Browsing by Subject "ERAS"

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    Demand for Medical Toxicology Fellowship Training Is at an All‑Time High
    (Springer, 2023) Pizon, Anthony F.; Kao, Louise; Mycyk, Mark B.; Wax, Paul M.; Emergency Medicine, School of Medicine
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    Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia
    (Frontiers Media, 2023-11-03) Kuznicki, Michelle L.; Yasukawa, Maya; Mallen, Adrianne R.; Lam, Clarissa; Eggers, Erica; Regis, Jefferson; Wells, Ali; Todd, Sarah L.; Robertson, Sharon E.; Tanner, Jean-Paul; Anderson, Matthew L.; Rutherford, Thomas J.; Obstetrics and Gynecology, School of Medicine
    Objective: This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria. Methods: Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann-Whitney two-sample test. Results: Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point. Conclusions: PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.
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    What Is the Best Pain Control After Major Hepatopancreatobiliary Surgery?
    (Elsevier, 2018-09) Kim, Bradford J.; Soliz, Jose M.; Aloia, Thomas A.; Vauthey, Jean-Nicolas; Surgery, School of Medicine
    In the modern era, hepato-pancreato-biliary (HPB) surgery has become safe with significant reductions in morbidity and mortality at high volume centers for both liver and pancreas surgery. While laparoscopic surgery has provided a safe approach with superior pain control laparotomy is still needed for the majority of HPB operations. Inadequate pain control is not only associated with poor patient experience but contributes to inferior outcomes. Specifically, inadequate pain control affects the neuroendocrine stress response, increases complication rates, and prolongs length of stay. Furthermore, there is an ongoing opioid epidemic and all fields of medicine should strive to reduce narcotic use to limit transformation into chronic opiate dependence. As such, successful pain control after HPB surgery continues to be a challenge and rigorous studies evaluating postoperative results are needed. The following article reviews the modalities debated to be the best strategies for pain control after major HPB surgery, as well as a discussion of other important considerations when executing these plans.