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Protocol for the Enhanced Recovery After Surgery (ERAS) programme following PD PoD Targets for postoperative management 0 Postoperative analgesia Epidural or PCA Mobilisation Up to sit 1 Postoperative analgesia Epidural or PCA Mobilisation Up to sit for 1 hour 2 Postoperative analgesia Oral analgesia following NGT removal Nasogastric tube Remove if drainage volume <500ml (Refer to nasogastric tube removal criteria) Mobilisation Up to sit 2 hour
Source publication
Abstract: Objective: Pancreaticoduodenectomy is a technically challenging surgery requiring longer period of recovery post operatively. This study aims to examine the implementation of an enhanced recovery after surgery (ERAS) protocol following pancreaticoduodenectomy. Methods: All patient undergone pancreaticoduodenectomy were managed following E...
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Background
Enhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified. Methods
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Citations
... But studies on ERAS protocol implementation following PD are scarce, and most are retrospective [15,16]. A recent one-year prospective cohort study conducted in a tertiary teaching hospital in Malaysia has shown that ERAS is safe in our local setting [17]. Following this, we implemented the protocol as a standard clinical practice for the patient who underwent PD at the Universiti Kebangsaan Malaysia Medical Center. ...
Background: We implemented the Enhanced Recovery After Surgery (ERAS) for our post pancreaticoduodenectomy patients in our institution since 2013. This study aim to to determine the differences between the previous postoperative care and ERAS. Material and Method: We included all patients who underwent pancreaticoduodenectomy UKM Medical Centre (UKMMC) from Jan 2011 to April 2015. Subjects are divided into control group comprise pre-ERAS patient and study group comprise post ERAS implementation. Recorded data include demographics, patients’ characteristic, surgery data, complication, outcomes and length of stay. Results: Total subjects were 81 patients. There were no significant differences in the demographics and patients’ characteristic between both groups. Post-operative morbidity, re-laparotomy and readmission rate was equivalent. Mortality rate were more in pre-ERAS group but not significant. The length of stay was lower in the post ERAS group (11.7 days versus 15.4 days; p=0.002). Non-PD related complication is high within the pre-ERAS group (27.7% versus 5.9%; p=0,019). Conclusions: ERAS protocol have a lower complication rate and reduce hospital stay. It should be the standard management in post-operative pancreaticoduodenectomy care.
Introduction: Enhanced recovery after surgery is widely especially in the colorectal surgery units. However, there is paucity of data in Malaysia context. We report the application and outcome trends over a 1-year period in a colorectal surgery unit of a public hospital. Method: This is a prospective study involving patients who underwent surgery for colorectal cancer in the colorectal unit, Hospital Sultanah Aminah, from August 2020 to August 2021. Results: The cohort comprises 70 patients operated in a 1-year period from August 2020 to August 2021. There were 33 males and 37 females. The mean age was 63.26 years (SD 11.398), (range 25 to 81). Most of them were of American Society of Anesthesiologists (ASA) 2 category (n=43, 61.4%), followed by ASA 1(n=24, 34.3%) and 3(43%) of ASA 3 status. The mean duration of surgery was 171 min (81min to 310min). Anastomotic leak (n=8) and ileus (n=8) were seen in 11% of the study population respectively. There were 6(8.6%) readmissions, with surgical site infection being the commonest reason. The average length of stay was 5.13 days (2 to 18). Of the 26 components of ERAS that were audited for compliance, only 5 showed poor adherence of less than 75% while the rest scored between 75 and 100%. Conclusion: The increase in adherence to ERAS protocol reduced the length of stay and readmission rate. This series demonstrated a low mortality rate, with comparable morbidities to existing standards.
Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.
