var bibbase_data = {"data":"<img src=\"//bibbase.org/img/ajax-loader.gif\" id=\"spinner\"\n  style=\"display: none;\" alt=\"Loading..\" />\n\n<div id=\"bibbase\">\n\n  <script type=\"text/javascript\">\n    var bibbase = {\n      params: {\"folding\":\"1\",\"jsonp\":\"1\",\"host\":\"bibbase.org\",\"ssl\":false},\n      data: [{\"title\":\"Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores\",\"type\":\"misc\",\"year\":\"2020\",\"source\":\"International Journal of Obstetric Anesthesia\",\"pages\":\"36-38\",\"volume\":\"43\",\"id\":\"9a9eafa6-0a0c-35f3-8003-9b7cd7b700af\",\"created\":\"2020-10-01T19:23:24.586Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-01T21:17:39.244Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"misc\",\"author\":\"Bollag, L. and Nelson, G.\",\"doi\":\"10.1016/j.ijoa.2020.05.006\",\"bibtex\":\"@misc{\\n title = {Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores},\\n type = {misc},\\n year = {2020},\\n source = {International Journal of Obstetric Anesthesia},\\n pages = {36-38},\\n volume = {43},\\n id = {9a9eafa6-0a0c-35f3-8003-9b7cd7b700af},\\n created = {2020-10-01T19:23:24.586Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-01T21:17:39.244Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {misc},\\n author = {Bollag, L. and Nelson, G.},\\n doi = {10.1016/j.ijoa.2020.05.006}\\n}\",\"author_short\":[\"Bollag,  L.\",\"Nelson,  G.\"],\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"bollag-nelson-enhancedrecoveryaftercesareaneracbeyondthepainscores-2020\",\"role\":\"author\",\"urls\":{},\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations\",\"type\":\"article\",\"year\":\"2020\",\"keywords\":\"ERAS,Enhanced Recovery After Surgery,gynecology,vaginal surgery,vulvar surgery\",\"pages\":\"475-485\",\"volume\":\"223\",\"websites\":\"https://doi.org/10.1016/j.ajog.2020.07.039\",\"publisher\":\"Elsevier Inc.\",\"id\":\"c86c1863-ca22-3f95-bf7f-dcf8aa465eb7\",\"created\":\"2020-10-05T20:47:07.487Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-05T20:47:40.984Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.\",\"bibtype\":\"article\",\"author\":\"Altman, Alon D. and Robert, Magali and Armbrust, Robert and Fawcett, William J. and Nihira, Mikio and Jones, Chris N. and Tamussino, Karl and Sehouli, Jalid and Dowdy, Sean C. and Nelson, Gregg\",\"doi\":\"10.1016/j.ajog.2020.07.039\",\"journal\":\"American Journal of Obstetrics and Gynecology\",\"number\":\"4\",\"bibtex\":\"@article{\\n title = {Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations},\\n type = {article},\\n year = {2020},\\n keywords = {ERAS,Enhanced Recovery After Surgery,gynecology,vaginal surgery,vulvar surgery},\\n pages = {475-485},\\n volume = {223},\\n websites = {https://doi.org/10.1016/j.ajog.2020.07.039},\\n publisher = {Elsevier Inc.},\\n id = {c86c1863-ca22-3f95-bf7f-dcf8aa465eb7},\\n created = {2020-10-05T20:47:07.487Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-05T20:47:40.984Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.},\\n bibtype = {article},\\n author = {Altman, Alon D. and Robert, Magali and Armbrust, Robert and Fawcett, William J. and Nihira, Mikio and Jones, Chris N. and Tamussino, Karl and Sehouli, Jalid and Dowdy, Sean C. and Nelson, Gregg},\\n doi = {10.1016/j.ajog.2020.07.039},\\n journal = {American Journal of Obstetrics and Gynecology},\\n number = {4}\\n}\",\"author_short\":[\"Altman,  A., D.\",\"Robert,  M.\",\"Armbrust,  R.\",\"Fawcett,  W., J.\",\"Nihira,  M.\",\"Jones,  C., N.\",\"Tamussino,  K.\",\"Sehouli,  J.\",\"Dowdy,  S., C.\",\"Nelson,  G.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2bf62eaf-bfb4-e613-0b8f-0e44da64c301/ERAS_Vulva_Vagina.pdf.pdf\",\"Website\":\"https://doi.org/10.1016/j.ajog.2020.07.039\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020\",\"role\":\"author\",\"keyword\":[\"ERAS\",\"Enhanced Recovery After Surgery\",\"gynecology\",\"vaginal surgery\",\"vulvar surgery\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study\",\"type\":\"article\",\"year\":\"2020\",\"pages\":\"252\",\"volume\":\"8\",\"id\":\"dd602a16-e91e-3bcc-aa92-ed38c2d239b0\",\"created\":\"2020-10-05T20:47:07.734Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.534Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.\",\"bibtype\":\"article\",\"author\":\"Johnson, Eric and Parrish II, Richard and Nelson, Gregg and Elias, Kevin and Kramer, Brian and Gaviola, Marian\",\"doi\":\"10.3390/healthcare8030252\",\"journal\":\"Healthcare\",\"number\":\"3\",\"bibtex\":\"@article{\\n title = {Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study},\\n type = {article},\\n year = {2020},\\n pages = {252},\\n volume = {8},\\n id = {dd602a16-e91e-3bcc-aa92-ed38c2d239b0},\\n created = {2020-10-05T20:47:07.734Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.534Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.},\\n bibtype = {article},\\n author = {Johnson, Eric and Parrish II, Richard and Nelson, Gregg and Elias, Kevin and Kramer, Brian and Gaviola, Marian},\\n doi = {10.3390/healthcare8030252},\\n journal = {Healthcare},\\n number = {3}\\n}\",\"author_short\":[\"Johnson,  E.\",\"Parrish II,  R.\",\"Nelson,  G.\",\"Elias,  K.\",\"Kramer,  B.\",\"Gaviola,  M.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/294ae642-d1f4-e343-631d-ca9fa084c559/ERAS_Pharmacy.pdf.pdf\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management\",\"type\":\"article\",\"year\":\"2020\",\"keywords\":\"Cytoreductive surgery,Enhanced recovery,Guidelines,HIPEC,Perioperative care\",\"id\":\"00838a02-8933-3411-8ab6-7db42183e222\",\"created\":\"2020-10-05T20:47:07.745Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-05T20:47:23.451Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.\",\"bibtype\":\"article\",\"author\":\"Hübner, Martin and Kusamura, Shigeki and Villeneuve, Laurent and Al-Niaimi, Ahmed and Alyami, Mohammad and Balonov, Konstantin and Bell, John and Bristow, Robert and Guiral, Delia Cortés and Fagotti, Anna and Falcão, Luiz Fernando R. and Glehen, Olivier and Lambert, Laura and Mack, Lloyd and Muenster, Tino and Piso, Pompiliu and Pocard, Marc and Rau, Beate and Sgarbura, Olivia and somashekhar, S. P. and Wadhwa, Anupama and Altman, Alon and Fawcett, William and Veerapong, Jula and Nelson, Gregg\",\"doi\":\"10.1016/j.ejso.2020.07.041\",\"journal\":\"European Journal of Surgical Oncology\",\"number\":\"xxxx\",\"bibtex\":\"@article{\\n title = {Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management},\\n type = {article},\\n year = {2020},\\n keywords = {Cytoreductive surgery,Enhanced recovery,Guidelines,HIPEC,Perioperative care},\\n id = {00838a02-8933-3411-8ab6-7db42183e222},\\n created = {2020-10-05T20:47:07.745Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-05T20:47:23.451Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.},\\n bibtype = {article},\\n author = {Hübner, Martin and Kusamura, Shigeki and Villeneuve, Laurent and Al-Niaimi, Ahmed and Alyami, Mohammad and Balonov, Konstantin and Bell, John and Bristow, Robert and Guiral, Delia Cortés and Fagotti, Anna and Falcão, Luiz Fernando R. and Glehen, Olivier and Lambert, Laura and Mack, Lloyd and Muenster, Tino and Piso, Pompiliu and Pocard, Marc and Rau, Beate and Sgarbura, Olivia and somashekhar, S. P. and Wadhwa, Anupama and Altman, Alon and Fawcett, William and Veerapong, Jula and Nelson, Gregg},\\n doi = {10.1016/j.ejso.2020.07.041},\\n journal = {European Journal of Surgical Oncology},\\n number = {xxxx}\\n}\",\"author_short\":[\"Hübner,  M.\",\"Kusamura,  S.\",\"Villeneuve,  L.\",\"Al-Niaimi,  A.\",\"Alyami,  M.\",\"Balonov,  K.\",\"Bell,  J.\",\"Bristow,  R.\",\"Guiral,  D., C.\",\"Fagotti,  A.\",\"Falcão,  L., F., R.\",\"Glehen,  O.\",\"Lambert,  L.\",\"Mack,  L.\",\"Muenster,  T.\",\"Piso,  P.\",\"Pocard,  M.\",\"Rau,  B.\",\"Sgarbura,  O.\",\"somashekhar,  S., P.\",\"Wadhwa,  A.\",\"Altman,  A.\",\"Fawcett,  W.\",\"Veerapong,  J.\",\"Nelson,  G.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1d482058-a414-d69b-4ee5-28cd0394c685/ERAS_CRS_HIPEC_Part_I.pdf.pdf\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020\",\"role\":\"author\",\"keyword\":[\"Cytoreductive surgery\",\"Enhanced recovery\",\"Guidelines\",\"HIPEC\",\"Perioperative care\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":1,\"html\":\"\"},{\"title\":\"Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice\",\"type\":\"article\",\"year\":\"2020\",\"keywords\":\"gynecologic surgical procedures,ovarian cancer,postoperative care,postoperative complications,surgical procedures, operative\",\"pages\":\"1471-1478\",\"volume\":\"30\",\"id\":\"cc678440-9358-3472-8652-2422b7d047b2\",\"created\":\"2020-10-05T20:47:07.785Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.123Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.\",\"bibtype\":\"article\",\"author\":\"Bhandoria, Geetu Prakash and Bhandarkar, Prashant and Ahuja, Vijay and Maheshwari, Amita and Sekhon, Rupinder K. and Gultekin, Murat and Ayhan, Ali and Demirkiran, Fuat and Kahramanoglu, Ilker and Wan, Yee Loi Louise and Knapp, Pawel and Dobroch, Jakub and Zmaczyński, Andrzej and Jach, Robert and Nelson, Gregg\",\"doi\":\"10.1136/ijgc-2020-001683\",\"journal\":\"International Journal of Gynecological Cancer\",\"number\":\"10\",\"bibtex\":\"@article{\\n title = {Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice},\\n type = {article},\\n year = {2020},\\n keywords = {gynecologic surgical procedures,ovarian cancer,postoperative care,postoperative complications,surgical procedures, operative},\\n pages = {1471-1478},\\n volume = {30},\\n id = {cc678440-9358-3472-8652-2422b7d047b2},\\n created = {2020-10-05T20:47:07.785Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.123Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.},\\n bibtype = {article},\\n author = {Bhandoria, Geetu Prakash and Bhandarkar, Prashant and Ahuja, Vijay and Maheshwari, Amita and Sekhon, Rupinder K. and Gultekin, Murat and Ayhan, Ali and Demirkiran, Fuat and Kahramanoglu, Ilker and Wan, Yee Loi Louise and Knapp, Pawel and Dobroch, Jakub and Zmaczyński, Andrzej and Jach, Robert and Nelson, Gregg},\\n doi = {10.1136/ijgc-2020-001683},\\n journal = {International Journal of Gynecological Cancer},\\n number = {10}\\n}\",\"author_short\":[\"Bhandoria,  G., P.\",\"Bhandarkar,  P.\",\"Ahuja,  V.\",\"Maheshwari,  A.\",\"Sekhon,  R., K.\",\"Gultekin,  M.\",\"Ayhan,  A.\",\"Demirkiran,  F.\",\"Kahramanoglu,  I.\",\"Wan,  Y., L., L.\",\"Knapp,  P.\",\"Dobroch,  J.\",\"Zmaczyński,  A.\",\"Jach,  R.\",\"Nelson,  G.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/506685b1-94f4-df83-2673-e527c9b4c8dd/ERAS_Gyne_Onc_Peri_op.pdf.pdf\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020\",\"role\":\"author\",\"keyword\":[\"gynecologic surgical procedures\",\"ovarian cancer\",\"postoperative care\",\"postoperative complications\",\"surgical procedures\",\"operative\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes\",\"type\":\"article\",\"year\":\"2020\",\"volume\":\"000\",\"websites\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/\",\"id\":\"b4c3ef8d-ecdd-3bae-993f-c962d2512c79\",\"created\":\"2020-10-05T20:47:07.792Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-05T20:47:15.943Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"article\",\"author\":\"Gregory, Alexander J. and Grant, Michael C. and Boyle, Edward and Arora, Rakesh C. and Williams, Judson B. and Salenger, Rawn and Chatterjee, Subhasis and Lobdell, Kevin W. and Jahangiri, Marjan and Engelman, Daniel T.\",\"doi\":\"10.1053/j.jvca.2020.08.007\",\"journal\":\"Journal of Cardiothoracic and Vascular Anesthesia\",\"bibtex\":\"@article{\\n title = {Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes},\\n type = {article},\\n year = {2020},\\n volume = {000},\\n websites = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/},\\n id = {b4c3ef8d-ecdd-3bae-993f-c962d2512c79},\\n created = {2020-10-05T20:47:07.792Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-05T20:47:15.943Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {article},\\n author = {Gregory, Alexander J. and Grant, Michael C. and Boyle, Edward and Arora, Rakesh C. and Williams, Judson B. and Salenger, Rawn and Chatterjee, Subhasis and Lobdell, Kevin W. and Jahangiri, Marjan and Engelman, Daniel T.},\\n doi = {10.1053/j.jvca.2020.08.007},\\n journal = {Journal of Cardiothoracic and Vascular Anesthesia}\\n}\",\"author_short\":[\"Gregory,  A., J.\",\"Grant,  M., C.\",\"Boyle,  E.\",\"Arora,  R., C.\",\"Williams,  J., B.\",\"Salenger,  R.\",\"Chatterjee,  S.\",\"Lobdell,  K., W.\",\"Jahangiri,  M.\",\"Engelman,  D., T.