner M, Addor V, Slieker J, et al. The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study. Int J Surg, 2015, 24(Pt A): 45-50.
18.	Joliat GR, Labgaa I, Petermann D, et al. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg, 2015, 102(13): 1676-1683.
19.	Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology. Gynecol Oncol, 2014, 135(3): 586-594.
20.	Segelman J, Nygren J. Evidence or eminence in abdominal surgery: recent improvements in perioperative care. World J Gastroenterol, 2014, 20(44): 16615-6619.
21.	Ryska O, Serclová Z, Antoš F.Compliance with the procedures of modern perioperative care (Enhanced Recovery After Surgery) at surgery departments in the Czech Republic-results of a national survey. Rozhl Chir, 2013, 92(8): 435-442.
22.	Ripollés-Melchor J, Casans-Francés R, Abad-Gurumeta A, et al. Spanish survey on enhanced recovery after surgery. Rev Esp Anestesiol Reanim, 2016, pii: S0034-9356(15)00279-0.Available online 13 January 2016 In Press.
23.	Gillissen F, Hoff C, Maessen JM, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in The Netherlands. World J Surg, 2013, 37(5): 1082-1093.
24.	Ahmed J, Khan S, Gatt M, et al. Compliance with enhanced recovery programmes in elective colorectal surgery. Br J Surg, 2010, 97(5): 754-758.
25.	Ahmed J, Khan S, Lim M, et al. Enhanced recovery after surgery protocols-compliance and variations in practice during routine colorectal surgery. Colorectal Dis, 2012, 14(9): 1045-1051.
26.	Hammond JS, Humphries S, Simson N, et al. Adherence to enhanced recovery after surgery protocols across a high-volume gastrointestinal surgical service. Dig Surg, 2014, 31(2): 117-122.
27.	Smart NJ, White P, Allison AS, et al. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis, 2012, 14(10): e727-e734.
28.	de Groot JJ, Maessen JM, Slangen BF, et al. A stepped strategy that aims at the nationwide implementation of the enhanced recovery after surgery programme in major gynaecological surgery: studypro-tocol of a cluster randomised controlled trial. Implement Sci, 2015, 30(10): 106.
29.	Devin CJ, McGirt MJ. Best evidence in multimodal pain manage-ment in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci, 2015, 22(6): 930-938.
30.	Vetter TR, Goeddel LA, Boudreaux AM, et al. The perioperative surgical home: how can it make the case so everyone wins? BMC Anesthesiol, 2013, 13: 6-16.
31.	Aahlin EK, von Meyenfeldt M, Aahlin EK, et al. Functional recovery is considered the most important target: a survey of dedicated professionals. Perioper Med (Lond), 2014, 3: 5.
32.	Gillissen F, Ament SM, Maessen JM, et al. Sustainability of an enhanced recovery after surgery program (ERAS) in colonic surgery. World J Surg, 2015, 39(2): 526-533.
33.	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): 1153-1159.
34.	Geltzeiler CB, Rotramel A, Wilson C, et al. Prospective study of colorectal enhanced recovery after surgery in a community hospital. JAMA Surg, 2014,149(9): 955-961.
35.	Ament SM, Gillissen F, Moser A, et al. Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study. BMC Health Serv Res, 2014, 14: 641.
36.	McLeod RS, Aarts MA, Chung F, et al. Development of an enhanced recovery after surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg, 2015, 262(6): 1016-1025.
37.	Lyon A, Solomon MJ, Harrison JD. A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. World J Surg, 2014, 38(6): 1374-1380.
38.	Pearsall EA, Meghji Z, Pitzul KB, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg, 2015, 261(1): 92-96.
39.	Renz BW, Kasparek MS, Seeliger S, et al.The CR-POSSUM risk calculator predicts failure of enhanced recovery after colorectal surgery. Acta Chir Belg, 2015, 115: 20-26.
40.	Chaudhary A, Barreto SG, Talole SD, et al. Early discharge after pancreatoduodenectomy: what helps and what prevents? Pancreas, 2015, 44(2): 273-278.
