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Enhanced recovery pathways for ambulatory surgery.

Girish P Joshi1

  • 1University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Current Opinion in Anaesthesiology
|October 1, 2020
PubMed
Summary

Enhanced recovery pathways (ERPs) enable complex surgeries in outpatient settings, improving patient safety and outcomes. Key elements include careful patient selection, optimized perioperative care, and a multidisciplinary approach for successful implementation.

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Area of Science:

  • Ambulatory Surgery
  • Perioperative Medicine
  • Surgical Outcomes

Background:

  • Enhanced recovery pathways (ERPs) facilitate the migration of complex surgical procedures from inpatient to outpatient settings.
  • These programs are designed to improve patient safety and enhance patient-reported outcomes.

Purpose of the Study:

  • To discuss the principles of enhanced recovery pathways in adults undergoing ambulatory surgery.
  • To highlight strategies for improving patient safety and postoperative outcomes in ambulatory surgical settings.

Main Methods:

  • Review of principles and elements of enhanced recovery pathways for ambulatory surgery.
  • Discussion of key factors influencing perioperative outcomes, including patient selection and perioperative management.

Main Results:

  • Successful implementation hinges on procedure and patient selection, optimization of comorbid conditions, and comprehensive patient education.
  • Key components include minimal preoperative fasting, adequate hydration, fast-track anesthesia, lung-protective ventilation, fluid balance, and multimodal prophylaxis for pain and nausea/vomiting.

Conclusions:

  • Enhanced recovery pathways necessitate a multidisciplinary approach, with anesthesiologists leading collaboration with surgeons and nurses.
  • Auditing compliance is crucial for evaluating success and refining protocols, using metrics like complication rates and readmission rates.