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/200d6a16-64bc-ce49-7e02-a1828fd4cb35/Gregory_et_al_2020_Journal_of_Cardiothoracic_Vascular_Anesthesia.pdf.pdf\",\"Website\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)\",\"type\":\"article\",\"year\":\"2020\",\"pages\":\"3197-3198\",\"volume\":\"44\",\"websites\":\"https://doi.org/10.1007/s00268-020-05734-5\",\"publisher\":\"Springer International Publishing\",\"id\":\"f213822b-9c4a-3af4-ad2f-263a60cb65d3\",\"created\":\"2020-10-05T20:47:07.968Z\",\"file_attached\":\"true\",\"profile_id\":\"cc3590e9-225c-33d0-b4a2-69b4f662f67d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-05T20:47:18.108Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"article\",\"author\":\"Ljungqvist, Olle and Nelson, Gregg and Demartines, Nicolas\",\"doi\":\"10.1007/s00268-020-05734-5\",\"journal\":\"World Journal of Surgery\",\"number\":\"10\",\"bibtex\":\"@article{\\n title = {The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)},\\n type = {article},\\n year = {2020},\\n pages = {3197-3198},\\n volume = {44},\\n websites = {https://doi.org/10.1007/s00268-020-05734-5},\\n publisher = {Springer International Publishing},\\n id = {f213822b-9c4a-3af4-ad2f-263a60cb65d3},\\n created = {2020-10-05T20:47:07.968Z},\\n file_attached = {true},\\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-05T20:47:18.108Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {article},\\n author = {Ljungqvist, Olle and Nelson, Gregg and Demartines, Nicolas},\\n doi = {10.1007/s00268-020-05734-5},\\n journal = {World Journal of Surgery},\\n number = {10}\\n}\",\"author_short\":[\"Ljungqvist,  O.\",\"Nelson,  G.\",\"Demartines,  N.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/62b827bb-5fff-5fa7-69c9-ffaff2e4cc61/Ljungqvist2020_Article_ThePostCOVID_19SurgicalBacklog.pdf.pdf\",\"Website\":\"https://doi.org/10.1007/s00268-020-05734-5\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration\",\"type\":\"article\",\"year\":\"2020\",\"pages\":\"E19-E20\",\"volume\":\"63\",\"websites\":\"http://canjsurg.ca/vol63-issue1/63-1-E19/\",\"month\":\"10\",\"day\":\"8\",\"id\":\"54e6843d-4d50-3fae-8d30-bfd82209d138\",\"created\":\"2020-10-08T17:27:28.414Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.557Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"private_publication\":false,\"abstract\":\"Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute's Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.\",\"bibtype\":\"article\",\"author\":\"Gramlich, Leah M. and Surgeoner, Brae and Baldini, Gabriele and Ballah, Erin and Baum, Melinda and Carli, Franco and Karimuddin, Ahmer A. and Nelson, Gregg and Richebé, Philippe and Watson, Deborah and Williams, Carla and LaFlamme, Claude\",\"doi\":\"10.1503/cjs.006819\",\"journal\":\"Canadian Journal of Surgery\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration},\\n type = {article},\\n year = {2020},\\n pages = {E19-E20},\\n volume = {63},\\n websites = {http://canjsurg.ca/vol63-issue1/63-1-E19/},\\n month = {10},\\n day = {8},\\n id = {54e6843d-4d50-3fae-8d30-bfd82209d138},\\n created = {2020-10-08T17:27:28.414Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.557Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n private_publication = {false},\\n abstract = {Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute's Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.},\\n bibtype = {article},\\n author = {Gramlich, Leah M. and Surgeoner, Brae and Baldini, Gabriele and Ballah, Erin and Baum, Melinda and Carli, Franco and Karimuddin, Ahmer A. and Nelson, Gregg and Richebé, Philippe and Watson, Deborah and Williams, Carla and LaFlamme, Claude},\\n doi = {10.1503/cjs.006819},\\n journal = {Canadian Journal of Surgery},\\n number = {1}\\n}\",\"author_short\":[\"Gramlich,  L., M.\",\"Surgeoner,  B.\",\"Baldini,  G.\",\"Ballah,  E.\",\"Baum,  M.\",\"Carli,  F.\",\"Karimuddin,  A., A.\",\"Nelson,  G.\",\"Richebé,  P.\",\"Watson,  D.\",\"Williams,  C.\",\"LaFlamme,  C.\"],\"urls\":{\"Website\":\"http://canjsurg.ca/vol63-issue1/63-1-E19/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations\",\"type\":\"article\",\"year\":\"2020\",\"pages\":\"2482-2492\",\"volume\":\"44\",\"websites\":\"http://link.springer.com/10.1007/s00268-020-05530-1\",\"month\":\"10\",\"day\":\"8\",\"id\":\"71a8673b-a631-39b2-8eaf-d6ffe7611e3d\",\"created\":\"2020-10-08T17:27:28.433Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.108Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"Background: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.\",\"bibtype\":\"article\",\"author\":\"Brindle, Mary E. and McDiarmid, Caraline and Short, Kristin and Miller, Kathleen and MacRobie, Ali and Lam, Jennifer Y.K. and Brockel, Megan and Raval, Mehul V. and Howlett, Alexandra and Lee, Kyong Soon and Offringa, Martin and Wong, Kenneth and de Beer, David and Wester, Tomas and Skarsgard, Erik D. and Wales, Paul W. and Fecteau, Annie and Haliburton, Beth and Goobie, Susan M. and Nelson, Gregg\",\"doi\":\"10.1007/s00268-020-05530-1\",\"journal\":\"World Journal of Surgery\",\"number\":\"8\",\"bibtex\":\"@article{\\n title = {Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations},\\n type = {article},\\n year = {2020},\\n pages = {2482-2492},\\n volume = {44},\\n websites = {http://link.springer.com/10.1007/s00268-020-05530-1},\\n month = {10},\\n day = {8},\\n id = {71a8673b-a631-39b2-8eaf-d6ffe7611e3d},\\n created = {2020-10-08T17:27:28.433Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.108Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {Background: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.},\\n bibtype = {article},\\n author = {Brindle, Mary E. and McDiarmid, Caraline and Short, Kristin and Miller, Kathleen and MacRobie, Ali and Lam, Jennifer Y.K. and Brockel, Megan and Raval, Mehul V. and Howlett, Alexandra and Lee, Kyong Soon and Offringa, Martin and Wong, Kenneth and de Beer, David and Wester, Tomas and Skarsgard, Erik D. and Wales, Paul W. and Fecteau, Annie and Haliburton, Beth and Goobie, Susan M. and Nelson, Gregg},\\n doi = {10.1007/s00268-020-05530-1},\\n journal = {World Journal of Surgery},\\n number = {8}\\n}\",\"author_short\":[\"Brindle,  M., E.\",\"McDiarmid,  C.\",\"Short,  K.\",\"Miller,  K.\",\"MacRobie,  A.\",\"Lam,  J., Y.\",\"Brockel,  M.\",\"Raval,  M., V.\",\"Howlett,  A.\",\"Lee,  K., S.\",\"Offringa,  M.\",\"Wong,  K.\",\"de Beer,  D.\",\"Wester,  T.\",\"Skarsgard,  E., D.\",\"Wales,  P., W.\",\"Fecteau,  A.\",\"Haliburton,  B.\",\"Goobie,  S., M.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"http://link.springer.com/10.1007/s00268-020-05530-1\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"enhanced recovery after surgery,food,nutrition therapy,patient satisfaction,qualitative research\",\"pages\":\"606-615\",\"volume\":\"34\",\"websites\":\"http://doi.wiley.com/10.1002/ncp.10215\",\"month\":\"10\",\"day\":\"8\",\"id\":\"d0b9fc81-d257-318e-844e-687913c6d9b6\",\"created\":\"2020-10-08T17:27:28.632Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.547Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"Background: Close adherence to the Enhanced Recovery After Surgery (ERAS) program is associated with improved outcomes. A nutrition-focused qualitative analysis of patient experience and of ERAS implementation across our province was conducted to better understand the barriers to successful adoption of ERAS nutrition elements. Methods: Enrolled colorectal patients (n = 27) were asked to describe their surgical experience. Narrative interviews (n = 20) and focus groups (n = 7) were transcribed verbatim and analyzed inductively for food and nutrition themes. Qualitative data sources (n = 198 documents) collected throughout our implementation of ERAS were categorized as institutional barriers that impeded the successful adoption of ERAS nutrition practices. Results: We identified patient barriers related to 3 main themes. The first theme, Mistaken nutrition facts & beliefs, describes how information provision was a key barrier to the successful adoption of nutrition elements. Patients held misconceptions and providers tended to provide them with contradictory nutrition messages, ultimately impeding adequate food intake and adherence to ERAS elements. The second theme, White bread is good for the soul?, represents a mismatch between prescribed medical diets and patient priorities. The third theme, Food is medicine, details patient beliefs that food is healing; the perception that nutritious food and dietary support was lacking produced dissatisfaction among patients. Overall, the most important institutional barrier limiting successful adoption of nutrition practices was the lack of education for patients and providers. Conclusion: Applying a patient-centered model of care that focuses on personalizing the ERAS nutrition elements might be a useful strategy to improve patient satisfaction, encourage food intake, correct previously held beliefs, and promote care adherence.\",\"bibtype\":\"article\",\"author\":\"Gillis, Chelsia and Martin, Lisa and Gill, Marlyn and Gilmour, Loreen and Nelson, Gregg and Gramlich, Leah\",\"doi\":\"10.1002/ncp.10215\",\"journal\":\"Nutrition in Clinical Practice\",\"number\":\"4\",\"bibtex\":\"@article{\\n title = {Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting},\\n type = {article},\\n year = {2019},\\n keywords = {enhanced recovery after surgery,food,nutrition therapy,patient satisfaction,qualitative research},\\n pages = {606-615},\\n volume = {34},\\n websites = {http://doi.wiley.com/10.1002/ncp.10215},\\n month = {10},\\n day = {8},\\n id = {d0b9fc81-d257-318e-844e-687913c6d9b6},\\n created = {2020-10-08T17:27:28.632Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.547Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {Background: Close adherence to the Enhanced Recovery After Surgery (ERAS) program is associated with improved outcomes. A nutrition-focused qualitative analysis of patient experience and of ERAS implementation across our province was conducted to better understand the barriers to successful adoption of ERAS nutrition elements. Methods: Enrolled colorectal patients (n = 27) were asked to describe their surgical experience. Narrative interviews (n = 20) and focus groups (n = 7) were transcribed verbatim and analyzed inductively for food and nutrition themes. Qualitative data sources (n = 198 documents) collected throughout our implementation of ERAS were categorized as institutional barriers that impeded the successful adoption of ERAS nutrition practices. Results: We identified patient barriers related to 3 main themes. The first theme, Mistaken nutrition facts & beliefs, describes how information provision was a key barrier to the successful adoption of nutrition elements. Patients held misconceptions and providers tended to provide them with contradictory nutrition messages, ultimately impeding adequate food intake and adherence to ERAS elements. The second theme, White bread is good for the soul?, represents a mismatch between prescribed medical diets and patient priorities. The third theme, Food is medicine, details patient beliefs that food is healing; the perception that nutritious food and dietary support was lacking produced dissatisfaction among patients. Overall, the most important institutional barrier limiting successful adoption of nutrition practices was the lack of education for patients and providers. Conclusion: Applying a patient-centered model of care that focuses on personalizing the ERAS nutrition elements might be a useful strategy to improve patient satisfaction, encourage food intake, correct previously held beliefs, and promote care adherence.},\\n bibtype = {article},\\n author = {Gillis, Chelsia and Martin, Lisa and Gill, Marlyn and Gilmour, Loreen and Nelson, Gregg and Gramlich, Leah},\\n doi = {10.1002/ncp.10215},\\n journal = {Nutrition in Clinical Practice},\\n number = {4}\\n}\",\"author_short\":[\"Gillis,  C.\",\"Martin,  L.\",\"Gill,  M.\",\"Gilmour,  L.\",\"Nelson,  G.\",\"Gramlich,  L.\"],\"urls\":{\"Website\":\"http://doi.wiley.com/10.1002/ncp.10215\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019\",\"role\":\"author\",\"keyword\":[\"enhanced recovery after surgery\",\"food\",\"nutrition therapy\",\"patient satisfaction\",\"qualitative research\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"Caesarean section,Enhanced Recovery After Surgery (ERAS),obstetrical surgery,perioperative care\",\"pages\":\"1775-1788\",\"volume\":\"41\",\"websites\":\"https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164\",\"month\":\"10\",\"day\":\"8\",\"id\":\"1b4f2bc0-880f-3284-aef5-67b85a886171\",\"created\":\"2020-10-08T17:27:28.689Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.130Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"There is an increasing body of evidence to support the success of Enhanced Recovery After Surgery (ERAS) for a wide range of surgical procedures. There has been little formalized application, however, of ERAS principles in obstetrical surgery. The aim of this review was to examine the evidence base of perioperative care for patients undergoing Caesarean delivery (CD) and to determine the feasibility of developing an ERAS Society guideline for this obstetrical care plan. The literature on enhanced recovery programs was reviewed, including fast-track surgery and perioperative care components in the preoperative, intraoperative, and postoperative phases of CD. These studies included randomized controlled trials (RCTs), prospective cohort studies, non-RCT studies, meta-analyses, systematic reviews, reviews, and case studies. This is not a systematic review because each ERAS topic area would require a new question. Certain ERAS elements have the potential to benefit patients undergoing CD. These elements include patient education, preoperative optimization, prophylaxis against thromboembolism, antimicrobial prophylaxis, postoperative nausea and vomiting prevention, hypothermia prevention, perioperative fluid management, postoperative analgesia, ileus prevention, breastfeeding promotion, and early mobilization. ERAS has the potential to be successfully implemented in CD on the basis of the evidence obtained from this review. Knowledge transfer and implementation will require multidisciplinary coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS guideline.