Protocolos de recuperación mejorada en cirugía cardiaca. Revisión sistemática con metanálisis de ensayos clínicos aleatorizados / Improved recovery protocols in cardiac surgery: Systematic review with metaanalysis of randomized clinical trails

Introducción: Múltiples son los esfuerzos realizados para incluir los protocolos de recuperación mejorada como un indicador de calidad en la atención al paciente quirúrgico, bajo la premisa de acelerar la recuperación de los enfermos, sin que esto vaya en detrimento del proceso asistencial y obtener su alta satisfacción. Para ello se hace necesario el desarrollo de la investigación avalada por la mejor evidencia científica y práctica. Objetivo: Estimar, a través de la literatura publicada, la efectividad de la aplicación de los protocolos de recuperación precoz sobre la evolución perioperatoria de pacientes a los que se les realizan procedimientos quirúrgicos cardíacos. Método: Se incluyeron ensayos clínicos controlados y aleatorizados, publicados entre enero del año 2013 y mayo de 2020. La revisión sistemática se realizó según las recomendaciones del manual 5.1.0 para revisores de la biblioteca Cochrane. Resultados: Se analizaron 6 estudios (687 pacientes/Grupo estudio=345, Grupo Control=342). La calidad metodológica de la mayoría de las investigaciones evaluadas fue buena. Se muestra una superioridad de los protocolos, ya que se acompañan de una disminución en la incidencia de complicaciones perioperatorias (RR=0,61 [0,40, 0,93]). De forma similar se encuentran relacionados con la disminución la estadía hospitalaria (diferencia de medias, efecto aleatorio, fue de -2,98 [-3,31, -2,65]. Conclusiones: A pesar de los pocos estudios incluidos, la evidencia sugiere que estos programas mejoran la evolución perioperatoria de los pacientes(AU)

Introduction: Multiple efforts are made to include improved recovery protocols as an indicator of quality in care for surgical patients, under the premise of accelerating the recovery of patients, without this being detrimental to the care process, and thus guarantee high patient satisfaction. In view of this, the development of research supported by the best scientific and practical evidence is necessary. Objective: To estimate, through the published literature, the effectiveness of the application of early recovery protocols on the perioperative evolution of patients who undergo cardiac surgical procedures. Method: Randomized controlled clinical trials, published between January 2013 and May 2020, were included. The systematic review was carried out according to the recommendations of the Cochrane Library manual 5.1.0 for reviewers. Results: Six studies were analyzed (687 patients/study group: 345, control group: 342). The methodological quality of most of the researches assessed was good. A superiority of the protocols is shown, since they are accompanied by a decrease in the incidence of perioperative complications (RR=0.61 [0.40, 0.93]). Similarly, they are related to the decrease in hospital stay (mean difference, random effect, was -2.98 [-3.31, -2.65]). Conclusions: Despite the few studies included, the evidence suggests that these programs improve the perioperative outcome of patients(AU)

Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Protocolo de Ensayo Clínico Aleatorizado / Assessment of the efficacy of improved recovery protocols in cardiac surgery. Randomized Clinical Trial Protocol

Introducción: Múltiples son los artículos publicados que abordan el tema de la ciencia abierta y su importancia para la sociedad, especialmente para la comunidad de investigadores. Esta constituye, ineludiblemente, el presente y futuro de las revistas científicas como método de expandir las investigaciones con alta calidad y credibilidad. La ciencia abierta como movimiento, tiene varios componentes y dentro de ellos, la gestión de citas y referencias de datos, códigos y materiales, que fundamentan la necesidad de que los autores tengan disponibles los contenidos subyacentes a los artículos que se publican y que constituyen la base de los resultados obtenidos en cada investigación. Objetivo: Evaluación de la eficacia de los protocolos de recuperación mejorada en cirugía cardiaca. Métodos: El protocolo que se propone fue elaborado por la investigadora principal (registro público cubano de ensayos clínicos RPCEC00000304) y se describe acorde a las recomendaciones de la lista internacional de chequeo para ensayos clínicos (SPIRIT). Conclusiones: Estarían en relación a si se puede demostrar, después de terminada la investigación, si el protocolo motivo de la Intervención, es mejor, igual o peor que el protocolo de control(AU)

