Enhanced recovery after surgery

Watt, D. G., McSorley, S. T. , Horgan, P. G. and McMillan, D. C. (2015) Enhanced recovery after surgery. Medicine, 94(36), e1286. (doi: 10.1097/md.0000000000001286) (PMCID:PMC4616657)

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Enhanced Recovery or Fast Track Recovery after Surgery protocols (ERAS) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery. The present systematic review aimed to examine the impact on the magnitude of the systemic inflammatory response (SIR) for each ERAS component following colorectal surgery using objective markers such as C-reactive protein (CRP) and interleukin-6 (IL-6). A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2015. Included studies had to assess the impact of the selected ERAS component on the SIR using either CRP or IL-6. Nineteen studies, including 1898 patients, were included. Fourteen studies (1246 patients) examined the impact of laparoscopic surgery on the postoperative markers of SIR. Ten of these studies (1040 patients) reported that laparoscopic surgery reduced postoperative CRP. One study (53 patients) reported reduced postoperative CRP using opioid-minimising analgesia. One study (142 patients) reported no change in postoperative CRP following preoperative carbohydrate loading. Two studies (108 patients) reported conflicting results with respect to the impact of goal-directed fluid therapy on postoperative IL-6. No studies examined the effect of other ERAS components, including mechanical bowel preparation, antibiotic prophylaxis, thromboprophylaxis, and avoidance of nasogastric tubes and peritoneal drains on markers of the postoperative SIR following colorectal surgery. The present systematic review shows that, with the exception of laparoscopic surgery, objective evidence of the effect of individual components of ERAS protocols in reducing the stress response following colorectal surgery is limited.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Horgan, Professor Paul and McMillan, Professor Donald and Watt, Dr David and McSorley, Dr Stephen
Authors: Watt, D. G., McSorley, S. T., Horgan, P. G., and McMillan, D. C.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Medicine
Publisher:Lippincott, Williams and Wilkins
ISSN (Online):1536-5964
Copyright Holders:Copyright © 2015 5 Wolters Kluwer Health, Inc.
First Published:First published in Medicine 94(36):e1286
Publisher Policy:Reproduced under a creative commons license

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