\",\"bibtype\":\"article\",\"author\":\"Huang, Jeffrey and Cao, Cathy and Nelson, Gregg and Wilson, R. Douglas\",\"doi\":\"10.1016/j.jogc.2018.05.043\",\"journal\":\"Journal of Obstetrics and Gynaecology Canada\",\"number\":\"12\",\"bibtex\":\"@article{\\n title = {A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery},\\n type = {article},\\n year = {2019},\\n keywords = {Caesarean section,Enhanced Recovery After Surgery (ERAS),obstetrical surgery,perioperative care},\\n pages = {1775-1788},\\n volume = {41},\\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164},\\n month = {10},\\n day = {8},\\n id = {1b4f2bc0-880f-3284-aef5-67b85a886171},\\n created = {2020-10-08T17:27:28.689Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.130Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {There is an increasing body of evidence to support the success of Enhanced Recovery After Surgery (ERAS) for a wide range of surgical procedures. There has been little formalized application, however, of ERAS principles in obstetrical surgery. The aim of this review was to examine the evidence base of perioperative care for patients undergoing Caesarean delivery (CD) and to determine the feasibility of developing an ERAS Society guideline for this obstetrical care plan. The literature on enhanced recovery programs was reviewed, including fast-track surgery and perioperative care components in the preoperative, intraoperative, and postoperative phases of CD. These studies included randomized controlled trials (RCTs), prospective cohort studies, non-RCT studies, meta-analyses, systematic reviews, reviews, and case studies. This is not a systematic review because each ERAS topic area would require a new question. Certain ERAS elements have the potential to benefit patients undergoing CD. These elements include patient education, preoperative optimization, prophylaxis against thromboembolism, antimicrobial prophylaxis, postoperative nausea and vomiting prevention, hypothermia prevention, perioperative fluid management, postoperative analgesia, ileus prevention, breastfeeding promotion, and early mobilization. ERAS has the potential to be successfully implemented in CD on the basis of the evidence obtained from this review. Knowledge transfer and implementation will require multidisciplinary coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS guideline.},\\n bibtype = {article},\\n author = {Huang, Jeffrey and Cao, Cathy and Nelson, Gregg and Wilson, R. Douglas},\\n doi = {10.1016/j.jogc.2018.05.043},\\n journal = {Journal of Obstetrics and Gynaecology Canada},\\n number = {12}\\n}\",\"author_short\":[\"Huang,  J.\",\"Cao,  C.\",\"Nelson,  G.\",\"Wilson,  R., D.\"],\"urls\":{\"Website\":\"https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019\",\"role\":\"author\",\"keyword\":[\"Caesarean section\",\"Enhanced Recovery After Surgery (ERAS)\",\"obstetrical surgery\",\"perioperative care\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives\",\"type\":\"article\",\"year\":\"2020\",\"keywords\":\"Enhanced recovery after surgery,Implementation,Leadership perspectives,Sustainability\",\"pages\":\"361\",\"volume\":\"20\",\"websites\":\"https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0\",\"month\":\"10\",\"day\":\"8\",\"id\":\"e01cf6f2-4454-3c64-ba53-cbde2973aa33\",\"created\":\"2020-10-08T17:27:28.771Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.123Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"Background: Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system. Methods: Alberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple's, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12. Results: Forty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines. Conclusions: Health care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.\",\"bibtype\":\"article\",\"author\":\"Gramlich, Leah and Nelson, Gregg and Nelson, Alison and Lagendyk, Laura and Gilmour, Loreen E. and Wasylak, Tracy\",\"doi\":\"10.1186/s12913-020-05227-0\",\"journal\":\"BMC Health Services Research\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives},\\n type = {article},\\n year = {2020},\\n keywords = {Enhanced recovery after surgery,Implementation,Leadership perspectives,Sustainability},\\n pages = {361},\\n volume = {20},\\n websites = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0},\\n month = {10},\\n day = {8},\\n id = {e01cf6f2-4454-3c64-ba53-cbde2973aa33},\\n created = {2020-10-08T17:27:28.771Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.123Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {Background: Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system. Methods: Alberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple's, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12. Results: Forty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines. Conclusions: Health care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.},\\n bibtype = {article},\\n author = {Gramlich, Leah and Nelson, Gregg and Nelson, Alison and Lagendyk, Laura and Gilmour, Loreen E. and Wasylak, Tracy},\\n doi = {10.1186/s12913-020-05227-0},\\n journal = {BMC Health Services Research},\\n number = {1}\\n}\",\"author_short\":[\"Gramlich,  L.\",\"Nelson,  G.\",\"Nelson,  A.\",\"Lagendyk,  L.\",\"Gilmour,  L., E.\",\"Wasylak,  T.\"],\"urls\":{\"Website\":\"https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020\",\"role\":\"author\",\"keyword\":[\"Enhanced recovery after surgery\",\"Implementation\",\"Leadership perspectives\",\"Sustainability\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"cesarean delivery,enhanced recovery\",\"pages\":\"247.e1-247.e9\",\"volume\":\"221\",\"websites\":\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721\",\"month\":\"10\",\"day\":\"8\",\"id\":\"2751aba3-c6e2-3959-8819-9c45b1bb0677\",\"created\":\"2020-10-08T17:27:28.775Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.555Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"Background: This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. Objective: The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. Study Design: The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Delivery,” “Cesarean Section Delivery,” and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. Results: The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. Conclusion: As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.\",\"bibtype\":\"article\",\"author\":\"Macones, George A. and Caughey, Aaron B. and Wood, Stephen L. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg and Wilson, R. Douglas\",\"doi\":\"10.1016/j.ajog.2019.04.012\",\"journal\":\"American Journal of Obstetrics and Gynecology\",\"number\":\"3\",\"bibtex\":\"@article{\\n title = {Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)},\\n type = {article},\\n year = {2019},\\n keywords = {cesarean delivery,enhanced recovery},\\n pages = {247.e1-247.e9},\\n volume = {221},\\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721},\\n month = {10},\\n day = {8},\\n id = {2751aba3-c6e2-3959-8819-9c45b1bb0677},\\n created = {2020-10-08T17:27:28.775Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.555Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {Background: This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. Objective: The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. Study Design: The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Delivery,” “Cesarean Section Delivery,” and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. Results: The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. Conclusion: As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.},\\n bibtype = {article},\\n author = {Macones, George A. and Caughey, Aaron B. and Wood, Stephen L. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg and Wilson, R. Douglas},\\n doi = {10.1016/j.ajog.2019.04.012},\\n journal = {American Journal of Obstetrics and Gynecology},\\n number = {3}\\n}\",\"author_short\":[\"Macones,  G., A.\",\"Caughey,  A., B.\",\"Wood,  S., L.\",\"Wrench,  I., J.\",\"Huang,  J.\",\"Norman,  M.\",\"Pettersson,  K.\",\"Fawcett,  W., J.\",\"Shalabi,  M., M.\",\"Metcalfe,  A.\",\"Gramlich,  L.\",\"Nelson,  G.\",\"Wilson,  R., D.\"],\"urls\":{\"Website\":\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019\",\"role\":\"author\",\"keyword\":[\"cesarean delivery\",\"enhanced recovery\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs\",\"type\":\"article\",\"year\":\"2019\",\"pages\":\"3020-3021\",\"volume\":\"33\",\"websites\":\"https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750\",\"month\":\"10\",\"day\":\"8\",\"id\":\"2500df8a-cb08-3514-869b-9f2b5ed9be0c\",\"created\":\"2020-10-08T17:27:28.775Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.105Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"bibtype\":\"article\",\"author\":\"Gregory, Alexander J.\",\"doi\":\"10.1053/j.jvca.2019.06.022\",\"journal\":\"Journal of Cardiothoracic and Vascular Anesthesia\",\"number\":\"11\",\"bibtex\":\"@article{\\n title = {Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs},\\n type = {article},\\n year = {2019},\\n pages = {3020-3021},\\n volume = {33},\\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750},\\n month = {10},\\n day = {8},\\n id = {2500df8a-cb08-3514-869b-9f2b5ed9be0c},\\n created = {2020-10-08T17:27:28.775Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.105Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n bibtype = {article},\\n author = {Gregory, Alexander J.},\\n doi = {10.1053/j.jvca.2019.06.022},\\n journal = {Journal of Cardiothoracic and Vascular Anesthesia},\\n number = {11}\\n}\",\"author_short\":[\"Gregory,  A., J.\"],\"urls\":{\"Website\":\"https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"ERAS,compliance,gynecologic oncology,gynecologic surgery,length of stay,perioperative care\",\"pages\":\"237.e1-237.e11\",\"volume\":\"221\",\"websites\":\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131\",\"month\":\"10\",\"day\":\"8\",\"id\":\"858a502a-ffac-3b05-ac1e-e7d950fb3be3\",\"created\":\"2020-10-08T17:27:28.807Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.821Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"abstract\":\"Background: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. Objective: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. Study Design: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. Results: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4–11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90–0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82–0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. Conclusion: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.\",\"bibtype\":\"article\",\"author\":\"Wijk, Lena and Udumyan, Ruzan and Pache, Basile and Altman, Alon D. and Williams, Laura L. and Elias, Kevin M. and McGee, Jake and Wells, Tiffany and Gramlich, Leah and Holcomb, Kevin and Achtari, Chahin and Ljungqvist, Olle and Dowdy, Sean C. and Nelson, Gregg\",\"doi\":\"10.1016/j.ajog.2019.04.028\",\"journal\":\"American Journal of Obstetrics and Gynecology\",\"number\":\"3\",\"bibtex\":\"@article{\\n title = {International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery},\\n type = {article},\\n year = {2019},\\n keywords = {ERAS,compliance,gynecologic oncology,gynecologic surgery,length of stay,perioperative care},\\n pages = {237.e1-237.e11},\\n volume = {221},\\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131},\\n month = {10},\\n day = {8},\\n id = {858a502a-ffac-3b05-ac1e-e7d950fb3be3},\\n created = {2020-10-08T17:27:28.807Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.821Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n abstract = {Background: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. Objective: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. Study Design: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. Results: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4–11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90–0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82–0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. Conclusion: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.},\\n bibtype = {article},\\n author = {Wijk, Lena and Udumyan, Ruzan and Pache, Basile and Altman, Alon D. and Williams, Laura L. and Elias, Kevin M. and McGee, Jake and Wells, Tiffany and Gramlich, Leah and Holcomb, Kevin and Achtari, Chahin and Ljungqvist, Olle and Dowdy, Sean C. and Nelson, Gregg},\\n doi = {10.1016/j.ajog.2019.04.028},\\n journal = {American Journal of Obstetrics and Gynecology},\\n number = {3}\\n}\",\"author_short\":[\"Wijk,  L.