Enhanced recovery after surgery (ERAS® ) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items

Bowen K Powers; Harley L Ponder; Rachelle Findley; Rachel Wolfe; Gourang P Patel; Richard H Parrish 2nd; Enhanced Recovery Comparative Pharmacotherapy Collaborative

doi:10.1002/wjs.12101

Enhanced recovery after surgery (ERAS^® ) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items

World J Surg. 2024 Mar;48(3):509-523. doi: 10.1002/wjs.12101. Epub 2024 Feb 13.

Authors

Bowen K Powers¹, Harley L Ponder¹, Rachelle Findley^{2

3}, Rachel Wolfe^{3

4}, Gourang P Patel^{3

5}, Richard H Parrish 2nd^{1

3}; Enhanced Recovery Comparative Pharmacotherapy Collaborative

Affiliations

¹ Mercer University School of Medicine, Columbus, Georgia, USA.
² Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
³ Enhanced Recovery Comparative Pharmacotherapy Collaborative, Perioperative Care Practice and Research Network, American College of Clinical Pharmacy, Hermitage, Tennessee, USA.
⁴ Department of Pharmacy Services, Barners-Jewish Hospital, St. Louis, Missouri, USA.
⁵ Department of Pharmacy Services, University of Chicago Hospitals, Chicago, Illinois, USA.

PMID: 38348514
DOI: 10.1002/wjs.12101

Abstract

Introduction: Worldwide, ERAS^® Society guidelines have ushered in a new era of perioperative care. The purpose of this systematic review is to compare published core elements and pharmacotherapy recommendations embedded within ERAS^® Society abdominal and thoracic surgery (ATS) guidelines. Determining whether a consensus exists for pharmacological core items would make future guideline preparation for similar surgeries more standardized and could improve patient care by reducing unnecessary protocol variations.

Methods: From the ERAS^® Society website as of May 2023, 16 current ERAS^® published ATS guidelines were included in the analysis to determine consensus and differing statements regarding each ERAS^® perioperative and pharmacotherapy-related item. The aims were to (a) determine whether a consensus for each item could be derived, (b) identify gaps in ERAS^® protocol development, and (c) propose potential research directions for addressing the identified gaps in the literature.

Results: Core items with consensus included: preoperative smoking and alcohol cessation; avoiding bowel reparation and fasting; multimodal preanesthetic, perioperative analgesia, and postoperative nausea and vomiting regimens; low molecular weight heparins for in-hospital and at-home venous thromboembolism prophylaxis; antibiotic prophylaxis; skin preparation; goal-directed perioperative fluid management with balanced crystalloids; perioperative nutrition care; ileus prevention with peripherally-acting mu receptor antagonists; and glucose control.

Conclusion: While consensus was found for aspects of 21 current ERAS^® guideline core items related to pharmacotherapy choice, details related to doses, regimen, timing of administration as well as unique aspects pertaining to specific surgeries remain to be researched and harmonized to promote guideline consistency and further optimize patient outcomes.

Keywords: ERAS; guidelines; operative; pharmacotherapy; prophylaxis; surgical procedures; viscera.

Publication types

Systematic Review

MeSH terms

Enhanced Recovery After Surgery*
Humans
Perioperative Care / methods
Postoperative Nausea and Vomiting
Practice Guidelines as Topic
Thoracic Surgery*
Thoracic Surgical Procedures*