Pagina Iniziale » Fegato » Interventi Chirurgici sul Fegato » Protocollo ERAS
ERAS
Enhanced Recovery After Surgery
Protocollo per il miglior recupero dopo l'intervento chirurgico
Protocollo ERAS
L’ERAS (Enhanced Recovery After Surgery, ovvero il “miglior recupero post- intervento chirurgico”) è un sistema innovativo e multidisciplinare per la gestione del paziente che deve affrontare un’operazione chirurgica.
L’ERAS coinvolge infatti numerosi specialisti e professionisti, tra cui il chirurgo, l’anestesista, l’infermiere, il fisioterapista e il dietista, che assistono il paziente durante il suo percorso prima e dopo un intervento chirurgico, anche se eseguito sul fegato, sulle vie biliari o sul pancreas.
I protocolli ERAS si basano sulle aggiornate evidenze scientifiche e sono sviluppati e promossi dalla ERAS Society (una società scientifica internazionale, professionale, no profit).
Cosa prevede il protocollo ERAS nella Chirurgia del Fegato e del Pancreas
- Un colloquio di informazione con il paziente che deve essere operato e con i suoi familiari/accompagnatori per illustrare come sarà la gestione dell’intervento;
- L’abolizione del consueto digiuno pre-operatorio, consentendo una blanda alimentazione prima dell’operazione (cibi solidi fino a 6 ore prima dell’operazione; assunzione di liquidi fino a 2 ore prima dell’intervento);
- Assunzione di una dieta ricca di carboidrati;
- Eliminazione della premedicazione con farmaci ansiolitici
- Analgesia epidurale toracica (se possibile e indicata);
- Prevenzione dell’ipotermia;
- Monitoraggio della pressione venosa centrale (CVP: central vein pressure) mantenendola intorno a valori di 5 mmHg;
- Non drenaggi addominali;
- Nessun posizionamento del sondino naso gastrico (la piccola sonda che veniva sempre inserita nel naso del paziente ed arrivava nello stomaco, per detenderlo);
- Ripristino dell’assunzione di acqua e altri liquidi per via orale;
- Mobilizzazione precoce dell’ammalato;
- Prevenzione della nausea e del vomito post-operatorio;
- Profilassi antitrombotica;
- Profilassi antibiotica
- Rivalutazione giornaliera della possibilità di dimissione dall’ospedale;
- Prevenzione della paralisi funzionale dell’intestino (c.d. ileo paralitico);
- Ripresa di una normale dieta liquida e solida in 1° giornata post-operatoria;
- Sospensione dell’infusione endovenosa di liquidi dalla 1° giornata post-operatoria;
- Analgesia orale dalla 1° giornata post-operatoria;
- Dieta normale dalla 2° giornata post-operatoria;
- Rimozione del catetere vescicale in 2° giornata post-operatoria;
- Termine dell’analgesia epidurale o endovenosa in 3° giornata post-operatoria;
- Completa mobilizzazione del paziente in 3° giornata post-operatoria.
Quali sono gli obiettivi del protocollo ERAS
Gli obiettivi dell’ERAS quindi prevedono:
- l’introduzione di un supporto nutrizionale preoperatorio, di particolare importanza nel paziente malnutrito;
- un aumento della quantità di carboidrati nel periodo preoperatorio, per contrastare l’insulino resistenza che insorge nel postoperatorio;
- la scelta (quando possibile) dell’analgesia epidurale o spinale per ridurre la risposta endocrina allo stress;
- l’utilizzo di farmaci antinfiammatori per ridurre la risposta infiammatoria;
- una rapida ripresa dell’alimentazione dopo l’intervento chirurgico, al fine di assicurare maggiore energia al paziente e per stimolare la funzione dell’intestino;
- una gestione ottimale del dolore per evitare lo stress e l’insulino resistenza.
Il mantenimento di un normale volume di liquidi circolanti nel paziente è importante per evitare un’insufficiente o un eccessivo introito di fluidi somministrati per via endovenosa, che andrebbero ad incidere sulla perfusione degli organi, sull’attività cardiaca e sull’insorgenza di maggiori complicanze.
Un buon equilibrio nell’introduzione di fluidi, ossigeno e nutrienti ai tessuti sono infatti necessari per preservare le funzioni cellulari, soprattutto quando si è sottoposti ad un intervento chirurgico.
I protocolli ERAS vengono applicati veramente?
