The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Kathie L. Hullfish - One of the best experts on this subject based on the ideXlab platform.
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Enhanced Recovery Program for minimally invasive and vaginal urogynecologic surgery
International Urogynecology Journal, 2019Co-Authors: Elisa Rodriguez Trowbridge, Sarah L. Evans, Bethany M. Sarosiek, Susan C. Modesitt, Dana L. Redick, Mohamed Tiouririne, Robert H. Thiele, Traci L. Hedrick, Kathie L. HullfishAbstract:Introduction and hypothesis Enhanced Recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite Recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. Methods An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. Results One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p
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enhanced Recovery Program for minimally invasive and vaginal urogynecologic surgery
International Urogynecology Journal, 2019Co-Authors: Elisa Rodriguez Trowbridge, Sarah L. Evans, Bethany M. Sarosiek, Susan C. Modesitt, Dana L. Redick, Mohamed Tiouririne, Robert H. Thiele, Traci L. Hedrick, Kathie L. HullfishAbstract:Enhanced Recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite Recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p < 0.01) and total intravenous fluids administered (2.7 l vs. 1.5 l, p < 0.0001). Hospital discharges before noon doubled (32.9 vs. 60.2%, p < 0.01). More patients in the ERP group ambulated on the day of surgery (17.1 vs. 73.7%, p < 0.01) and ambulated at least two times the day following surgery (34.2 vs. 72.9%, p < 0.01). No differences were seen in average pain scores (highest pain score 7.39 vs. 7.37, p = 0.95), hospital readmissions (3.9 vs. 3.4%, p = 0.84), or postoperative complications (6.58 vs. 8.47%, p = 0.79). Patient satisfaction significantly improved. ERP was not associated with an increase in 30-day total hospital costs. Implementation of ERP for pelvic reconstructive surgery patients was associated with a reduced length of hospital stay, improved patient satisfaction, and decreased administration of intravenous fluids and opioids without an increase in complications, readmissions, or hospital costs.
Tonia M. Young-fadok - One of the best experts on this subject based on the ideXlab platform.
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Enhanced Recovery Program implementation: an evidence-based review of the art and the science
Surgical Endoscopy, 2019Co-Authors: Thomas A Aloia, Rebecca B. Kowalski, Margaret M. Luciano, Jonathan A. Myers, Prashant Sinha, Henry Lin, Konstantinos Spaniolas, Deborah S Keller, Tonia M. Young-fadokAbstract:BackgroundThe benefits of enhanced Recovery Program (ERP) implementation include patient engagement, improved patient outcomes and satisfaction, better team relationships, lower per episode costs of care, lower public consumption of narcotic prescription pills, and the promise of greater access to quality surgical care. Despite these positive attributes, vast numbers of surgical patients are not treated on ERPs, and many of those considered “on pathway” are unlikely to be exposed to a majority of recommended ERP elements.MethodsTo explain the gap between ERP knowledge and action, this manuscript reviewed formal implementation strategies, proposed a novel change adoption model and focused on common barriers (and corollary solutions) that are encountered during the journey to a fully implemented and successful ERP. Given the nature of this review, IRB approval was not required/obtained.ResultsThe information reviewed indicates that implementation of best practice is both a science and an art. What many surgeons have learned is that the “soft” skills of emotional intelligence, leadership, team dynamics, culture, buy-in, motivation, and sustainability are central to a successful ERP implementation.ConclusionsTo lead teams toward achievement of pervasive and sustained adherence to best practices, surgeons need to learn new strategies, techniques, and skills.
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Enhanced Recovery Program implementation: an evidence-based review of the art and the science.
Surgical endoscopy, 2019Co-Authors: Thomas A Aloia, Rebecca B. Kowalski, Margaret M. Luciano, Prashant Sinha, Henry Lin, Konstantinos Spaniolas, Deborah S Keller, Jonathan Myers, Tonia M. Young-fadokAbstract:Background The benefits of enhanced Recovery Program (ERP) implementation include patient engagement, improved patient outcomes and satisfaction, better team relationships, lower per episode costs of care, lower public consumption of narcotic prescription pills, and the promise of greater access to quality surgical care. Despite these positive attributes, vast numbers of surgical patients are not treated on ERPs, and many of those considered “on pathway” are unlikely to be exposed to a majority of recommended ERP elements.