Introduction: There are multiple articles published that address the subject of open science and its importance for society, especially for the research community. This constitutes, inevitably, the present and future of scientific journals as a method of expanding research with high quality and credibility. Open science, as a movement, has several components including the management of citations and references of data, codes and materials, which support the need for authors to have available the underlying content of the articles published and constituting the base for the results obtained in each investigation. Objective: Assessment of the efficacy of improved recovery protocols in cardiac surgery. Methods: The proposed protocol was prepared by the main researcher (Cuban public registry of clinical trials: RPCEC00000304) and is described according to the recommendations of the international checklist for clinical trials (SPIRIT). Conclusions: They would be related to whether it can be demonstrated, after the end of the investigation, if the protocol reason for the intervention is better, equal to, or worse than the control protocol(AU)

Expert consensus of perioperative management in pediatric liver transplantation / 中华外科杂志

Pediatric liver transplantation (PLT) is an effective strategy of treating various acute or chronic end-stage liver diseases and inherited metabolic diseases in children.PLT has been applied in many transplant centers nationwide and has achieved satisfactory results.However,the development of transplant centers is uneven,and there is a lack of consensus and standards within the industry.In order to reduce post-operative complications,accelerate post-operative recovery,and improve the short-and long-term quality of life of children,the Enhanced Recovery After Surgery Committee of Chinese Research Hospital Association organized multidisciplinary experts to summarize the progress of domestic and international research,and formulated a perioperative consensus on PLT based on the principles of evidence-based medicine.The consensus provides recommendations for perioperative PLT from three aspects:preoperative assessment and preparation,intraoperative management and postoperative management,in order to provide reference guidelines for centers that are conducting or preparing to conduct PLT.

Vías de recuperación mejorada perioperatoria: adaptación a la cirugía pediátrica / Enhanced recovery after surgery pathways: adaptation to pediatric surgery / Caminhos de melhora da recuperação perioperatória: adaptação à cirurgia pediátrica

Dos grandes cambios han mejorado los resultados anestésico quirúrgicos en los últimas décadas. La cirugía mínimamente invasiva (CMI) y la atención multidisciplinaria perioperatoria incorporando la medicina basada en la evidencia. Tradicionalmente, los cirujanos, anestesiólogos y enfermeras han prestado atención a las experiencias individuales. Las vías de recuperación mejorada, ERAS por sus siglas en inglés (Enhanced Recovery After Surgery) representan un cambio paradigmático de la atención tradicional, buscando integrar múltiples elementos individuales de la atención perioperatoria, así como el compromiso de los pacientes y cuidadores para comprender mejor el proceso de recuperación. Al aprovechar los logros alcanzados por las técnicas de CMI con las vías ERAS, el objetivo fue mejorar aún más la recuperación, disminuir las complicaciones y disminuir la variabilidad en la práctica, lo que a su vez se reflejaría en una internación más corta y con menos costos asistenciales. El desarrollo de la vía de recuperación mejorada no consiste en crear nuevas hipótesis para una mejor atención, sino más bien en la organización de la mejor evidencia científica disponible, que ayude a estandarizar la atención a través de una práctica, institución o sociedad profesional. En la siguiente revisión bibliográfica, buscamos el enfoque desde el punto de vista de la cirugía pediátrica, la cual presenta cada vez más interés en esta modalidad de atención.

Two major changes have improved anesthetic-surgical outcomes in recent decades. Minimally invasive surgery (CMI) and perioperative multidisciplinary care incorporating evidence-based medicine. Traditionally, surgeons, anesthesiologists and nurses have paid attention to individual experiences. Improved recovery pathways ERAS (Enhanced Recovery After Surgery) represent a paradigm shift of traditional care, seeking to integrate multiple individual elements of perioperative care, as well as the commitment of patients and caregivers to better understand the recovery process. By taking advantage of the achievements of the CMI techniques with the ERAS pathways, the objective was to further improve recovery, reduce complications and reduce variability in practice, which in turn would be reflected in a shorter hospital stay with less healthcare costs. The development of the improved recovery path does not consist of creating new hypotheses for better care, but rather in the organization of the best available scientific evidence, which helps to standardize care through a practice, institution or professional society. In the following bibliographical review, we look for the approach from the point of view of pediatric surgery, which presents more and more interest in this type of care.

