Enhanced Recovery After Surgery (ERAS) for Radical Cystectomy: History, Rationale and Programmatic Implementation - Thomas Guzzo
February 19, 2018
Dr. Thomas Guzzo starts his discussion by dialing back to 1997 to share with listeners the beginning of Enhanced Recovery After Surgery (ERAS) and the work of Dr. Kelhlet from Denmark who described multifactorial surgical stress responses such as the pathogenesis of postoperative sleep disturbances as multifactorial, and includes different neural stimulus (surgical stress), cytokines, pain, use of opioids, and noise and awakenings during monitoring and nursing procedures as reasoning to answer “why a technically successful operation, should result in an unsuccessful outcome.”
A paradigm shift in perioperative care, ERAS results in substantial improvements in clinical outcomes and cost savings and is a multimodal, multidisciplinary approach to the care of the surgical patient. The ERAS process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator, and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations.
Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties.
Biography: Thomas J. Guzzo, M.D. Associate Program Director, Penn Urology Residency Chief, Division of Urology, University of Pennsylvania Health System, Associate Professor of Urology in Surgery at the Hospital of the University of Pennsylvania. Dr. Thomas Guzzo was elected to Penn Medicine Academy of Master Clinicians, 2016
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