Franco Carli - One of the best experts on this subject based on the ideXlab platform.
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impact of adherence to care pathway interventions on Recovery following bowel resection within an established enhanced Recovery Program
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Nicolò Pecorelli, Julio F. Fiore, Olivia Hershorn, Patrick Charlebois, Barry Stein, Franco Carli, Gabriele Baldini, Sender A Liberman, Liane S FeldmanAbstract:Guidelines recommend incorporation of more than 20 perioperative interventions within an enhanced Recovery Program (ERP). However, the impact of overall adherence to the pathway and the relative contribution of each intervention are unclear. The aim of this study was to estimate the extent to which adherence to ERP elements is associated with outcomes and identify key ERP elements predicting successful Recovery following bowel resection. Prospectively collected data entered in a registry specifically designed for ERPs were reviewed. Patients undergoing elective bowel resection between 2012 and 2014 were treated within an ERP comprising 23 care elements. Primary outcome was successful Recovery defined as the absence of complications, discharge by postoperative day 4 and no readmission. Secondary outcomes were length of hospital stay (LOS), 30-day morbidity, and severity (Comprehensive complication index, CCI, 0–100). Regression analyses were adjusted for potential confounders. A total of 347 patients were included in the study. Median primary LOS was 4 days (IQR 3–7). Patients were adherent to median 18 (IQR 16–20) elements. A total of 156 (45 %) patients had successful Recovery. Morbidity occurred in 175 (50 %) patients with median CCI 8.6 (IQR 0–22.6). There was a positive association between adherence and successful Recovery (OR 1.39 for every additional element, p < 0.001), LOS (11 % reduction for every additional element, p < 0.001), 30-day postoperative morbidity (OR 0.78, p < 0.001), and the CCI (17 % reduction, p < 0.001). Laparoscopy (OR 4.32, p < 0.001), early mobilization out of bed (OR 2.25, p = 0.021), and early termination of IV fluid infusion (OR 2.00, p = 0.013) significantly predicted successful Recovery. These factors were also associated with reduced morbidity and complication severity. Increased adherence to ERP interventions was associated with successful early Recovery and a reduction in postoperative morbidity and complication severity. In an established ERP where overall adherence was high, laparoscopic approach, perioperative fluid management, and patient mobilization remain key elements associated with improved outcomes.
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impact of adherence to care pathway interventions on Recovery following bowel resection within an established enhanced Recovery Program
Surgical Endoscopy and Other Interventional Techniques, 2017Co-Authors: Nicolò Pecorelli, Julio F. Fiore, Olivia Hershorn, Patrick Charlebois, Barry Stein, Franco Carli, Gabriele Baldini, Sender A Liberman, Liane S FeldmanAbstract:Introduction Guidelines recommend incorporation of more than 20 perioperative interventions within an enhanced Recovery Program (ERP). However, the impact of overall adherence to the pathway and the relative contribution of each intervention are unclear. The aim of this study was to estimate the extent to which adherence to ERP elements is associated with outcomes and identify key ERP elements predicting successful Recovery following bowel resection.
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Ensuring Early Mobilization Within an Enhanced Recovery Program for Colorectal Surgery: A Randomized Controlled Trial.
