The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)
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EDITORIAL PERSPECTIVE
The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS) Olle Ljungqvist1 • Gregg Nelson2 • Nicolas Demartines3
Accepted: 1 August 2020 / Published online: 14 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
The COVID-19 pandemic has taken an unimaginable toll on human life, economy and the healthcare system. As a surgical community, this required implementing drastic changes including rapid adoption of triage algorithms to guide cancellation or postponement of surgeries. Current estimates are that more than 28 million surgeries have been cancelled or postponed during the first peak 12 weeks of the pandemic [1]. While the majority of these cancelled operations were for benign disease, a significant percentage was for cancer [1]. Just as triage algorithms for cancellation and postponement were devised during the pandemic, so too now must we develop strategies to address the surgical backlog as we begin to emerge from this crisis. Provided a 20% increase in baseline surgical volume is possible, it would take nearly a year (median of 45 weeks) to clear the surgical case backlog [1]. This expansion of surgeries has to take place during a time when national and regional economies are under maximum pressure, and many healthcare professionals furloughed. One of the key questions facing surgeons, anaesthesiologists and healthcare administrators is where will hospitals find this increased capacity? And when? The answer is Enhanced Recovery After Surgery (ERAS).
& Olle Ljungqvist [email protected] 1
Department of Surgery, School of Health and Medical ¨ rebro University, Sciences, Faculty of Medicine and Health, O ¨ rebro, Sweden O
2
Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
3
Department of Visceral Surgery, University Hospital CHUV and University of Lausanne, Lausanne, Switzerland
There are several undeniable and important reasons why ERAS should be applied now worldwide; ERAS has repeatedly been shown all over the world to reduce complications (reduced by 20–50%), bringing down the need for hospital care from weeks to days without increasing the readmission rate and minimizing need for care in the ICU. In addition, ERAS allows health cost saving between 5000 and 8000 USD per case in major surgery with a return on investment (ROI) ratio & 4 [2, 3]. Despite these proven benefits, ERAS is still not main stream practice, even if many surgeons claim that they ‘‘do ERAS’’ and some key opinion leading surgeons may believe it is done everywhere for years. ERAS is not being done everywhere—this becomes obvious when reviewing length of stay from national data registries from highly developed countries such as Germany [4], Japan [5] and France [6] all with length of stay after colorectal surgery exceeding 10 days (with some averaging length of stay as high as 24.7 days) and compared with reports from large consecutive cohorts with demonstrated real ERAS protocols in place where length of stay i
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