DR. BAYU AGUNG ALAMSYAH, SP.
JOURNAL OF VASCULAR SURGERY, 2019
Overview
Definition
Purpose
Pathway
ERAS: Definition
Comprehensive perioperative care pathway that uses evidence-
based best practices across specialties to achieve early recovery
for patients undergoing major surgery.
https://erassociety.org/guidelines/list-of-guidelines/
ERAS: Pathway
Preoperative patient education and expectation setting, preoperative
medical and nutritional optimization, pre-emptive multimodal analgesia
Intraoperative goal-based fluid strategy
Postoperative opioid minimization, pre-emptive antiemetic and bowel
regimen, early drain and line removal, early mobilization, and early
resumption of regular diet
ERAS: Results
Morbidity
Mortality
Length of Stay
Pain
Time to regular diet
Complications
A systematic review of
enhanced recovery after
surgery for vascular
operations
Background
Patients undergoing vascular operations face high rates of
intraoperative and postoperative complications and delayed return to
baseline.
ERAS high-quality perioperative care and accelerating recovery
well suited to this patients.
Methods
Preferred Reporting Items for Systematic Reviews and Meta-
Analyses guidelines the use and effectiveness of ERAS in all
types of vascular and endovascular operations.
MEDLINE, Embase, Web of Science, Scopus, ProQuest
Dissertations and Theses Global, Cochrane Central Register of
Controlled Trials, Prospero, and Google Scholar.
Two reviewers independent
1997, through December 7, 2017.
ERAS perioperative morbidity, mortality, and length of stay
were collected.
Eligible?
Search Strategy
Results
In the final analysis, 19 studies were included: 4 RCT and 15
observational studies.
Let Evidence Guide Every New Decision (LEGEND) criteria, the two
good-quality studies are RCT that evaluated a specific part of an ERAS
pathway.
All other studies were considered poor quality.
Meta-analysis of the five studies describing ERAS-like pathways
demonstrated a reduction in length of stay by 3.5 days (P=0.0012).
Conclusion
the use of ERAS pathways in vascular surgery is limited, and existing
evidence of their feasibility and effectiveness is low quality
There is minimal poor to moderate quality evidence describing the use of
ERAS pathways in open aortic operations.
There is scarce, poor-quality evidence related to ERAS pathways in lower
extremity operations and no published evidence related to ERAS pathways
in endovascular operations.
Although the risk of bias is high in most of the studies done to date, all of
them observed improvements in length of stay, postoperative diet, and
ambulation.
It is reasonable to consider the implementation of ERAS pathways in the
care of vascular surgery patients, specifically those undergoing open aortic
operations
