Enhanced recovery after surgery and practical application to liver transplanation

Publication date: Available online 18 February 2020Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): M. Susan Mandell, Jiapeng Huang, Jing ZhaoAbstractThere is a growing support for the use of protocols that incorporate multiple steps aimed to reduce the time patients require to regain health. A recurring limitation is the variable outcomes of these protocols with more or less success at the sites they are instituted. This review examines the essential building blocks needed to launch a successful ERAS protocol. It address why there are differences in outcome measures between centers such as length of stay and the cost of care even if the protocols and patient populations are similar.To understand what factors can affect the success of an enhanced recovery program, we explore ERAS as a process rather than a summary of detailed care steps. The influence of integrated care delivery, leadership style and choice of goals of care are explained in the context of ERAS as a process of how medical care is delivered. ERAS is presented as a solution to fragmented health care delivery which increases the cost of care and often delays recovery. The importance of Integrated Delivery System and its relationship to high quality healthcare delivery and better outcomes is explored. The role of ERAS in liver transplant is examined and how the clinical goal of early extubation resulted in a progression of evidence-based care steps to that are consistent with ERAS protocols.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research