Duas grandes mudanças melhoraram os resultados cirúrgicos da anestesia nas últimas décadas. Cirurgia minimamente invasiva (CMI) e assistência multidisciplinar perioperatória incorporando medicina baseada em evidências. Tradicionalmente, cirurgiões, anestesiologistas e enfermeiras prestam atenção às experiências individuais. Pathways recuperação avançada de ERAS por sua sigla em Inglês (Recuperação aprimorada após a cirurgia) representam uma mudança de paradigma de cuidados tradicionais, buscando integrar vários elementos individuais de cuidados perioperatórios e compromisso com os pacientes e cuidadores a entender melhor o processo de recuperação. Ao alavancar as realizações de técnicas CMI com ERAS forma, o objetivo foi o de melhorar ainda mais a recuperação, reduzir as complicações e reduzir a variabilidade na prática, que por sua vez se reflete em um hospital estadia mais curta e menos custos de saúde. O desenvolvimento de um melhor caminho de recuperação para não criar novas hipóteses de melhores cuidados, mas sim na organização da melhor evidência científica disponível, para ajudar a padronizar o cuidado através de uma prática, instituição ou sociedade profissional. Na revisão bibliográfica a seguir, buscamos a abordagem do ponto de vista da cirurgia pediátrica, que apresenta cada vez mais interesse nesse tipo de cuidado.

Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery: a single center cohort study / Aceleração da recuperação após protocolo cirúrgico versus cuidados perioperatórios convencionais em cirurgia colorretal: um estudo de coorte em centro único

Abstract Background Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. Methods Single center observational study. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, 3 years before (Pre-ERAS) and 2 years after (Post-ERAS) the implementation of an ERAS protocol. Baseline characteristics of both groups were compared. The primary outcome was the number of patients with 180 days follow-up with moderate or severe complications; secondary outcomes were postoperative length of stay, and specific complications. Data were extracted from patient records. Results There were 360 patients in the Pre-ERAS group and 319 patients in the Post-ERAS Group. 214 (59.8%) patients developed at least one complication in the pre ERAS group, versus 163 patients in the Post-ERAS group (51.10%). More patients in the Pre-ERAS group developed moderate or severe complications (31.9% vs. 22.26%, p = 0.009); and severe complications (15.5% vs. 5.3%; p < 0.0001). The median length of stay was 13 (17) days in Pre-ERAS Group and 11 (10) days in the Post-ERAS Group (p = 0.034). No differences were found on mortality rates (4.7% vs. 2.5%; p = 0.154), or readmission (6.39% vs. 4.39%; p = 0.31). Overall ERAS protocol compliance in the Post-ERAS cohort was 88%. Conclusions The implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay.

Resumo Justificativa O protocolo ERAS - do Inglês Enhanced Recovery After Surgery - consiste em um conjunto de medidas perioperatórias destinadas a melhorar a recuperação do paciente e diminuir o tempo de internação e as complicações pós-operatórias. Avaliamos a implantação e os resultados de um protocolo ERAS para cirurgia colorretal. Métodos Estudo observacional em centro único. Os dados foram coletados de pacientes consecutivos submetidos à cirurgia colorretal aberta ou laparoscópica durante dois períodos: três anos antes (pré-ERAS) e dois anos após (pós-ERAS) a implantação de um protocolo ERAS. As características basais de ambos os grupos foram comparadas. O desfecho primário foi o número de pacientes com 180 dias de acompanhamento com complicações moderadas ou graves. Os desfechos secundários foram tempo de internação pós-cirurgia e complicações específicas. Os dados foram extraídos de prontuários dos pacientes. Resultados O grupo pré-ERAS foi composto por 360 pacientes e o grupo pós-ERAS por 319. No grupo pré ERAS, 214 pacientes (59,8%) desenvolveram pelo menos uma complicação versus 163 (51,10%) no grupo pós-ERAS. Um número maior de pacientes do grupo pré-ERAS desenvolveu complicações moderadas ou graves (31,9% vs. 22,26%, p = 0,009); e complicações graves (15,5% vs. 5,3%; p < 0,0001). A mediana do tempo de internação foi de 13 (17) dias no grupo pré-ERAS e de 11 (10) dias no grupo pós-ERAS (p = 0,034). Não houve diferença nas taxas de mortalidade (4,7% vs. 2,5%; p = 0,1554) ou de reinternação (6,39% vs. 4,39%; p = 0,31). A conformidade geral do protocolo ERAS na coorte pós-ERAS foi de 88%. Conclusões A implantação do protocolo ERAS para cirurgia colorretal foi associada a uma redução significativa das complicações pós-operatórias e do tempo de internação.