\",\"Udumyan,  R.\",\"Pache,  B.\",\"Altman,  A., D.\",\"Williams,  L., L.\",\"Elias,  K., M.\",\"McGee,  J.\",\"Wells,  T.\",\"Gramlich,  L.\",\"Holcomb,  K.\",\"Achtari,  C.\",\"Ljungqvist,  O.\",\"Dowdy,  S., C.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019\",\"role\":\"author\",\"keyword\":[\"ERAS\",\"compliance\",\"gynecologic oncology\",\"gynecologic surgery\",\"length of stay\",\"perioperative care\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Efficacy of TAP blocks following ovarian cancer surgery\",\"type\":\"article\",\"year\":\"2019\",\"pages\":\"151\",\"volume\":\"154\",\"websites\":\"https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546\",\"month\":\"10\",\"day\":\"8\",\"id\":\"9a1fa7e0-bcef-32ca-9fca-140e96afff7a\",\"created\":\"2020-10-08T17:27:28.852Z\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.126Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"source_type\":\"JOUR\",\"language\":\"en\",\"private_publication\":false,\"bibtype\":\"article\",\"author\":\"Bisch, S.P. and Glaze, S.J. and Cameron, A. and Nation, J. and Nelson, G.\",\"doi\":\"10.1016/j.ygyno.2019.04.356\",\"journal\":\"Gynecologic Oncology\",\"bibtex\":\"@article{\\n title = {Efficacy of TAP blocks following ovarian cancer surgery},\\n type = {article},\\n year = {2019},\\n pages = {151},\\n volume = {154},\\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546},\\n month = {10},\\n day = {8},\\n id = {9a1fa7e0-bcef-32ca-9fca-140e96afff7a},\\n created = {2020-10-08T17:27:28.852Z},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.126Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n source_type = {JOUR},\\n language = {en},\\n private_publication = {false},\\n bibtype = {article},\\n author = {Bisch, S.P. and Glaze, S.J. and Cameron, A. and Nation, J. and Nelson, G.},\\n doi = {10.1016/j.ygyno.2019.04.356},\\n journal = {Gynecologic Oncology}\\n}\",\"author_short\":[\"Bisch,  S.\",\"Glaze,  S.\",\"Cameron,  A.\",\"Nation,  J.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Nutrients\",\"keywords\":\"ERAS,Enhanced recovery after surgery,Gynecologic/oncology,Nutrition\",\"volume\":\"11\",\"issue\":\"5\",\"websites\":\"/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/\",\"month\":\"5\",\"publisher\":\"MDPI AG\",\"day\":\"1\",\"id\":\"199ba733-8435-31d1-a2dd-b25546021c22\",\"created\":\"2020-10-08T17:33:58.219Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.800Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Enhanced recovery after surgery (ERAS) pathways aim to improve surgical outcomes by applying evidence-based practices before, during, and after surgery. Patients undergoing surgery for gynecologic malignancies are at high risk of complications due to population, patient, disease, and surgical factors. The nutritional status of the patient provides the foundation for recovery after surgery, and opportunities to optimize outcomes exist from the first patient assessment to the early days after surgery. This review highlights the importance of nutritional assessment and intervention during the pre-operative and post-operative periods in the context of ERAS in gynecologic oncology surgery. The emerging role of immunonutrition, carbohydrate loading, and the importance of individualized care are explored. Evidence from studies in gynecologic oncology is presented, where available, and extrapolated from colorectal and other cancer surgery trials when applicable.\",\"bibtype\":\"misc\",\"author\":\"Bisch, Steven and Nelson, Gregg and Altman, Alon\",\"doi\":\"10.3390/nu11051088\",\"bibtex\":\"@misc{\\n title = {Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology},\\n type = {misc},\\n year = {2019},\\n source = {Nutrients},\\n keywords = {ERAS,Enhanced recovery after surgery,Gynecologic/oncology,Nutrition},\\n volume = {11},\\n issue = {5},\\n websites = {/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/},\\n month = {5},\\n publisher = {MDPI AG},\\n day = {1},\\n id = {199ba733-8435-31d1-a2dd-b25546021c22},\\n created = {2020-10-08T17:33:58.219Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.800Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Enhanced recovery after surgery (ERAS) pathways aim to improve surgical outcomes by applying evidence-based practices before, during, and after surgery. Patients undergoing surgery for gynecologic malignancies are at high risk of complications due to population, patient, disease, and surgical factors. The nutritional status of the patient provides the foundation for recovery after surgery, and opportunities to optimize outcomes exist from the first patient assessment to the early days after surgery. This review highlights the importance of nutritional assessment and intervention during the pre-operative and post-operative periods in the context of ERAS in gynecologic oncology surgery. The emerging role of immunonutrition, carbohydrate loading, and the importance of individualized care are explored. Evidence from studies in gynecologic oncology is presented, where available, and extrapolated from colorectal and other cancer surgery trials when applicable.},\\n bibtype = {misc},\\n author = {Bisch, Steven and Nelson, Gregg and Altman, Alon},\\n doi = {10.3390/nu11051088}\\n}\",\"author_short\":[\"Bisch,  S.\",\"Nelson,  G.\",\"Altman,  A.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/13399be4-1186-8ba5-3252-d382367553e9/full_text.pdf.pdf\",\"Website\":\"/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019\",\"role\":\"author\",\"keyword\":[\"ERAS\",\"Enhanced recovery after surgery\",\"Gynecologic/oncology\",\"Nutrition\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Cmaj\",\"pages\":\"S27-S29\",\"volume\":\"191\",\"issue\":\"1\",\"websites\":\"https://tableau.albertahealth\",\"month\":\"12\",\"publisher\":\"Canadian Medical Association\",\"day\":\"4\",\"id\":\"390e1916-451f-3b6b-9593-25d68c0ee5f4\",\"created\":\"2020-10-08T17:34:26.075Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.804Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"CMAJ | VOLUME 191 | SUPPLEMENT 1 S27 P ublicly funded surgical care in Alberta is delivered at 55 hospitals and 42 nonhospital surgical facilities, with more than 293 000 surgeries completed per year at an annual budget of about $2 billion. 1 However, about 1.6% of Alber-ta's population is on a surgical wait list (70 000 out of 4.3 million Albertans), and about 50% of these patients are waiting longer than clinically recommended. 2,3 The number of Albertans waiting for an initial consultation with a surgical specialist is unknown. In August 2019, the Blue Ribbon Panel on Alberta's Finances reported that per capita health care expenditures in Alberta ($5077) were higher than other provinces (e.g., British Columbia, $4267; Ontario, $4080; and Quebec, $4370), but Alberta lagged behind these provinces on several key performance indicators, such as wait times, lengths of stay and readmission rates. 4 The needs of these patients are diverse, and root causes for untimely access and outcomes are complex and require system-level solutions that address fundamental and recurring challenges such as inefficient referral pathways , increasing disease chronicity, variation in surgical outcomes , antiquated models of care that are provider centric and a mismatch between demand and system capacity. Recognizing the need to address these challenges at a systems level, Alberta Health Services created the Surgery Strategic Clinical Network (SCN; www.ahs.ca/surgeryscn) in 2013 with the goal of bringing together front-line health care professionals, operational leaders, academic partners and the community to identify priorities and develop novel solutions to transform the surgical landscape in Alberta. At the time, common metrics, processes and approaches to explicate surgical care were lacking. Although there were several quality-improvement initiatives at local sites, they were not centrally coordinated, integrated or widely shared. The creation of the Surgery SCN sparked a paradigm shift toward system innovation and learning, with a focus on using objective data to drive change and improve outcomes. From the beginning, it was imperative that the Surgery SCN balance local, facility-based needs and priorities for efficient and effective service delivery (the operational business) while also identifying areas for collective action, improvement and innovation (the strategic business). In its first 3 years (2013-2016), the network focused on specific actions, tools and processes that would improve access, safety and quality of surgical care, and enable ongoing measurement and improvement. Three examples of this work include developing a standardized measurement system, the Alberta Coding Access Targets for Surgery tool to elucidate scheduled wait times, customizing and implementing the Safe Surgery Checklist to reduce surgical errors and implementing care pathways on a provincial scale (e.g., Enhanced Recovery After Surgery guidelines) to standardize care and improve patient outcomes and experience. These initiatives have provided considerable value to the people of Alberta through improved outcomes, patient experience and access to surgical care, system-wide learning and quality improvement on a provincial scale. The network has contributed to the successful implementation of this work and its ongoing evaluation. For example, the Alberta Coding Access Targets for Surgery 5 has improved transparency for surgical wait lists and how they are managed. When a surgery is booked, each patient is assigned 1 of around 2000 diagnostic codes, with a recommended maximum wait time and a \\\"ready-to-treat\\\" date. These data are used to optimize wait lists for surgeons to ensure that urgent cases are prioritized and patients who have been waiting the longest are operated on first. The common measurement system was developed and is adjudicated through consensus by surgeons, bringing together the subspecialties across the province. The implementation was coordin ated through a provincial team working directly with surgeons , their medical office assistants, medical and administrative COMMENTARY KEY POINTS • Timely and equitable access to surgical care continues to feature prominently in public discourse and policy debates across Canada and is currently under scrutiny by Alberta decision-makers. • The first 4 years of the Surgery Strategic Clinical Network (SCN), which was created in 2013 with a mandate to address gaps in care and unwarranted variation, were a \\\"learning-and-doing\\\" period, after which it shifted to a more strategic focus and approach. • Comprising operational leaders, clinicians, academic partners and patient advisors, the Surgery SCN has successfully co-designed, tested, validated and implemented major surgical quality-improvement programs with substantial returns on investment.\",\"bibtype\":\"misc\",\"author\":\"Beesoon, Sanjay and Robert, Jill and White, Jonathan\",\"doi\":\"10.1503/cmaj.190590\",\"bibtex\":\"@misc{\\n title = {Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta},\\n type = {misc},\\n year = {2019},\\n source = {Cmaj},\\n pages = {S27-S29},\\n volume = {191},\\n issue = {1},\\n websites = {https://tableau.albertahealth},\\n month = {12},\\n publisher = {Canadian Medical Association},\\n day = {4},\\n id = {390e1916-451f-3b6b-9593-25d68c0ee5f4},\\n created = {2020-10-08T17:34:26.075Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.804Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {CMAJ | VOLUME 191 | SUPPLEMENT 1 S27 P ublicly funded surgical care in Alberta is delivered at 55 hospitals and 42 nonhospital surgical facilities, with more than 293 000 surgeries completed per year at an annual budget of about $2 billion. 1 However, about 1.6% of Alber-ta's population is on a surgical wait list (70 000 out of 4.3 million Albertans), and about 50% of these patients are waiting longer than clinically recommended. 2,3 The number of Albertans waiting for an initial consultation with a surgical specialist is unknown. In August 2019, the Blue Ribbon Panel on Alberta's Finances reported that per capita health care expenditures in Alberta ($5077) were higher than other provinces (e.g., British Columbia, $4267; Ontario, $4080; and Quebec, $4370), but Alberta lagged behind these provinces on several key performance indicators, such as wait times, lengths of stay and readmission rates. 