Sì! Questo nuovo modo di gestire l’intervento chirurgico viene applicato in tanti ospedali italiani e nel mondo.
I protocolli ERAS sono risultati efficaci anche nel ridurre i giorni di degenza ospedaliera dal 30 al 50%, le complicanze (del 50%), le ri-ospedalizzazioni e i costi.
I principali ostacoli alla sempre maggiore diffusione del protocollo ERAS sono sostanzialmente:
- la resistenza al cambiamento,
- l’assenza di tempo per formazione e pianificazione,
- personale insufficiente,
- una scarsa comunicazione, collaborazione e poco coordinamento tra i vari reparti.
Centro di Chirurgia Epato-Bilio-Pancreatica
- Ultimo aggiornamento della pagina: 10/12/2023
Linee Guida ERAS per la Chirurgia Epatica
2022
Joliat G; Kobayashi K; Hasegawa K; Thomson J; Padbury R; Scott M; Brustia R; Scatton O; Cao H S T; Vauthey J; Dincler S; Clavien P; Wigmore S J; Demartines N; Melloul E
Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022 Journal Article
In: World Journal of Surgery, 2022, ISSN: 03642313, (Cited by: 0; All Open Access, Green Open Access, Hybrid Gold Open Access).
@article{Joliat2022,
title = {Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022},
author = {Gaëtan-Romain Joliat and Kosuke Kobayashi and Kiyoshi Hasegawa and John-Edwin Thomson and Robert Padbury and Michael Scott and Raffaele Brustia and Olivier Scatton and Hop S. Tran Cao and Jean-Nicolas Vauthey and Selim Dincler and Pierre-Alain Clavien and Stephen J. Wigmore and Nicolas Demartines and Emmanuel Melloul},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85141000530&doi=10.1007%2fs00268-022-06732-5&partnerID=40&md5=1086c50d7ba7b6e5086cec811742e90f},
doi = {10.1007/s00268-022-06732-5},
issn = {03642313},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {World Journal of Surgery},
publisher = {Springer Science and Business Media Deutschland GmbH},
abstract = {Background: Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature. Methods: A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system. Results: A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy. Conclusions: These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed. © 2022, The Author(s).},
note = {Cited by: 0; All Open Access, Green Open Access, Hybrid Gold Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bayramov N; Mammadova Sh
A review of the current ERAS guidelines for liver resection, liver transplantation and pancreatoduodenectomy Journal Article
In: Annals of Medicine and Surgery, vol. 82, 2022, ISSN: 20490801, (Cited by: 0; All Open Access, Gold Open Access, Green Open Access).
@article{Bayramov2022,
title = {A review of the current ERAS guidelines for liver resection, liver transplantation and pancreatoduodenectomy},
author = {N. Bayramov and Sh. Mammadova},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85137637638&doi=10.1016%2fj.amsu.2022.104596&partnerID=40&md5=2a8999cca65566b0018e5d60125bbb89},
doi = {10.1016/j.amsu.2022.104596},
issn = {20490801},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Annals of Medicine and Surgery},
volume = {82},
publisher = {Elsevier Ltd},
abstract = {In perioperative care after liver resection, transplantation and pancreatoduodenectomy, ERAS (Enhanced Recovery After Surgery) recommendations are based on the reducing invasiveness of procedures and the severity of the surgical stress, which results in decreasing complications and enhanced recovery. Recommendations for all three operations can be classified into five groups: recommended for all patients, recommended for special patient groups, rejected for all patients, controversial recommendations, specific recommendations for all three operations. Preoperative counselling and psychological support, nutritional support, smoking and alcohol cessation, pre- and intraoperative antibiotic prophylaxis, thrombosis prevention, limiting of preoperative hunger and thirst to 4 and 6 h, preoperative intaking carbohydrate rich drink, alcohol-based antiseptics for skin preparation, a goal-directed infusion therapy, providing normothermia, early removal of the drainage tube, glycemic control, dual antiemetic therapy, multimodal analgesia strategies, early oral feeding and activation, audit recommend for all patients. Postoperative antibiotic prophylaxis, enteral and parenteral nutrition, short-acting anxiolytics are recommended for individual patients. It is recommended to avoid Mercedes type incision, use of long-acting anxiolytics and postoperative nasogastric tube. The benefits of preoperative physical exercise, immunonutrition and probiotics are controversial. There are no specific recommendations for thoracic epidural anesthesia, preventing delayed gastric emptying and intestinal paresis in liver surgery. © 2022},
note = {Cited by: 0; All Open Access, Gold Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Brustia R; Monsel A; Skurzak S; Schiffer E; Carrier F M; Patrono D; Kaba A; Detry O; Malbouisson L; Andraus W; Vandenbroucke-Menu F; Biancofiore G; Kaido T; Compagnon P; Uemoto S; Laiz G R; Boer M D; Orloff S; Melgar P; Buis C; Zeillemaker-Hoekstra M; Usher H; Reyntjens K; Baird E; Demartines N; Wigmore S; Scatton O
Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery after Surgery (ERAS) Recommendations Journal Article
In: Transplantation, vol. 106, no 3, pp. 552 – 561, 2022, ISSN: 00411337, (Cited by: 10; All Open Access, Green Open Access).
