Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery

Martin Thomas; Riddhi Joshi; Manish Bhandare; Vandana Agarwal

doi:10.5005/jp-journals-10071-23615

Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery

Indian J Crit Care Med. 2020 Sep;24(Suppl 4):S205-S210. doi: 10.5005/jp-journals-10071-23615.

Authors

Martin Thomas¹, Riddhi Joshi², Manish Bhandare³, Vandana Agarwal⁴

Affiliations

¹ Department of Medicine, Dubbo Base Hospital, Dubbo, New South Wales, Australia.
² Department of Anesthesia, Dubbo Base Hospital, Dubbo, New South Wales, Australia.
³ Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
⁴ Department of Anesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Abstract

Background: Enhanced recovery after surgery (ERAS) is currently the standard of care in perioperative medicine, but it is widely underutilized in our healthcare setting because of the lack of awareness of benefits exerted by ERAS and its components. ERAS is a multidisciplinary collaboration, where intensivists play an important role in the implementation of the protocol during the perioperative period.

Aim: This review article aims to appraise the role of ERAS pathway on complications following supramajor gastrointestinal surgery.

Review: A summary and review of evidence was conducted on the role of ERAS and its elements on non-specific and surgery-specific complications. Enhanced recovery pathways (ERPs) and its elements were directly found to be associated with lower incidence of hospital-associated infections, postoperative ileus, and postoperative pulmonary complications. Although there are no specific elements of ERPs found to have beneficial effect in preventing major adverse cardiac and cerebrovascular events, and surgery-specific complications such as postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, post-hepatic liver failure, bile, and anastomotic leak, studies have demonstrated that implementation of an ERP bundle can decrease the incidence of these complications. Implementation of an ERP was associated with an increase in the incidence of acute kidney injury with minor elevations in creatinine that returned to baseline before discharge.

Conclusion: Although there is ample evidence that ERAS is beneficial in reducing complications and hospital stay following supramajor gastrointestinal surgery, there is scope for further research to unravel the role of ERAS on patient-reported outcomes.

How to cite this article: Thomas M, Joshi R, Bhandare M, Agarwal V. Complications after Supramajor Gastrointestinal Surgery: Role of Enhanced Recovery after Surgery. Indian J Crit Care Med 2020;24(Suppl 4):S205-S210.

Keywords: Acute kidney injury; Anastomotic leak; Catheter-associated urinary tract infection; Enhanced recovery after surgery; Epidural analgesia; Gastrointestinal surgery; Pancreatic fistula; Perioperative medicine; Postoperative complications; Surgical site infection.

Publication types

Review