4 The needs of these patients are diverse, and root causes for untimely access and outcomes are complex and require system-level solutions that address fundamental and recurring challenges such as inefficient referral pathways , increasing disease chronicity, variation in surgical outcomes , antiquated models of care that are provider centric and a mismatch between demand and system capacity. Recognizing the need to address these challenges at a systems level, Alberta Health Services created the Surgery Strategic Clinical Network (SCN; www.ahs.ca/surgeryscn) in 2013 with the goal of bringing together front-line health care professionals, operational leaders, academic partners and the community to identify priorities and develop novel solutions to transform the surgical landscape in Alberta. At the time, common metrics, processes and approaches to explicate surgical care were lacking. Although there were several quality-improvement initiatives at local sites, they were not centrally coordinated, integrated or widely shared. The creation of the Surgery SCN sparked a paradigm shift toward system innovation and learning, with a focus on using objective data to drive change and improve outcomes. From the beginning, it was imperative that the Surgery SCN balance local, facility-based needs and priorities for efficient and effective service delivery (the operational business) while also identifying areas for collective action, improvement and innovation (the strategic business). In its first 3 years (2013-2016), the network focused on specific actions, tools and processes that would improve access, safety and quality of surgical care, and enable ongoing measurement and improvement. Three examples of this work include developing a standardized measurement system, the Alberta Coding Access Targets for Surgery tool to elucidate scheduled wait times, customizing and implementing the Safe Surgery Checklist to reduce surgical errors and implementing care pathways on a provincial scale (e.g., Enhanced Recovery After Surgery guidelines) to standardize care and improve patient outcomes and experience. These initiatives have provided considerable value to the people of Alberta through improved outcomes, patient experience and access to surgical care, system-wide learning and quality improvement on a provincial scale. The network has contributed to the successful implementation of this work and its ongoing evaluation. For example, the Alberta Coding Access Targets for Surgery 5 has improved transparency for surgical wait lists and how they are managed. When a surgery is booked, each patient is assigned 1 of around 2000 diagnostic codes, with a recommended maximum wait time and a \\\"ready-to-treat\\\" date. These data are used to optimize wait lists for surgeons to ensure that urgent cases are prioritized and patients who have been waiting the longest are operated on first. The common measurement system was developed and is adjudicated through consensus by surgeons, bringing together the subspecialties across the province. The implementation was coordin ated through a provincial team working directly with surgeons , their medical office assistants, medical and administrative COMMENTARY KEY POINTS • Timely and equitable access to surgical care continues to feature prominently in public discourse and policy debates across Canada and is currently under scrutiny by Alberta decision-makers. • The first 4 years of the Surgery Strategic Clinical Network (SCN), which was created in 2013 with a mandate to address gaps in care and unwarranted variation, were a \\\"learning-and-doing\\\" period, after which it shifted to a more strategic focus and approach. • Comprising operational leaders, clinicians, academic partners and patient advisors, the Surgery SCN has successfully co-designed, tested, validated and implemented major surgical quality-improvement programs with substantial returns on investment.},\\n bibtype = {misc},\\n author = {Beesoon, Sanjay and Robert, Jill and White, Jonathan},\\n doi = {10.1503/cmaj.190590}\\n}\",\"author_short\":[\"Beesoon,  S.\",\"Robert,  J.\",\"White,  J.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/170685e5-d056-a621-53af-dcd3d2557711/full_text.pdf.pdf\",\"Website\":\"https://tableau.albertahealth\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Embracing change—the time for pediatric enhanced recovery after surgery is now\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Journal of Pediatric Urology\",\"pages\":\"491-493\",\"volume\":\"15\",\"issue\":\"5\",\"websites\":\"http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract\",\"month\":\"10\",\"publisher\":\"Elsevier Ltd\",\"day\":\"1\",\"id\":\"6b29f139-a8d8-3ccd-a84c-28e194040667\",\"created\":\"2020-10-08T17:35:24.711Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:27:59.790Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"misc\",\"author\":\"Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.\",\"doi\":\"10.1016/j.jpurol.2019.04.005\",\"bibtex\":\"@misc{\\n title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},\\n type = {misc},\\n year = {2019},\\n source = {Journal of Pediatric Urology},\\n pages = {491-493},\\n volume = {15},\\n issue = {5},\\n websites = {http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract},\\n month = {10},\\n publisher = {Elsevier Ltd},\\n day = {1},\\n id = {6b29f139-a8d8-3ccd-a84c-28e194040667},\\n created = {2020-10-08T17:35:24.711Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:27:59.790Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {misc},\\n author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},\\n doi = {10.1016/j.jpurol.2019.04.005}\\n}\",\"author_short\":[\"Rove,  K., O.\",\"Brockel,  M., A.\",\"Brindle,  M., E.\",\"Scott,  M., J.\",\"Herndon,  C., D.\",\"Ljungqvist,  O.\",\"Koyle,  M., A.\"],\"urls\":{\"Website\":\"http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Optimizing postoperative follow-up in pediatric surgery (OFIPS)\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up\",\"pages\":\"1013-1018\",\"volume\":\"54\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/30826120/\",\"month\":\"5\",\"publisher\":\"W.B. Saunders\",\"day\":\"1\",\"id\":\"892d3444-ad4a-380e-834a-59c2bbd4a828\",\"created\":\"2020-10-08T17:36:34.845Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.306Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.\",\"bibtype\":\"article\",\"author\":\"Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.\",\"doi\":\"10.1016/j.jpedsurg.2019.01.045\",\"journal\":\"Journal of Pediatric Surgery\",\"number\":\"5\",\"bibtex\":\"@article{\\n title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},\\n type = {article},\\n year = {2019},\\n keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},\\n pages = {1013-1018},\\n volume = {54},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/30826120/},\\n month = {5},\\n publisher = {W.B. Saunders},\\n day = {1},\\n id = {892d3444-ad4a-380e-834a-59c2bbd4a828},\\n created = {2020-10-08T17:36:34.845Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.306Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},\\n bibtype = {article},\\n author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},\\n doi = {10.1016/j.jpedsurg.2019.01.045},\\n journal = {Journal of Pediatric Surgery},\\n number = {5}\\n}\",\"author_short\":[\"Gimon,  T.\",\"Almosallam,  O.\",\"Lopushinsky,  S.\",\"Eccles,  R.\",\"Brindle,  M.\",\"Yanchar,  N., L.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/30826120/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\",\"role\":\"author\",\"keyword\":[\"Clinic value\",\"Costs\",\"Pediatric surgery\",\"Perceived value\",\"Postoperative follow-up\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"International Journal of Gynecological Cancer\",\"keywords\":\"Enhanced Recovery After Surger,intraoperative care,postoperative care,preoperative care,surgery\",\"pages\":\"651-668\",\"volume\":\"29\",\"issue\":\"4\",\"websites\":\"http://ijgc.bmj.com/\",\"month\":\"5\",\"publisher\":\"BMJ Publishing Group\",\"day\":\"1\",\"id\":\"10daa046-8542-38e1-bd4a-a47d5a71b9ae\",\"created\":\"2020-10-08T17:37:30.029Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2021-08-30T16:28:00.339Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.\",\"bibtype\":\"misc\",\"author\":\"Nelson, Gregg and Bakkum-Gamez, Jamie and Kalogera, Eleftheria and Glaser, Gretchen and Altman, Alon and Meyer, Larissa A. and Taylor, Jolyn S. and Iniesta, Maria and Lasala, Javier and Mena, Gabriel and Scott, Michael and Gillis, Chelsia and Elias, Kevin and Wijk, Lena and Huang, Jeffrey and Nygren, Jonas and Ljungqvist, Olle and Ramirez, Pedro T. and Dowdy, Sean C.\",\"doi\":\"10.1136/ijgc-2019-000356\",\"bibtex\":\"@misc{\\n title = {Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update},\\n type = {misc},\\n year = {2019},\\n source = {International Journal of Gynecological Cancer},\\n keywords = {Enhanced Recovery After Surger,intraoperative care,postoperative care,preoperative care,surgery},\\n pages = {651-668},\\n volume = {29},\\n issue = {4},\\n websites = {http://ijgc.bmj.com/},\\n month = {5},\\n publisher = {BMJ Publishing Group},\\n day = {1},\\n id = {10daa046-8542-38e1-bd4a-a47d5a71b9ae},\\n created = {2020-10-08T17:37:30.029Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2021-08-30T16:28:00.339Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.},\\n bibtype = {misc},\\n author = {Nelson, Gregg and Bakkum-Gamez, Jamie and Kalogera, Eleftheria and Glaser, Gretchen and Altman, Alon and Meyer, Larissa A. and Taylor, Jolyn S. and Iniesta, Maria and Lasala, Javier and Mena, Gabriel and Scott, Michael and Gillis, Chelsia and Elias, Kevin and Wijk, Lena and Huang, Jeffrey and Nygren, Jonas and Ljungqvist, Olle and Ramirez, Pedro T. and Dowdy, Sean C.},\\n doi = {10.1136/ijgc-2019-000356}\\n}\",\"author_short\":[\"Nelson,  G.\",\"Bakkum-Gamez,  J.\",\"Kalogera,  E.\",\"Glaser,  G.\",\"Altman,  A.\",\"Meyer,  L., A.\",\"Taylor,  J., S.\",\"Iniesta,  M.\",\"Lasala,  J.\",\"Mena,  G.\",\"Scott,  M.\",\"Gillis,  C.\",\"Elias,  K.\",\"Wijk,  L.\",\"Huang,  J.\",\"Nygren,  J.\",\"Ljungqvist,  O.\",\"Ramirez,  P., T.\",\"Dowdy,  S., C.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7cf8dfc0-fa77-6b79-3dd7-25f406e62a5d/full_text.pdf.pdf\",\"Website\":\"http://ijgc.bmj.com/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019\",\"role\":\"author\",\"keyword\":[\"Enhanced Recovery After Surger\",\"intraoperative care\",\"postoperative care\",\"preoperative care\",\"surgery\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"JAMA Surgery\",\"keywords\":\"The JAMA Network\",\"pages\":\"755-766\",\"volume\":\"154\",\"issue\":\"8\",\"websites\":\"https://jamanetwork.com/\",\"month\":\"8\",\"publisher\":\"American Medical Association\",\"day\":\"1\",\"id\":\"ae82a777-0785-33cc-8174-8ea7f357182a\",\"created\":\"2020-10-08T17:38:01.095Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.928Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.\",\"bibtype\":\"misc\",\"author\":\"Engelman, Daniel T. and Ben Ali, Walid and Williams, Judson B. and Perrault, Louis P. and Reddy, V. Seenu and Arora, Rakesh C. and Roselli, Eric E. and Khoynezhad, Ali and Gerdisch, Marc and Levy, Jerrold H. and Lobdell, Kevin and Fletcher, Nick and Kirsch, Matthias and Nelson, Gregg and Engelman, Richard M. and Gregory, Alexander J. and Boyle, Edward M.\",\"doi\":\"10.1001/jamasurg.2019.1153\",\"bibtex\":\"@misc{\\n title = {Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations},\\n type = {misc},\\n year = {2019},\\n source = {JAMA Surgery},\\n keywords = {The JAMA Network},\\n pages = {755-766},\\n volume = {154},\\n issue = {8},\\n websites = {https://jamanetwork.com/},\\n month = {8},\\n publisher = {American Medical Association},\\n day = {1},\\n id = {ae82a777-0785-33cc-8174-8ea7f357182a},\\n created = {2020-10-08T17:38:01.095Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.928Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.},\\n bibtype = {misc},\\n author = {Engelman, Daniel T. and Ben Ali, Walid and Williams, Judson B. and Perrault, Louis P. and Reddy, V. Seenu and Arora, Rakesh C. and Roselli, Eric E. and Khoynezhad, Ali and Gerdisch, Marc and Levy, Jerrold H. and Lobdell, Kevin and Fletcher, Nick and Kirsch, Matthias and Nelson, Gregg and Engelman, Richard M. and Gregory, Alexander J. and Boyle, Edward M.},\\n doi = {10.1001/jamasurg.2019.1153}\\n}\",\"author_short\":[\"Engelman,  D., T.\",\"Ben Ali,  W.\",\"Williams,  J., B.\",\"Perrault,  L., P.\",\"Reddy,  V., S.\",\"Arora,  R., C.\",\"Roselli,  E., E.\",\"Khoynezhad,  A.\",\"Gerdisch,  M.\",\"Levy,  J., H.\",\"Lobdell,  K.\",\"Fletcher,  N.\",\"Kirsch,  M.\",\"Nelson,  G.\",\"Engelman,  R., M.\",\"Gregory,  A., J.\",\"Boyle,  E., M.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/4c1dbd91-abb7-91e9-4b2f-9014aba6386d/full_text.pdf.pdf\",\"Website\":\"https://jamanetwork.com/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019\",\"role\":\"author\",\"keyword\":[\"The JAMA Network\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Enhanced recovery after surgery: Implementing a new standard of surgical care\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Cmaj\",\"pages\":\"E469-E475\",\"volume\":\"191\",\"issue\":\"17\",\"websites\":\"www.erassociety.org\",\"month\":\"4\",\"publisher\":\"Canadian Medical Association\",\"day\":\"29\",\"id\":\"b3a9d3a0-05fc-3483-8721-9fa01c288c16\",\"created\":\"2020-10-08T17:38:10.939Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.970Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"KEY POINTS\\nEnhanced recovery after surgery (ERAS) is an evidence-based and multidisciplinary perioperative care pathway and a surgical quality improvement initiative, which has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital length of stay and\",\"bibtype\":\"misc\",\"author\":\"Altman, Alon D. and Helpman, Limor and McGee, Jacob and Samouëlian, Vanessa and Auclair, Marie Hélène and Brar, Harinder and Nelson, Gregg S.