@article{Brustia2022552,
title = {Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery after Surgery (ERAS) Recommendations},
author = {Raffaele Brustia and Antoine Monsel and Stefano Skurzak and Eduardo Schiffer and François Martin Carrier and Damiano Patrono and Abdourahamane Kaba and Olivier Detry and Luiz Malbouisson and Wellington Andraus and Franck Vandenbroucke-Menu and Gianni Biancofiore and Toshimi Kaido and Philippe Compagnon and Shinji Uemoto and Gonzalo Rodriguez Laiz and Marieke De Boer and Susan Orloff and Paola Melgar and Carlijn Buis and Miriam Zeillemaker-Hoekstra and Helen Usher and Koen Reyntjens and Emily Baird and Nicolas Demartines and Stephen Wigmore and Olivier Scatton},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85125006375&doi=10.1097%2fTP.0000000000003808&partnerID=40&md5=082ddb84c23154f85ae4617dbd1f8be7},
doi = {10.1097/TP.0000000000003808},
issn = {00411337},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Transplantation},
volume = {106},
number = {3},
pages = {552 – 561},
publisher = {Lippincott Williams and Wilkins},
abstract = {Background. Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus Methods. PubMed and ClinicalTrials.gov were searched in April 2019 for published and ongoing randomized clinical trials on LT in the last 15 y. Studies were selected by 5 independent reviewers and were eligible if focusing on each validated ERAS item in the area of adult LT. An e-Delphi method was used with an extended interdisciplinary panel of experts to validate the final recommendations. Results. Forty-three articles were included in the systematic review. A consensus was reached among experts after the second round. Patients should be screened for malnutrition and treated whenever possible. Prophylactic nasogastric intubation and prophylactic abdominal drainage may be omitted, and early extubation should be considered. Early oral intake, mobilization, and multimodal-balanced analgesia are recommended. Conclusions. The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the e-Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol. © 2022 Lippincott Williams and Wilkins. All rights reserved.},
note = {Cited by: 10; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2016
Melloul E; Hübner M; Scott M; Snowden C; Prentis J; Dejong C H C; Garden O J; Farges O; Kokudo N; Vauthey J; Clavien P; Demartines N
Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations Journal Article
In: World Journal of Surgery, vol. 40, no 10, pp. 2425 – 2440, 2016, ISSN: 03642313, (Cited by: 279; All Open Access, Bronze Open Access, Green Open Access).
@article{Melloul20162425,
title = {Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations},
author = {Emmanuel Melloul and Martin Hübner and Michael Scott and Chris Snowden and James Prentis and Cornelis H. C. Dejong and O. James Garden and Olivier Farges and Norihiro Kokudo and Jean-Nicolas Vauthey and Pierre-Alain Clavien and Nicolas Demartines},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84983484849&doi=10.1007%2fs00268-016-3700-1&partnerID=40&md5=3186dea22b6ff9289d33faffa4d0336d},
doi = {10.1007/s00268-016-3700-1},
issn = {03642313},
year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {World Journal of Surgery},
volume = {40},
number = {10},
pages = {2425 – 2440},
publisher = {Springer New York LLC},
abstract = {Background: Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. Methods: A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. Results: A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. Conclusions: The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol. © 2016, Société Internationale de Chirurgie.},
note = {Cited by: 279; All Open Access, Bronze Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2014
Aldrighetti L; Francesca R; Federica C; Annalisa G; Reineke R; Laura C; Silvia M; Frati E; Casiraghi U; Elisabetta B
Protocollo ERAS Resezioni Epatiche Working paper
2014, (Protocollo ERAS per le resezioni epatiche a cura del P.O.I.S. – Pre-Operative Italian Society).
