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Enhanced Recovery After Surgery (ERAS) in the Oncologic Patient

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Abstract

Enhanced Recovery After Surgery (ERAS) is a term used to describe perioperative care protocols that have been demonstrated to improve patient outcomes after major oncologic surgery. In 2001, a group of academic surgeons invented ERAS with the goal of developing optimal perioperative pathways that will provide optimal care throughout the patient’s journey. Some authors use other terms such as enhanced recovery programs (ERP) or fast-track surgery. ERAS guidelines include a series of perioperative evidence-based interventions to maintain physiological function, enhance mobilization, minimize pain, and facilitate early oral nutrition postoperatively by reducing perioperative surgical stress. Further, the guidelines strive to attenuate the loss of functional capacity after surgery (Lassen et al. World J Surg. 2013;37:240–58). The adoption of ERAS will improve outcome as evidenced by morbidity rate reduction, faster recovery, and decrease length of hospital stay (Thorell et al. World J Surg. 2016;40:2065–83). The effectiveness of ERAS protocols has shown to be beneficial in the maintenance of homeostasis via controlling metabolism and fluid shifts, and the support of the return of key functions through early detection and rescue of symptom burden. The principles of ERAS are gaining ground and spreading into a range of different surgical specialties and procedures. The utilization of evidence-based ERAS protocols will minimize healthcare team’s practice variation resulting in patient engagement, timely quality recovery, safety, positive outcomes, and cost reduction. The chapter will describe the implications of ERAS pathways when caring for oncologic patients perioperatively through interdisciplinary approach. A key focus for critical care teams is to provide a comprehensive overview and targeted areas of care to implement interventions consistent with new healthcare delivery trends.

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Authors and Affiliations

  1. Department of Critical Care and Respiratory Care, Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joshua Botdorf & Ninotchka Brydges

  2. Department of Surgical Oncology, Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Celia R. Ledet

  3. University of Minnesota Nurse Anesthesia Program, Minneapolis, MN, USA

    Danilo Lovinaria

  4. Department of Anesthesiology, Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Garry Brydges

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  1. Joshua Botdorf
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  2. Celia R. Ledet
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  3. Ninotchka Brydges
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  4. Danilo Lovinaria
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  5. Garry Brydges
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Corresponding author

Correspondence to Joshua Botdorf .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Joseph L. Nates

  2. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Division of Anesthesia, Critical Care and Pain Medicine, Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Garry Brydges DNP, MBA, CRNA, ACNP-BC, FAAN

Appendix

Appendix

See Tables 1–10.

Table 1 Collaborative management approach
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Table 2 The stress response cascade [5, 36, 77, 81, 82, 112]
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Table 3 High complex oncologic surgery
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Table 4 List of anesthetic agents for multi-modal techniques [5, 36, 77, 81, 82, 112]
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Table 5 Regional anesthesia blocks by surgery [5, 36, 77, 81, 82, 112]
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Table 6 Intraoperative management by type of surgery [5, 36, 77, 81, 82, 112]
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Table 7 Postoperative oncologic management and surgical disciplines [5, 36, 77, 81, 82, 112]
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Table 8 Postoperative complications
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Table 9 Essential items for ICU admission
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Table 10 ERAS outcome and economic impact
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Botdorf, J., Ledet, C.R., Brydges, N., Lovinaria, D., Brydges, G. (2019). Enhanced Recovery After Surgery (ERAS) in the Oncologic Patient. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_202-1

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  • DOI: https://doi.org/10.1007/978-3-319-74698-2_202-1

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