\",\"doi\":\"10.1503/cmaj.180635\",\"bibtex\":\"@misc{\\n title = {Enhanced recovery after surgery: Implementing a new standard of surgical care},\\n type = {misc},\\n year = {2019},\\n source = {Cmaj},\\n pages = {E469-E475},\\n volume = {191},\\n issue = {17},\\n websites = {www.erassociety.org},\\n month = {4},\\n publisher = {Canadian Medical Association},\\n day = {29},\\n id = {b3a9d3a0-05fc-3483-8721-9fa01c288c16},\\n created = {2020-10-08T17:38:10.939Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.970Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {KEY POINTS\\nEnhanced recovery after surgery (ERAS) is an evidence-based and multidisciplinary perioperative care pathway and a surgical quality improvement initiative, which has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital length of stay and},\\n bibtype = {misc},\\n author = {Altman, Alon D. and Helpman, Limor and McGee, Jacob and Samouëlian, Vanessa and Auclair, Marie Hélène and Brar, Harinder and Nelson, Gregg S.},\\n doi = {10.1503/cmaj.180635}\\n}\",\"author_short\":[\"Altman,  A., D.\",\"Helpman,  L.\",\"McGee,  J.\",\"Samouëlian,  V.\",\"Auclair,  M., H.\",\"Brar,  H.\",\"Nelson,  G., S.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/6c73269f-496f-9243-7a4d-08ca37e63d1d/full_text.pdf.pdf\",\"Website\":\"www.erassociety.org\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"International Journal of Surgery\",\"keywords\":\"Cost Savings,Humans,Jenna K Lovely,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care*,Pharmacists*,Postoperative Complications / prevention & control,PubMed Abstract,Recovery of Function,Review,Richard H Parrish,Sara Jordan Hyland,doi:10.1016/j.ijsu.2019.01.006,pmid:30665004\",\"pages\":\"58-62\",\"volume\":\"63\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/30665004/\",\"month\":\"3\",\"publisher\":\"Elsevier Ltd\",\"day\":\"1\",\"id\":\"164da341-3fdd-3c56-b8f4-2c3e437dfdee\",\"created\":\"2020-10-08T17:38:34.220Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.869Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.\",\"bibtype\":\"misc\",\"author\":\"Lovely, Jenna K. and Hyland, Sara Jordan and Smith, April N. and Nelson, Gregg and Ljungqvist, Olle and Parrish, Richard H.\",\"doi\":\"10.1016/j.ijsu.2019.01.006\",\"bibtex\":\"@misc{\\n title = {Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs},\\n type = {misc},\\n year = {2019},\\n source = {International Journal of Surgery},\\n keywords = {Cost Savings,Humans,Jenna K Lovely,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care*,Pharmacists*,Postoperative Complications / prevention & control,PubMed Abstract,Recovery of Function,Review,Richard H Parrish,Sara Jordan Hyland,doi:10.1016/j.ijsu.2019.01.006,pmid:30665004},\\n pages = {58-62},\\n volume = {63},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/30665004/},\\n month = {3},\\n publisher = {Elsevier Ltd},\\n day = {1},\\n id = {164da341-3fdd-3c56-b8f4-2c3e437dfdee},\\n created = {2020-10-08T17:38:34.220Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.869Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.},\\n bibtype = {misc},\\n author = {Lovely, Jenna K. and Hyland, Sara Jordan and Smith, April N. and Nelson, Gregg and Ljungqvist, Olle and Parrish, Richard H.},\\n doi = {10.1016/j.ijsu.2019.01.006}\\n}\",\"author_short\":[\"Lovely,  J., K.\",\"Hyland,  S., J.\",\"Smith,  A., N.\",\"Nelson,  G.\",\"Ljungqvist,  O.\",\"Parrish,  R., H.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/30665004/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019\",\"role\":\"author\",\"keyword\":[\"Cost Savings\",\"Humans\",\"Jenna K Lovely\",\"MEDLINE\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Perioperative Care*\",\"Pharmacists*\",\"Postoperative Complications / prevention & control\",\"PubMed Abstract\",\"Recovery of Function\",\"Review\",\"Richard H Parrish\",\"Sara Jordan Hyland\",\"doi:10.1016/j.ijsu.2019.01.006\",\"pmid:30665004\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"compliance,elective colorectal surgery,enhanced recovery after surgery,nutrition risk screening,perioperative nutrition care\",\"pages\":\"206-219\",\"volume\":\"43\",\"websites\":\"https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417\",\"month\":\"2\",\"publisher\":\"John Wiley and Sons Inc.\",\"day\":\"23\",\"id\":\"eba90cba-dacf-32a5-9321-a96b3e8c9d85\",\"created\":\"2020-10-08T17:39:15.041Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.778Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes. Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013–2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications. Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%–61%), early postoperative oral feeding (P <.001), and mobilization (P <.001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (<70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11–3.64; P <.001) and a trend for LOS >5 days (OR 1.40; 95% CI, 1.00–1.96; P =.052). Low compliance to ERAS (<70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23–3.24; P <.001). Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.\",\"bibtype\":\"article\",\"author\":\"Martin, Lisa and Gillis, Chelsia and Atkins, Marlis and Gillam, Melani and Sheppard, Caroline and Buhler, Sue and Hammond, Carlota Basualdo and Nelson, Gregg and Gramlich, Leah\",\"doi\":\"10.1002/jpen.1417\",\"journal\":\"Journal of Parenteral and Enteral Nutrition\",\"number\":\"2\",\"bibtex\":\"@article{\\n title = {Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery},\\n type = {article},\\n year = {2019},\\n keywords = {compliance,elective colorectal surgery,enhanced recovery after surgery,nutrition risk screening,perioperative nutrition care},\\n pages = {206-219},\\n volume = {43},\\n websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417},\\n month = {2},\\n publisher = {John Wiley and Sons Inc.},\\n day = {23},\\n id = {eba90cba-dacf-32a5-9321-a96b3e8c9d85},\\n created = {2020-10-08T17:39:15.041Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.778Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes. Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013–2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications. Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%–61%), early postoperative oral feeding (P <.001), and mobilization (P <.001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (<70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11–3.64; P <.001) and a trend for LOS >5 days (OR 1.40; 95% CI, 1.00–1.96; P =.052). Low compliance to ERAS (<70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23–3.24; P <.001). Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.},\\n bibtype = {article},\\n author = {Martin, Lisa and Gillis, Chelsia and Atkins, Marlis and Gillam, Melani and Sheppard, Caroline and Buhler, Sue and Hammond, Carlota Basualdo and Nelson, Gregg and Gramlich, Leah},\\n doi = {10.1002/jpen.1417},\\n journal = {Journal of Parenteral and Enteral Nutrition},\\n number = {2}\\n}\",\"author_short\":[\"Martin,  L.\",\"Gillis,  C.\",\"Atkins,  M.\",\"Gillam,  M.\",\"Sheppard,  C.\",\"Buhler,  S.\",\"Hammond,  C., B.\",\"Nelson,  G.\",\"Gramlich,  L.\"],\"urls\":{\"Website\":\"https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019\",\"role\":\"author\",\"keyword\":[\"compliance\",\"elective colorectal surgery\",\"enhanced recovery after surgery\",\"nutrition risk screening\",\"perioperative nutrition care\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience\",\"type\":\"article\",\"year\":\"2016\",\"keywords\":\"Aged,Alberta,Clinical Protocols,Colon / surgery*,Female,Gregg Nelson,Guideline Adherence / economics,Guideline Adherence / statistics & numerical data,Humans,Lawrence N Kiyang,Leah M Gramlich,Length of Stay / statistics & numerical data,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Patient Readmission / statistics & numerical data,Perioperative Care / standards*,Postoperative Complications,PubMed Abstract,Rectum / surgery*,doi:10.1007/s00268-016-3472-7,pmid:26928854\",\"pages\":\"1092-1103\",\"volume\":\"40\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/26928854/\",\"month\":\"5\",\"publisher\":\"Springer New York LLC\",\"day\":\"1\",\"id\":\"c988171f-cbb2-3cb4-ad58-be400e3abff0\",\"created\":\"2020-10-08T17:41:13.178Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.325Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system. Methods: We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts. Results: A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value <0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient. Conclusion: The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.\",\"bibtype\":\"article\",\"author\":\"Nelson, Gregg and Kiyang, Lawrence N. and Crumley, Ellen T. and Chuck, Anderson and Nguyen, Thanh and Faris, Peter and Wasylak, Tracy and Basualdo-Hammond, Carlota and McKay, Susan and Ljungqvist, Olle and Gramlich, Leah M.\",\"doi\":\"10.1007/s00268-016-3472-7\",\"journal\":\"World Journal of Surgery\",\"number\":\"5\",\"bibtex\":\"@article{\\n title = {Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience},\\n type = {article},\\n year = {2016},\\n keywords = {Aged,Alberta,Clinical Protocols,Colon / surgery*,Female,Gregg Nelson,Guideline Adherence / economics,Guideline Adherence / statistics & numerical data,Humans,Lawrence N Kiyang,Leah M Gramlich,Length of Stay / statistics & numerical data,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Patient Readmission / statistics & numerical data,Perioperative Care / standards*,Postoperative Complications,PubMed Abstract,Rectum / surgery*,doi:10.1007/s00268-016-3472-7,pmid:26928854},\\n pages = {1092-1103},\\n volume = {40},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/26928854/},\\n month = {5},\\n publisher = {Springer New York LLC},\\n day = {1},\\n id = {c988171f-cbb2-3cb4-ad58-be400e3abff0},\\n created = {2020-10-08T17:41:13.178Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.325Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system. Methods: We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts. Results: A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value <0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient. Conclusion: The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.},\\n bibtype = {article},\\n author = {Nelson, Gregg and Kiyang, Lawrence N. and Crumley, Ellen T. and Chuck, Anderson and Nguyen, Thanh and Faris, Peter and Wasylak, Tracy and Basualdo-Hammond, Carlota and McKay, Susan and Ljungqvist, Olle and Gramlich, Leah M.},\\n doi = {10.1007/s00268-016-3472-7},\\n journal = {World Journal of Surgery},\\n number = {5}\\n}\",\"author_short\":[\"Nelson,  G.\",\"Kiyang,  L., N.\",\"Crumley,  E., T.\",\"Chuck,  A.\",\"Nguyen,  T.\",\"Faris,  P.\",\"Wasylak,  T.\",\"Basualdo-Hammond,  C.\",\"McKay,  S.\",\"Ljungqvist,  O.\",\"Gramlich,  L., M.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/26928854/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016\",\"role\":\"author\",\"keyword\":[\"Aged\",\"Alberta\",\"Clinical Protocols\",\"Colon / surgery*\",\"Female\",\"Gregg Nelson\",\"Guideline Adherence / economics\",\"Guideline Adherence / statistics & numerical data\",\"Humans\",\"Lawrence N Kiyang\",\"Leah M Gramlich\",\"Length of Stay / statistics & numerical data\",\"MEDLINE\",\"Male\",\"Middle Aged\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Patient Readmission / statistics & numerical data\",\"Perioperative Care / standards*\",\"Postoperative Complications\",\"PubMed Abstract\",\"Rectum / surgery*\",\"doi:10.1007/s00268-016-3472-7\",\"pmid:26928854\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta\",\"type\":\"article\",\"year\":\"2016\",\"keywords\":\"Anderson W. Chuck,Leah M. Gramlich,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Nguyen X. Thanh,PMC5125924,PubMed Abstract,doi:10.1503/cjs.006716,pmid:28445024\",\"pages\":\"415-421\",\"volume\":\"59\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28445024/\",\"month\":\"12\",\"publisher\":\"Canadian Medical Association\",\"day\":\"1\",\"id\":\"04defe8f-0779-324a-af01-ee10c7a5be70\",\"created\":\"2020-10-08T17:41:55.193Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.443Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return. Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.\",\"bibtype\":\"article\",\"author\":\"Thanh, Nguyen X. and Chuck, Anderson W. and Wasylak, Tracy and Lawrence, Jeannette and Faris, Peter and Ljungqvist, Olle and Nelson, Gregg and Gramlich, Leah M.\",\"doi\":\"10.1503/cjs.006716\",\"journal\":\"Canadian Journal of Surgery\",\"number\":\"6\",\"bibtex\":\"@article{\\n title = {An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta},\\n type = {article},\\n year = {2016},\\n keywords = {Anderson W. Chuck,Leah M. Gramlich,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Nguyen X. Thanh,PMC5125924,PubMed Abstract,doi:10.1503/cjs.006716,pmid:28445024},\\n pages = {415-421},\\n volume = {59},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28445024/},\\n month = {12},\\n publisher = {Canadian Medical Association},\\n day = {1},\\n id = {04defe8f-0779-324a-af01-ee10c7a5be70},\\n created = {2020-10-08T17:41:55.193Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.443Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return. Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.},\\n bibtype = {article},\\n author = {Thanh, Nguyen X. and Chuck, Anderson W. and Wasylak, Tracy and Lawrence, Jeannette and Faris, Peter and Ljungqvist, Olle and Nelson, Gregg and Gramlich, Leah M.},\\n doi = {10.1503/cjs.006716},\\n journal = {Canadian Journal of Surgery},\\n number = {6}\\n}\",\"author_short\":[\"Thanh,  N., X.\",\"Chuck,  A., W.\",\"Wasylak,  T.\",\"Lawrence,  J.\",\"Faris,  P.\",\"Ljungqvist,  O.\",\"Nelson,  G.\",\"Gramlich,  L., M.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a11f0b3-9f18-5fb1-0bad-85c5c37773a9/full_text.pdf.pdf\",\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28445024/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016\",\"role\":\"author\",\"keyword\":[\"Anderson W. Chuck\",\"Leah M. Gramlich\",\"MEDLINE\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Nguyen X. Thanh\",\"PMC5125924\",\"PubMed Abstract\",\"doi:10.1503/cjs.006716\",\"pmid:28445024\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":1,\"html\":\"\"},{\"title\":\"Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society\",\"type\":\"misc\",\"year\":\"2017\",\"source\":\"JAMA Otolaryngology - Head and Neck Surgery\",\"keywords\":\"The JAMA Network\",\"pages\":\"292-303\",\"volume\":\"143\",\"issue\":\"3\",\"websites\":\"http://www.erassociety.org\",\"month\":\"3\",\"publisher\":\"American Medical Association\",\"day\":\"1\",\"id\":\"a36721d5-88c7-36e5-8ad6-e4699bada3cf\",\"created\":\"2020-10-08T17:42:34.613Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.616Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included \\\"head and neck surgery,\\\" \\\"pharyngectomy,\\\" \\\"laryngectomy,\\\" \\\"laryngopharyngectomy,\\\" \\\"neck dissection,\\\"\\\"parotid lymphadenectomy,\\\"\\\"thyroidectomy,\\\"\\\"oral cavity resection,\\\"\\\"glossectomy,\\\" and \\\"head and neck.\\\" The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.\",\"bibtype\":\"misc\",\"author\":\"Dort, Joseph C. and Farwell, D. Gregory and Findlay, Merran and Huber, Gerhard F. and Kerr, Paul and Shea-Budgell, Melissa A. and Simon, Christian and Uppington, Jeffrey and Zygun, David and Ljungqvist, Olle and Harris, Jeffrey\",\"doi\":\"10.1001/jamaoto.2016.2981\",\"bibtex\":\"@misc{\\n title = {Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society},\\n type = {misc},\\n year = {2017},\\n source = {JAMA Otolaryngology - Head and Neck Surgery},\\n keywords = {The JAMA Network},\\n pages = {292-303},\\n volume = {143},\\n issue = {3},\\n websites = {http://www.erassociety.org},\\n month = {3},\\n publisher = {American Medical Association},\\n day = {1},\\n id = {a36721d5-88c7-36e5-8ad6-e4699bada3cf},\\n created = {2020-10-08T17:42:34.613Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.616Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included \\\"head and neck surgery,\\\" \\\"pharyngectomy,\\\" \\\"laryngectomy,\\\" \\\"laryngopharyngectomy,\\\" \\\"neck dissection,\\\"\\\"parotid lymphadenectomy,\\\"\\\"thyroidectomy,\\\"\\\"oral cavity resection,\\\"\\\"glossectomy,\\\" and \\\"head and neck.\\\" The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.},\\n bibtype = {misc},\\n author = {Dort, Joseph C. and Farwell, D. Gregory and Findlay, Merran and Huber, Gerhard F. and Kerr, Paul and Shea-Budgell, Melissa A. and Simon, Christian and Uppington, Jeffrey and Zygun, David and Ljungqvist, Olle and Harris, Jeffrey},\\n doi = {10.1001/jamaoto.2016.2981}\\n}\",\"author_short\":[\"Dort,  J., C.\",\"Farwell,  D., G.\",\"Findlay,  M.\",\"Huber,  G., F.\",\"Kerr,  P.\",\"Shea-Budgell,  M., A.\",\"Simon,  C.\",\"Uppington,  J.\",\"Zygun,  D.\",\"Ljungqvist,  O.\",\"Harris,  J.\"],\"urls\":{\"Website\":\"http://www.erassociety.org\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017\",\"role\":\"author\",\"keyword\":[\"The JAMA Network\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system\",\"type\":\"article\",\"year\":\"2017\",\"keywords\":\"Enhanced Recovery After Surgery,Implementation,QUERI,Theoretical Domains Framework\",\"pages\":\"67\",\"volume\":\"12\",\"websites\":\"http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5\",\"month\":\"5\",\"publisher\":\"BioMed Central Ltd.\",\"day\":\"19\",\"id\":\"a1961964-3924-3b25-b4c0-57aa038478e5\",\"created\":\"2020-10-08T17:42:36.845Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.382Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). Methods: ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Results: Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Conclusions: Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.\",\"bibtype\":\"article\",\"author\":\"Gramlich, Leah M. and Sheppard, Caroline E. and Wasylak, Tracy and Gilmour, Loreen E. and Ljungqvist, Olle and Basualdo-Hammond, Carlota and Nelson, Gregg\",\"doi\":\"10.1186/s13012-017-0597-5\",\"journal\":\"Implementation Science\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system},\\n type = {article},\\n year = {2017},\\n keywords = {Enhanced Recovery After Surgery,Implementation,QUERI,Theoretical Domains Framework},\\n pages = {67},\\n volume = {12},\\n websites = {http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5},\\n month = {5},\\n publisher = {BioMed Central Ltd.},\\n day = {19},\\n id = {a1961964-3924-3b25-b4c0-57aa038478e5},\\n created = {2020-10-08T17:42:36.845Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.382Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). Methods: ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Results: Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Conclusions: Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.},\\n bibtype = {article},\\n author = {Gramlich, Leah M. and Sheppard, Caroline E. and Wasylak, Tracy and Gilmour, Loreen E. and Ljungqvist, Olle and Basualdo-Hammond, Carlota and Nelson, Gregg},\\n doi = {10.1186/s13012-017-0597-5},\\n journal = {Implementation Science},\\n number = {1}\\n}\",\"author_short\":[\"Gramlich,  L., M.\",\"Sheppard,  C., E.\",\"Wasylak,  T.\",\"Gilmour,  L., E.\",\"Ljungqvist,  O.\",\"Basualdo-Hammond,  C.\",\"Nelson,  G.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/5e1a4272-28b8-85a9-7d51-0e7ce1a7d4ed/full_text.pdf.pdf\",\"Website\":\"http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017\",\"role\":\"author\",\"keyword\":[\"Enhanced Recovery After Surgery\",\"Implementation\",\"QUERI\",\"Theoretical Domains Framework\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations\",\"type\":\"inproceedings\",\"year\":\"2017\",\"keywords\":\"Claire Temple-Oberle,Consensus Development Conference,ERAS Society,Female,Humans,MEDLINE,Mammaplasty*,Melissa A Shea-Budgell,Meta-Analysis as Topic,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / standards*,Practice Guideline,Prospective Studies,PubMed Abstract,Randomized Controlled Trials as Topic,Review,Systematic Review,doi:10.1097/PRS.0000000000003242,pmid:28445352\",\"pages\":\"1056e-1071e\",\"volume\":\"139\",\"issue\":\"5\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28445352/\",\"month\":\"5\",\"publisher\":\"Lippincott Williams and Wilkins\",\"day\":\"1\",\"id\":\"4ffc228a-b7ca-33b7-92a0-18076980d130\",\"created\":\"2020-10-08T17:43:00.105Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.659Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.\",\"bibtype\":\"inproceedings\",\"author\":\"Temple-Oberle, Claire and Shea-Budgell, Melissa A. and Tan, Mark and Semple, John L. and Schrag, Christiaan and Barreto, Marcio and Blondeel, Phillip and Hamming, Jeremy and Dayan, Joseph and Ljungqvist, Olle\",\"doi\":\"10.1097/PRS.0000000000003242\",\"booktitle\":\"Plastic and Reconstructive Surgery\",\"bibtex\":\"@inproceedings{\\n title = {Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations},\\n type = {inproceedings},\\n year = {2017},\\n keywords = {Claire Temple-Oberle,Consensus Development Conference,ERAS Society,Female,Humans,MEDLINE,Mammaplasty*,Melissa A Shea-Budgell,Meta-Analysis as Topic,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / standards*,Practice Guideline,Prospective Studies,PubMed Abstract,Randomized Controlled Trials as Topic,Review,Systematic Review,doi:10.1097/PRS.0000000000003242,pmid:28445352},\\n pages = {1056e-1071e},\\n volume = {139},\\n issue = {5},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28445352/},\\n month = {5},\\n publisher = {Lippincott Williams and Wilkins},\\n day = {1},\\n id = {4ffc228a-b7ca-33b7-92a0-18076980d130},\\n created = {2020-10-08T17:43:00.105Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.659Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.},\\n bibtype = {inproceedings},\\n author = {Temple-Oberle, Claire and Shea-Budgell, Melissa A. and Tan, Mark and Semple, John L. and Schrag, Christiaan and Barreto, Marcio and Blondeel, Phillip and Hamming, Jeremy and Dayan, Joseph and Ljungqvist, Olle},\\n doi = {10.1097/PRS.0000000000003242},\\n booktitle = {Plastic and Reconstructive Surgery}\\n}\",\"author_short\":[\"Temple-Oberle,  C.\",\"Shea-Budgell,  M., A.\",\"Tan,  M.\",\"Semple,  J., L.\",\"Schrag,  C.\",\"Barreto,  M.\",\"Blondeel,  P.\",\"Hamming,  J.\",\"Dayan,  J.\",\"Ljungqvist,  O.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28445352/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017\",\"role\":\"author\",\"keyword\":[\"Claire Temple-Oberle\",\"Consensus Development Conference\",\"ERAS Society\",\"Female\",\"Humans\",\"MEDLINE\",\"Mammaplasty*\",\"Melissa A Shea-Budgell\",\"Meta-Analysis as Topic\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Perioperative Care / standards*\",\"Practice Guideline\",\"Prospective Studies\",\"PubMed Abstract\",\"Randomized Controlled Trials as Topic\",\"Review\",\"Systematic Review\",\"doi:10.1097/PRS.0000000000003242\",\"pmid:28445352\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery\",\"type\":\"article\",\"year\":\"2017\",\"keywords\":\"Bowel surgery,Colorectal surgery,Diet,Dietary protein,Energy,Enhanced Recovery After Surgery,Length of stay,Malnutrition screening tool,Nutrition,Oral nutrition supplement\",\"pages\":\"44-51\",\"volume\":\"106\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28468890/\",\"month\":\"7\",\"publisher\":\"American Society for Nutrition\",\"day\":\"1\",\"id\":\"8c303c6e-f852-3849-934c-d0952ea1804c\",\"created\":\"2020-10-08T17:43:28.938Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.547Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of $60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: 26.8, 22.0 d; P < 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS.\",\"bibtype\":\"article\",\"author\":\"Yeung, Sophia E. and Hilkewich, Leslee and Gillis, Chelsia and Heine, John A. and Fenton, Tanis R.\",\"doi\":\"10.3945/ajcn.116.148619\",\"journal\":\"American Journal of Clinical Nutrition\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery},\\n type = {article},\\n year = {2017},\\n keywords = {Bowel surgery,Colorectal surgery,Diet,Dietary protein,Energy,Enhanced Recovery After Surgery,Length of stay,Malnutrition screening tool,Nutrition,Oral nutrition supplement},\\n pages = {44-51},\\n volume = {106},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28468890/},\\n month = {7},\\n publisher = {American Society for Nutrition},\\n day = {1},\\n id = {8c303c6e-f852-3849-934c-d0952ea1804c},\\n created = {2020-10-08T17:43:28.938Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.547Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of $60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: 26.8, 22.0 d; P < 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS.},\\n bibtype = {article},\\n author = {Yeung, Sophia E. and Hilkewich, Leslee and Gillis, Chelsia and Heine, John A. and Fenton, Tanis R.},\\n doi = {10.3945/ajcn.116.148619},\\n journal = {American Journal of Clinical Nutrition},\\n number = {1}\\n}\",\"author_short\":[\"Yeung,  S., E.\",\"Hilkewich,  L.\",\"Gillis,  C.\",\"Heine,  J., A.\",\"Fenton,  T., R.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1f7eb0de-e998-ca91-1b05-e870d4e988dd/full_text.pdf.pdf\",\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28468890/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017\",\"role\":\"author\",\"keyword\":[\"Bowel surgery\",\"Colorectal surgery\",\"Diet\",\"Dietary protein\",\"Energy\",\"Enhanced Recovery After Surgery\",\"Length of stay\",\"Malnutrition screening tool\",\"Nutrition\",\"Oral nutrition supplement\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study\",\"type\":\"article\",\"year\":\"2017\",\"keywords\":\"Colorectal surgery,Quality in healthcare\",\"volume\":\"7\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28647727/\",\"month\":\"6\",\"publisher\":\"BMJ Publishing Group\",\"day\":\"1\",\"id\":\"43fb09fc-36cf-3715-bbea-f27413387b6f\",\"created\":\"2020-10-08T17:43:40.924Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.680Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.