@workingpaper{nokey,
title = {Protocollo ERAS Resezioni Epatiche},
author = {Luca Aldrighetti and Ratti Francesca and Cipriani Federica and Galliano Annalisa and Raffaella Reineke and Comotti Laura and Morero Silvia and Elena Frati and Umberto Casiraghi and Bassani Elisabetta},
editor = {POIS PeriOperative Italian Society – ERAS Italian Chapter},
url = {https://perioperativeitaliansociety.org/wp-content/uploads/2017/05/PROTOCOLLI-ERAS-NELLA-CHIRURGIA-EPATO-versione-novembre-2014.pdf},
year = {2014},
date = {2014-11-03},
urldate = {2014-11-03},
note = {Protocollo ERAS per le resezioni epatiche a cura del P.O.I.S. – Pre-Operative Italian Society},
keywords = {},
pubstate = {published},
tppubtype = {workingpaper}
}
Linee Guida ERAS per la Chirurgia Pancreatica
2022
Bayramov N; Mammadova Sh
A review of the current ERAS guidelines for liver resection, liver transplantation and pancreatoduodenectomy Journal Article
In: Annals of Medicine and Surgery, vol. 82, 2022, ISSN: 20490801, (Cited by: 0; All Open Access, Gold Open Access, Green Open Access).
@article{Bayramov2022,
title = {A review of the current ERAS guidelines for liver resection, liver transplantation and pancreatoduodenectomy},
author = {N. Bayramov and Sh. Mammadova},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85137637638&doi=10.1016%2fj.amsu.2022.104596&partnerID=40&md5=2a8999cca65566b0018e5d60125bbb89},
doi = {10.1016/j.amsu.2022.104596},
issn = {20490801},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Annals of Medicine and Surgery},
volume = {82},
publisher = {Elsevier Ltd},
abstract = {In perioperative care after liver resection, transplantation and pancreatoduodenectomy, ERAS (Enhanced Recovery After Surgery) recommendations are based on the reducing invasiveness of procedures and the severity of the surgical stress, which results in decreasing complications and enhanced recovery. Recommendations for all three operations can be classified into five groups: recommended for all patients, recommended for special patient groups, rejected for all patients, controversial recommendations, specific recommendations for all three operations. Preoperative counselling and psychological support, nutritional support, smoking and alcohol cessation, pre- and intraoperative antibiotic prophylaxis, thrombosis prevention, limiting of preoperative hunger and thirst to 4 and 6 h, preoperative intaking carbohydrate rich drink, alcohol-based antiseptics for skin preparation, a goal-directed infusion therapy, providing normothermia, early removal of the drainage tube, glycemic control, dual antiemetic therapy, multimodal analgesia strategies, early oral feeding and activation, audit recommend for all patients. Postoperative antibiotic prophylaxis, enteral and parenteral nutrition, short-acting anxiolytics are recommended for individual patients. It is recommended to avoid Mercedes type incision, use of long-acting anxiolytics and postoperative nasogastric tube. The benefits of preoperative physical exercise, immunonutrition and probiotics are controversial. There are no specific recommendations for thoracic epidural anesthesia, preventing delayed gastric emptying and intestinal paresis in liver surgery. © 2022},
note = {Cited by: 0; All Open Access, Gold Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2020
Melloul E; Lassen K; Roulin D; Grass F; Perinel J; Adham M; Wellge E B; Kunzler F; Besselink M G; Asbun H; Scott M J; Dejong C H C; Vrochides D; Aloia T; Izbicki J R; Demartines N
Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019 Journal Article
In: World Journal of Surgery, vol. 44, no 7, pp. 2056 – 2084, 2020, ISSN: 03642313, (Cited by: 106; All Open Access, Green Open Access).
