ERAS Pathway: Need of the Hour in Gynecological Malignancies
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EDITORIAL
ERAS Pathway: Need of the Hour in Gynecological Malignancies Geetu Bhandoria1 • S. P. Somashekhar2
Ó Association of Gynecologic Oncologists of India 2020
ERAS Approach: Need of the Hour Enhanced recovery after surgery (ERAS) is firmly established as a global surgical quality improvement pathway [1]. The results are in terms of both improved clinical outcomes and reduced hospital stay, translating ultimately into reduced health-care costs [2]. It is estimated that 234 million surgeries are performed globally annually [3]. Among these patients, 1 in 5 [4, 5] is expected to suffer post-surgical complications that are known to increase morbidity, hospital length of stay and cost and decrease long-term survival [5, 6]. Professor Henrik Kehlet, professor of perioperative therapy at Rigshospitalet, Copenhagen University, introduced the concept of enhanced recovery pathway in 2002 [7]. This approach was previous called as ‘Fast Track (FT) surgery’ or ‘Enhanced Recovery Programs.’ This multimodal FT surgery care team requires not only surgeons but also anesthesiologists, nurses and physiotherapists [8, 9]. Multiple evidence-based perioperative care elements are present which have the potential to decrease post-surgical complications by up to 50% [10], length of stay by 30% [10] and overall costs [11, 12]. Together, these elements form the basis of published enhanced recovery after surgery (ERAS) guidelines [13] now implemented in over 20 countries [1]. Such twenty-one guidelines exist as of today, in various surgical specialties and sub-specialties. [14]. There is an international society, ERAS society, that leads the way in developing and updating ERAS guidelines and has regular meets at various national and international levels [15]. The society was initially called ERAS study group, originated in 2001 by Professor Ken Fearon of University of Edinburgh, UK, and Professor Olle
& Geetu Bhandoria [email protected] 1
Department of Obstetrics and Gynecology/GynecologyOncology, Command Hospital and Armed Forces Medical College, Pune 411040, India
2
Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
Ljungqvist of Karolinska Insitutet, Sweden. ERAS society was officially formed in 2010 in Stockholm, Sweden [15]. The first ERAS Implementation program was run in Swe¨ rebro University Hospital. den from O The original ERAS question, posed by Prof Henrik Kehlet in 1997, was whether mitigation of the surgical stress response led to accelerated convalescence and improved surgical outcomes. Dr. Kehlet’s work focused largely on patient education and activation and attenuation of the surgical stress response through aggressive pain relief modalities, early mobilization and early enteral nutrition [16]. The global health-care community has come a long way since, with numerous surgical centers adopting ERAS protocols. These protocols are basically divided in three parts: preoperative, intraoperative and postoperative. Preoperative
Intraoperative
Postoperative
Patient and career education rel
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