41.	Carli F, Scheede-Bergdahl C.Prehabilitation to enhance periopera-tive care. Anesthesiol Clin, 2015, 33(1): 17-33.
42.	王一帆, 高科, 沈晨, 等. 术前肺康复运动训练在肺癌患者中的应用现状. 中国胸心血管外科临床杂志, 2016, 23(1): 66-71.
43.	Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perio-perative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Clin Nutr, 2012, 31(6): 783-800.

1. Steenhagen E. Enhanced recovery after surgery: it's time to change practice! Nutr Clin Pract, 2016, 31(1): 18-29.
2. Hoffmann H, Kettelhack C. Fast-track surgery--conditions and challenges in postsurgical treatment: a review of elements of translational research in enhanced recovery after surgery. Eur Surg Res, 2012, 49(1): 24-34.
3. Cotton P. Fast-track improves CABG outcomes. JAMA, 1993, 270(17): 2023.
4. Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS). Can J Anaesth, 2015, 62(2): 158-168.
5. Day RW, Cleeland CS, Wang XS, et al. Patient-reported outcomes accurately measure the value of an enhanced recovery program in liver surgery. J Am Coll Surg, 2015, 221(6): 1023-1030.
6. Galli E, Fagnani C, Laurora I, et al. Enhanced recovery after surgery (ERAS(^®)) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study. Int J Surg, 2015, 23(Pt A): 152-159.
7. Fagundes CP, Shi Q, Vaporciyan AA, et al. Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 2015, 150(3): 613-619.
8. Taniguchi H, Sasaki T, Fujita H, et al. Modified ERAS protocol using preoperative oral rehydration therapy: outcomes and issues. J Anesth, 2014, 28(1): 143-147.
9. Tiefenthal M, Asklid D, Hjern F, et al. Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an enhanced recovery after surgery (ERAS) protocol. Colorectal Dis, 2016, 18(2): 187-194.
10. de Groot JJ, van Es LE, Maessen JM, et al. Diffusion of enhanced recovery principles in gynecologic oncology surgery: is active imple-mentation still necessary? Gynecol Oncol, 2014, 134(3): 570-575.
11. Pędziwiatr M, Kisialeuski M, Wierdak M, et al. Early implementa-tion of enhanced recovery after surgery (ERAS^®) protocol-Comp-liance improves outcomes: A prospective cohort study. Int J Surg, 2015, 21: 75-81.
12. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2):187-196.
13. Parry S, Denehy L, Berney S, et al. Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study. Physiotherapy, 2014, 100(1): 47-53.
14. Jin Y, Xie G, Wang H, et al. Incidence and risk factors of postopera-tive pulmonary complications in noncardiac Chinese patients: a multicenter observational study in university hospitals. Biomed Res Int, 2015, 2015: 265165.
15. 鲍珊, 苏建华, 廖虎, 等. 合并慢性阻塞性肺病和手术方式对肺癌患者术后快速康复及治疗费用的影响. 中国胸心血管外科临床杂志, 2014, 21(1): 17-20.
16. Jones EL, Wainwright TW, Foster JD, et al. A systematic review of patient reported outcomes and patient experience in enhanced recovery after orthopaedic surgery. Ann R Coll Surg Engl, 2014, 96(2): 89-94.
17. Hübner M, Addor V, Slieker J, et al. The impact of an enhanced recovery pathway on nursing workload: A retrospective cohort study. Int J Surg, 2015, 24(Pt A): 45-50.
18. Joliat GR, Labgaa I, Petermann D, et al. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg, 2015, 102(13): 1676-1683.
19. Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology. Gynecol Oncol, 2014, 135(3): 586-594.
20. Segelman J, Nygren J. Evidence or eminence in abdominal surgery: recent improvements in perioperative care. World J Gastroenterol, 2014, 20(44): 16615-6619.