@article{Melloul20202056,
title = {Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019},
author = {Emmanuel Melloul and Kristoffer Lassen and Didier Roulin and Fabian Grass and Julie Perinel and Mustapha Adham and Erik Björn Wellge and Filipe Kunzler and Marc G. Besselink and Horacio Asbun and Michael J. Scott and Cornelis H. C. Dejong and Dionisos Vrochides and Thomas Aloia and Jakob R. Izbicki and Nicolas Demartines},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081884028&doi=10.1007%2fs00268-020-05462-w&partnerID=40&md5=3209299becbf54c400da096a5048c529},
doi = {10.1007/s00268-020-05462-w},
issn = {03642313},
year = {2020},
date = {2020-01-01},
urldate = {2020-01-01},
journal = {World Journal of Surgery},
volume = {44},
number = {7},
pages = {2056 – 2084},
publisher = {Springer},
abstract = {Background: Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus. Methods: A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations. Results: A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%). Conclusions: The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations. © 2020, Société Internationale de Chirurgie.},
note = {Cited by: 106; All Open Access, Green Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2013
Lassen K; Coolsen M M E; Slim K; Carli F; Aguilar-Nascimento J E D; Schäfer M; Parks R W; Fearon K C H; Lobo D N; Demartines N; Braga M; Ljungqvist O; Dejong C H C
Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced recovery after surgery (ERAS®) society recommendations Journal Article
In: World Journal of Surgery, vol. 37, no 2, pp. 240 – 258, 2013, ISSN: 14322323, (Cited by: 255; All Open Access, Bronze Open Access).
@article{Lassen2013240,
title = {Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced recovery after surgery (ERAS®) society recommendations},
author = {Kristoffer Lassen and Marielle M. E. Coolsen and Karem Slim and Francesco Carli and José E. De Aguilar-Nascimento and Markus Schäfer and Rowan W. Parks and Kenneth C. H. Fearon and Dileep N. Lobo and Nicolas Demartines and Marco Braga and Olle Ljungqvist and Cornelis H. C. Dejong},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84874078357&doi=10.1007%2fs00268-012-1771-1&partnerID=40&md5=4dfc1e3813aca85ef89167d29f792316},
doi = {10.1007/s00268-012-1771-1},
issn = {14322323},
year = {2013},
date = {2013-01-01},
urldate = {2013-01-01},
journal = {World Journal of Surgery},
volume = {37},
number = {2},
pages = {240 – 258},
abstract = {Background: Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. Methods: An international working group constructed within the Enhanced Recovery After Surgery (ERAS ®) Society constructed a comprehensive and evidence-based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated "high", "moderate", "low" or "very low". Recommendations were graded as "strong" or "weak". Results: Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusions: The present evidence-based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi-institutional prospective cohort registries and adequately powered randomised trials. © 2012 Société Internationale de Chirurgie.},
note = {Cited by: 255; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2012
Balzano G; Capretti G; Pecorelli N; Martani C; Casiraghi U
ERAS Protocol: Pancreatic Surgery Pancreatoduodenectomy Working paper
2012, (Protocollo ERAS per la duodeno-cefalopancreasectomia (DCP) a cura del P.O.I.S. – Pre-Operative Italian Society).
@workingpaper{nokey,
title = {ERAS Protocol: Pancreatic Surgery Pancreatoduodenectomy},
author = {Gianpaolo Balzano and Giovanni Capretti and Nicolò Pecorelli and Carla Martani and Umberto Casiraghi},
editor = {POIS PeriOperative Italian Society – ERAS Italian Chapter},
url = {https://perioperativeitaliansociety.org/wp-content/uploads/2017/05/PROTOCOLLO-ERAS-DCP-0613.pdf},
year = {2012},
date = {2012-06-04},
note = {Protocollo ERAS per la duodeno-cefalopancreasectomia (DCP) a cura del P.O.I.S. – Pre-Operative Italian Society},
keywords = {},
pubstate = {published},
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Balzano G; Capretti G; Pecorelli N; Martani C; Casiraghi U
ERAS Protocol: Pancreatic Surgery Distal Pancreatectomy Working paper
2012, (Protocollo ERAS per la pancreasectomia distale a cura del P.O.I.S. – Pre-Operative Italian Society).
@workingpaper{nokey,
title = {ERAS Protocol: Pancreatic Surgery Distal Pancreatectomy},
author = {Gianpaolo Balzano and Giovanni Capretti and Nicolò Pecorelli and Carla Martani and Umberto Casiraghi},
editor = {POIS PeriOperative Italian Society – ERAS Italian Chapter},
url = {https://perioperativeitaliansociety.org/wp-content/uploads/2017/05/PROTOCOLLO-ERAS1-pancreasectomia-distale-0613.pdf},
year = {2012},
date = {2012-06-04},
urldate = {2012-06-04},
note = {Protocollo ERAS per la pancreasectomia distale a cura del P.O.I.S. – Pre-Operative Italian Society},
keywords = {},
pubstate = {published},
tppubtype = {workingpaper}
}
