An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge

An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced... Background Ambulatory surgery for anorectal procedures has been proven to be safe and effective. Specific peri- operative pathways combining multiple interventions have been shown to optimize recovery and outcomes associ- ated with inpatient colorectal surgery. However, there are no major studies describing and evaluating a standardized protocol for ambulatory anorectal surgery. The purpose of this study was to evaluate the outcomes of a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery. Methods This was a retrospective review of prospectively collected data from 14 Southern California Kaiser Permanente medical centers. An eight-item protocol including: preoperative education, preoperative distribution of prescriptions, preoperative carbohydrate treatment, multimodal analgesia, preferential use of monitored anesthesia care (MAC), routine use of local anesthesia/regional blocks, intraoperative restriction of intravenous fluids, and post-discharge phone call. Postoperative pain scores and preventable returns to the emergency department or urgent care were assessed. Results Postoperative pain scores were reduced when all eight elements of the protocol were delivered (p = 0.005). On multivariate analysis, there was reduced postoperative pain when preoperative carbohydrate treatment was completed (p = 0.002), with MAC (p = 0.003), and when multimodal analgesia was used (p = 0.02). There were decreased preventable returns to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png World Journal of Surgery Springer Journals

An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge

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Publisher
Springer Journals
Copyright
Copyright © 2018 by Société Internationale de Chirurgie
Subject
Medicine & Public Health; Surgery; Abdominal Surgery; Cardiac Surgery; General Surgery; Thoracic Surgery; Vascular Surgery
ISSN
0364-2313
eISSN
1432-2323
D.O.I.
10.1007/s00268-017-4414-8
Publisher site
See Article on Publisher Site

Abstract

Background Ambulatory surgery for anorectal procedures has been proven to be safe and effective. Specific peri- operative pathways combining multiple interventions have been shown to optimize recovery and outcomes associ- ated with inpatient colorectal surgery. However, there are no major studies describing and evaluating a standardized protocol for ambulatory anorectal surgery. The purpose of this study was to evaluate the outcomes of a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery. Methods This was a retrospective review of prospectively collected data from 14 Southern California Kaiser Permanente medical centers. An eight-item protocol including: preoperative education, preoperative distribution of prescriptions, preoperative carbohydrate treatment, multimodal analgesia, preferential use of monitored anesthesia care (MAC), routine use of local anesthesia/regional blocks, intraoperative restriction of intravenous fluids, and post-discharge phone call. Postoperative pain scores and preventable returns to the emergency department or urgent care were assessed. Results Postoperative pain scores were reduced when all eight elements of the protocol were delivered (p = 0.005). On multivariate analysis, there was reduced postoperative pain when preoperative carbohydrate treatment was completed (p = 0.002), with MAC (p = 0.003), and when multimodal analgesia was used (p = 0.02). There were decreased preventable returns to

Journal

World Journal of SurgerySpringer Journals

Published: Jan 9, 2018

References

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