21. Ryska O, Serclová Z, Antoš F.Compliance with the procedures of modern perioperative care (Enhanced Recovery After Surgery) at surgery departments in the Czech Republic-results of a national survey. Rozhl Chir, 2013, 92(8): 435-442.
22. Ripollés-Melchor J, Casans-Francés R, Abad-Gurumeta A, et al. Spanish survey on enhanced recovery after surgery. Rev Esp Anestesiol Reanim, 2016, pii: S0034-9356(15)00279-0.Available online 13 January 2016 In Press.
23. Gillissen F, Hoff C, Maessen JM, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in The Netherlands. World J Surg, 2013, 37(5): 1082-1093.
24. Ahmed J, Khan S, Gatt M, et al. Compliance with enhanced recovery programmes in elective colorectal surgery. Br J Surg, 2010, 97(5): 754-758.
25. Ahmed J, Khan S, Lim M, et al. Enhanced recovery after surgery protocols-compliance and variations in practice during routine colorectal surgery. Colorectal Dis, 2012, 14(9): 1045-1051.
26. Hammond JS, Humphries S, Simson N, et al. Adherence to enhanced recovery after surgery protocols across a high-volume gastrointestinal surgical service. Dig Surg, 2014, 31(2): 117-122.
27. Smart NJ, White P, Allison AS, et al. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis, 2012, 14(10): e727-e734.
28. de Groot JJ, Maessen JM, Slangen BF, et al. A stepped strategy that aims at the nationwide implementation of the enhanced recovery after surgery programme in major gynaecological surgery: studypro-tocol of a cluster randomised controlled trial. Implement Sci, 2015, 30(10): 106.
29. Devin CJ, McGirt MJ. Best evidence in multimodal pain manage-ment in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci, 2015, 22(6): 930-938.
30. Vetter TR, Goeddel LA, Boudreaux AM, et al. The perioperative surgical home: how can it make the case so everyone wins? BMC Anesthesiol, 2013, 13: 6-16.
31. Aahlin EK, von Meyenfeldt M, Aahlin EK, et al. Functional recovery is considered the most important target: a survey of dedicated professionals. Perioper Med (Lond), 2014, 3: 5.
32. Gillissen F, Ament SM, Maessen JM, et al. Sustainability of an enhanced recovery after surgery program (ERAS) in colonic surgery. World J Surg, 2015, 39(2): 526-533.
33. 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): 1153-1159.
34. Geltzeiler CB, Rotramel A, Wilson C, et al. Prospective study of colorectal enhanced recovery after surgery in a community hospital. JAMA Surg, 2014,149(9): 955-961.
35. Ament SM, Gillissen F, Moser A, et al. Identification of promising strategies to sustain improvements in hospital practice: a qualitative case study. BMC Health Serv Res, 2014, 14: 641.
36. McLeod RS, Aarts MA, Chung F, et al. Development of an enhanced recovery after surgery guideline and implementation strategy based on the knowledge-to-action cycle. Ann Surg, 2015, 262(6): 1016-1025.
37. Lyon A, Solomon MJ, Harrison JD. A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. World J Surg, 2014, 38(6): 1374-1380.
38. Pearsall EA, Meghji Z, Pitzul KB, et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg, 2015, 261(1): 92-96.
39. Renz BW, Kasparek MS, Seeliger S, et al.The CR-POSSUM risk calculator predicts failure of enhanced recovery after colorectal surgery. Acta Chir Belg, 2015, 115: 20-26.
40. Chaudhary A, Barreto SG, Talole SD, et al. Early discharge after pancreatoduodenectomy: what helps and what prevents? Pancreas, 2015, 44(2): 273-278.
41. Carli F, Scheede-Bergdahl C.Prehabilitation to enhance periopera-tive care. Anesthesiol Clin, 2015, 33(1): 17-33.
42. 王一帆, 高科, 沈晨, 等. 术前肺康复运动训练在肺癌患者中的应用现状. 中国胸心血管外科临床杂志, 2016, 23(1): 66-71.
43. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perio-perative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations. Clin Nutr, 2012, 31(6): 783-800.

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