Annals of surgery, 2017Co-Authors: Julio F. Fiore, Tanya Castelino, Nicolò Pecorelli, Petru Niculiseanu, Saba Balvardi, Olivia Hershorn, Sender Liberman, Patrick Charlebois, Barry Stein, Franco CarliAbstract:Objective:To estimate the extent to which the addition of staff-directed facilitation of early mobilization to an Enhanced Recovery Program (ERP) impacts Recovery after colorectal surgery, compared with usual care.Summary Background Data:Early mobilization is considered an important component of ERP
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intravenous lidocaine versus thoracic epidural analgesia a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced Recovery Program
Regional Anesthesia and Pain Medicine, 2011Co-Authors: Mingkwan Wongyingsinn, Sender Liberman, Patrick Charlebois, Barry Stein, Gabriele Baldini, Franco CarliAbstract:Background and Objective: Laparoscopy, thoracic epidural analgesia, and enhanced Recovery Program (ERP) have been shown to be the major elements to facilitate the postoperative Recovery strategy in open colorectal surgery. This study compared the effect of intraoperative and postoperative intravenous (IV) lidocaine infusion with thoracic epidural analgesia on postoperative restoration of bowel function in patients undergoing laparoscopic colorectal resection using an ERP. Methods: Sixty patients scheduled for elective laparoscopic colorectal surgery were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or IV lidocaine infusion (IL group) (1 mg/kg per hour) with patient-controlled analgesia morphine for the first 48 hours after surgery. All patients received a similar ERP. The primary outcome was time to return of bowel function. Postoperative pain intensity, time out of bed, dietary intake, duration of hospital stay, and postoperative complications were also recorded. Results: Mean times and SD (95% confidence interval) to first flatus (TEA, 24 [SD, 11] [19-29] hrs vs IL, 27 [SD, 12] [22-32] hrs) and to bowel movements (TEA, 44 ±19 [35-52] hrs vs IL, 43 [SD, 20] [34-51] hrs) were similar in both groups (P = 0.887). Thoracic epidural analgesia provided better analgesia in patients undergoing rectal surgery. Time out of bed and dietary intake were similar. Patients in the TEA and IL groups were discharged on median day 3 (interquartile range, 3-4 days), P = 0.744. Sixty percent of patients in both groups left the hospital on day 3. Conclusions: Intraoperative and postoperative IV infusion of lidocaine in patients undergoing laparoscopic colorectal resection using an ERP had a similar impact on bowel function compared with thoracic epidural analgesia.
Elisa Rodriguez Trowbridge - One of the best experts on this subject based on the ideXlab platform.
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Enhanced Recovery Program for minimally invasive and vaginal urogynecologic surgery
International Urogynecology Journal, 2019Co-Authors: Elisa Rodriguez Trowbridge, Sarah L. Evans, Bethany M. Sarosiek, Susan C. Modesitt, Dana L. Redick, Mohamed Tiouririne, Robert H. Thiele, Traci L. Hedrick, Kathie L. HullfishAbstract:Introduction and hypothesis Enhanced Recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite Recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. Methods An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. Results One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p
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enhanced Recovery Program for minimally invasive and vaginal urogynecologic surgery
International Urogynecology Journal, 2019Co-Authors: Elisa Rodriguez Trowbridge, Sarah L. Evans, Bethany M. Sarosiek, Susan C. Modesitt, Dana L. Redick, Mohamed Tiouririne, Robert H. Thiele, Traci L. Hedrick, Kathie L. HullfishAbstract:Enhanced Recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite Recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients. An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study. One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p < 0.01) and total intravenous fluids administered (2.7 l vs. 1.5 l, p < 0.0001). Hospital discharges before noon doubled (32.9 vs. 60.2%, p < 0.01). More patients in the ERP group ambulated on the day of surgery (17.1 vs. 73.7%, p < 0.01) and ambulated at least two times the day following surgery (34.2 vs. 72.9%, p < 0.01). No differences were seen in average pain scores (highest pain score 7.39 vs. 7.37, p = 0.95), hospital readmissions (3.9 vs. 3.4%, p = 0.84), or postoperative complications (6.58 vs. 8.47%, p = 0.79). Patient satisfaction significantly improved. ERP was not associated with an increase in 30-day total hospital costs. Implementation of ERP for pelvic reconstructive surgery patients was associated with a reduced length of hospital stay, improved patient satisfaction, and decreased administration of intravenous fluids and opioids without an increase in complications, readmissions, or hospital costs.
Skye Hon-chun Cheng - One of the best experts on this subject based on the ideXlab platform.
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Is it appropriate to apply the enhanced Recovery Program to patients undergoing laparoscopic rectal surgery
Surgical endoscopy, 2010Co-Authors: Chien-chih Chen, I-ping Huang, Mei-ching Liu, James Jer-min Jian, Skye Hon-chun ChengAbstract:Background The laparoscopic approach has played a key role in the successful application of the enhanced Recovery Program (ERP) in perioperative care for postoperative colon surgery patients. Reports of applying ERP in laparoscopic rectal surgery are rare, and the feasibility of doing so has yet to be solidly evaluated. The goal of this study was to evaluate whether it is appropriate to use ERP on patients who undergo rectal surgery via the laparoscopic approach and to further investigate potential factors that may affect the results of this practice modality.