\",\"bibtype\":\"article\",\"author\":\"Gillis, Chelsia and Gill, Marlyn and Marlett, Nancy and Mackean, Gail and Germann, Kathy and Gilmour, Loreen and Nelson, Gregg and Wasylak, Tracy and Nguyen, Susan and Araujo, Edamil and Zelinsky, Sandra and Gramlich, Leah\",\"doi\":\"10.1136/bmjopen-2017-017002\",\"journal\":\"BMJ Open\",\"number\":\"6\",\"bibtex\":\"@article{\\n title = {Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study},\\n type = {article},\\n year = {2017},\\n keywords = {Colorectal surgery,Quality in healthcare},\\n volume = {7},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28647727/},\\n month = {6},\\n publisher = {BMJ Publishing Group},\\n day = {1},\\n id = {43fb09fc-36cf-3715-bbea-f27413387b6f},\\n created = {2020-10-08T17:43:40.924Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.680Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.},\\n bibtype = {article},\\n author = {Gillis, Chelsia and Gill, Marlyn and Marlett, Nancy and Mackean, Gail and Germann, Kathy and Gilmour, Loreen and Nelson, Gregg and Wasylak, Tracy and Nguyen, Susan and Araujo, Edamil and Zelinsky, Sandra and Gramlich, Leah},\\n doi = {10.1136/bmjopen-2017-017002},\\n journal = {BMJ Open},\\n number = {6}\\n}\",\"author_short\":[\"Gillis,  C.\",\"Gill,  M.\",\"Marlett,  N.\",\"Mackean,  G.\",\"Germann,  K.\",\"Gilmour,  L.\",\"Nelson,  G.\",\"Wasylak,  T.\",\"Nguyen,  S.\",\"Araujo,  E.\",\"Zelinsky,  S.\",\"Gramlich,  L.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3bb92bf8-4fc8-d1d5-3c96-f464169995c1/full_text.pdf.pdf\",\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28647727/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017\",\"role\":\"author\",\"keyword\":[\"Colorectal surgery\",\"Quality in healthcare\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Enhanced recovery in gynecologic oncology – A sea change in perioperative management\",\"type\":\"misc\",\"year\":\"2017\",\"source\":\"Gynecologic Oncology\",\"keywords\":\"Editorial,Female,Female / surgery*,Genital Neoplasms,Gregg Nelson,Gynecologic Surgical Procedures / methods*,Humans,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / methods*,PubMed Abstract,Randomized Controlled Trials as Topic,Sean C Dowdy,doi:10.1016/j.ygyno.2017.06.015,pmid:28645426\",\"pages\":\"225-227\",\"volume\":\"146\",\"issue\":\"2\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28645426/\",\"month\":\"8\",\"publisher\":\"Academic Press Inc.\",\"day\":\"1\",\"id\":\"d9f6d109-93f5-3d15-a27b-5b978231e0fb\",\"created\":\"2020-10-08T17:44:02.463Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.651Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"misc\",\"author\":\"Dowdy, Sean C. and Nelson, Gregg\",\"doi\":\"10.1016/j.ygyno.2017.06.015\",\"bibtex\":\"@misc{\\n title = {Enhanced recovery in gynecologic oncology – A sea change in perioperative management},\\n type = {misc},\\n year = {2017},\\n source = {Gynecologic Oncology},\\n keywords = {Editorial,Female,Female / surgery*,Genital Neoplasms,Gregg Nelson,Gynecologic Surgical Procedures / methods*,Humans,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / methods*,PubMed Abstract,Randomized Controlled Trials as Topic,Sean C Dowdy,doi:10.1016/j.ygyno.2017.06.015,pmid:28645426},\\n pages = {225-227},\\n volume = {146},\\n issue = {2},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28645426/},\\n month = {8},\\n publisher = {Academic Press Inc.},\\n day = {1},\\n id = {d9f6d109-93f5-3d15-a27b-5b978231e0fb},\\n created = {2020-10-08T17:44:02.463Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.651Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {misc},\\n author = {Dowdy, Sean C. and Nelson, Gregg},\\n doi = {10.1016/j.ygyno.2017.06.015}\\n}\",\"author_short\":[\"Dowdy,  S., C.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28645426/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017\",\"role\":\"author\",\"keyword\":[\"Editorial\",\"Female\",\"Female / surgery*\",\"Genital Neoplasms\",\"Gregg Nelson\",\"Gynecologic Surgical Procedures / methods*\",\"Humans\",\"MEDLINE\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Perioperative Care / methods*\",\"PubMed Abstract\",\"Randomized Controlled Trials as Topic\",\"Sean C Dowdy\",\"doi:10.1016/j.ygyno.2017.06.015\",\"pmid:28645426\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"ERAS—Value based surgery\",\"type\":\"misc\",\"year\":\"2017\",\"source\":\"Journal of Surgical Oncology\",\"keywords\":\"ERAS,clinical outcomes,cost of care,implementation\",\"pages\":\"608-612\",\"volume\":\"116\",\"issue\":\"5\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28873501/\",\"month\":\"10\",\"publisher\":\"John Wiley and Sons Inc.\",\"day\":\"1\",\"id\":\"5d77dee8-99d2-3783-beba-eca6bffb5797\",\"created\":\"2020-10-08T17:44:10.582Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.536Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.\",\"bibtype\":\"misc\",\"author\":\"Ljungqvist, Olle and Thanh, Nguyen X. and Nelson, Gregg\",\"doi\":\"10.1002/jso.24820\",\"bibtex\":\"@misc{\\n title = {ERAS—Value based surgery},\\n type = {misc},\\n year = {2017},\\n source = {Journal of Surgical Oncology},\\n keywords = {ERAS,clinical outcomes,cost of care,implementation},\\n pages = {608-612},\\n volume = {116},\\n issue = {5},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28873501/},\\n month = {10},\\n publisher = {John Wiley and Sons Inc.},\\n day = {1},\\n id = {5d77dee8-99d2-3783-beba-eca6bffb5797},\\n created = {2020-10-08T17:44:10.582Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.536Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.},\\n bibtype = {misc},\\n author = {Ljungqvist, Olle and Thanh, Nguyen X. and Nelson, Gregg},\\n doi = {10.1002/jso.24820}\\n}\",\"author_short\":[\"Ljungqvist,  O.\",\"Thanh,  N., X.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28873501/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017\",\"role\":\"author\",\"keyword\":[\"ERAS\",\"clinical outcomes\",\"cost of care\",\"implementation\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development\",\"type\":\"article\",\"year\":\"2017\",\"keywords\":\"ERAS®,Enhanced recovery after surgery,Guidelines,Surgery\",\"pages\":\"617-620\",\"volume\":\"147\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/28947172/\",\"month\":\"12\",\"publisher\":\"Academic Press Inc.\",\"day\":\"1\",\"id\":\"c78d5930-6ee1-3269-8d4f-34cd457ba7ff\",\"created\":\"2020-10-08T17:45:16.839Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.767Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"article\",\"author\":\"Nelson, G. and Dowdy, S. C. and Lasala, J. and Mena, G. and Bakkum-Gamez, J. and Meyer, L. A. and Iniesta, M. D. and Ramirez, P. T.\",\"doi\":\"10.1016/j.ygyno.2017.09.023\",\"journal\":\"Gynecologic Oncology\",\"number\":\"3\",\"bibtex\":\"@article{\\n title = {Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development},\\n type = {article},\\n year = {2017},\\n keywords = {ERAS®,Enhanced recovery after surgery,Guidelines,Surgery},\\n pages = {617-620},\\n volume = {147},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/28947172/},\\n month = {12},\\n publisher = {Academic Press Inc.},\\n day = {1},\\n id = {c78d5930-6ee1-3269-8d4f-34cd457ba7ff},\\n created = {2020-10-08T17:45:16.839Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.767Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {article},\\n author = {Nelson, G. and Dowdy, S. C. and Lasala, J. and Mena, G. and Bakkum-Gamez, J. and Meyer, L. A. and Iniesta, M. D. and Ramirez, P. T.},\\n doi = {10.1016/j.ygyno.2017.09.023},\\n journal = {Gynecologic Oncology},\\n number = {3}\\n}\",\"author_short\":[\"Nelson,  G.\",\"Dowdy,  S., C.\",\"Lasala,  J.\",\"Mena,  G.\",\"Bakkum-Gamez,  J.\",\"Meyer,  L., A.\",\"Iniesta,  M., D.\",\"Ramirez,  P., T.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2927c56a-6389-4525-4fcb-890e767a03e9/full_text.pdf.pdf\",\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/28947172/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017\",\"role\":\"author\",\"keyword\":[\"ERAS®\",\"Enhanced recovery after surgery\",\"Guidelines\",\"Surgery\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Enhanced Recovery for Cardiac Surgery\",\"type\":\"misc\",\"year\":\"2018\",\"source\":\"Journal of Cardiothoracic and Vascular Anesthesia\",\"keywords\":\"ERAS,ERCS,enhanced recovery\",\"pages\":\"2760-2770\",\"volume\":\"32\",\"issue\":\"6\",\"websites\":\"http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract\",\"month\":\"12\",\"publisher\":\"W.B. Saunders\",\"day\":\"1\",\"id\":\"3ec38b68-38ee-335b-b415-ab9a9c00caaf\",\"created\":\"2020-10-08T17:51:54.574Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.456Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest.\",\"bibtype\":\"misc\",\"author\":\"Noss, Christopher and Prusinkiewicz, Christopher and Nelson, Gregg and Patel, Prakash A. and Augoustides, John G. and Gregory, Alexander J.\",\"doi\":\"10.1053/j.jvca.2018.01.045\",\"bibtex\":\"@misc{\\n title = {Enhanced Recovery for Cardiac Surgery},\\n type = {misc},\\n year = {2018},\\n source = {Journal of Cardiothoracic and Vascular Anesthesia},\\n keywords = {ERAS,ERCS,enhanced recovery},\\n pages = {2760-2770},\\n volume = {32},\\n issue = {6},\\n websites = {http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract},\\n month = {12},\\n publisher = {W.B. Saunders},\\n day = {1},\\n id = {3ec38b68-38ee-335b-b415-ab9a9c00caaf},\\n created = {2020-10-08T17:51:54.574Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.456Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest.},\\n bibtype = {misc},\\n author = {Noss, Christopher and Prusinkiewicz, Christopher and Nelson, Gregg and Patel, Prakash A. and Augoustides, John G. and Gregory, Alexander J.},\\n doi = {10.1053/j.jvca.2018.01.045}\\n}\",\"author_short\":[\"Noss,  C.\",\"Prusinkiewicz,  C.\",\"Nelson,  G.\",\"Patel,  P., A.\",\"Augoustides,  J., G.\",\"Gregory,  A., J.\"],\"urls\":{\"Website\":\"http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018\",\"role\":\"author\",\"keyword\":[\"ERAS\",\"ERCS\",\"enhanced recovery\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes\",\"type\":\"article\",\"year\":\"2018\",\"keywords\":\"Clinical outcomes,Cost savings,ERAS,Gynecologic oncology\",\"pages\":\"117-123\",\"volume\":\"151\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/30100053/\",\"month\":\"10\",\"publisher\":\"Academic Press Inc.\",\"day\":\"1\",\"id\":\"1ad19dc3-c581-3887-932d-dd5a5787016a\",\"created\":\"2020-10-08T17:52:24.945Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.025Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Objective: Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system. Methods: We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics. Results: We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p < 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p < 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p < 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636). Conclusions: Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.\",\"bibtype\":\"article\",\"author\":\"Bisch, S. P. and Wells, T. and Gramlich, L. and Faris, P. and Wang, X. and Tran, D. T. and Thanh, N. X. and Glaze, S. and Chu, P. and Ghatage, P. and Nation, J. and Capstick, V. and Steed, H. and Sabourin, J. and Nelson, G.\",\"doi\":\"10.1016/j.ygyno.2018.08.007\",\"journal\":\"Gynecologic Oncology\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes},\\n type = {article},\\n year = {2018},\\n keywords = {Clinical outcomes,Cost savings,ERAS,Gynecologic oncology},\\n pages = {117-123},\\n volume = {151},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/30100053/},\\n month = {10},\\n publisher = {Academic Press Inc.},\\n day = {1},\\n id = {1ad19dc3-c581-3887-932d-dd5a5787016a},\\n created = {2020-10-08T17:52:24.945Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.025Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Objective: Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system. Methods: We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics. Results: We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p < 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p < 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p < 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636). Conclusions: Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.},\\n bibtype = {article},\\n author = {Bisch, S. P. and Wells, T. and Gramlich, L. and Faris, P. and Wang, X. and Tran, D. T. and Thanh, N. X. and Glaze, S. and Chu, P. and Ghatage, P. and Nation, J. and Capstick, V. and Steed, H. and Sabourin, J. and Nelson, G.},\\n doi = {10.1016/j.ygyno.2018.08.007},\\n journal = {Gynecologic Oncology},\\n number = {1}\\n}\",\"author_short\":[\"Bisch,  S., P.\",\"Wells,  T.\",\"Gramlich,  L.\",\"Faris,  P.\",\"Wang,  X.\",\"Tran,  D., T.\",\"Thanh,  N., X.\",\"Glaze,  S.\",\"Chu,  P.\",\"Ghatage,  P.\",\"Nation,  J.\",\"Capstick,  V.\",\"Steed,  H.\",\"Sabourin,  J.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/30100053/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018\",\"role\":\"author\",\"keyword\":[\"Clinical outcomes\",\"Cost savings\",\"ERAS\",\"Gynecologic oncology\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)\",\"type\":\"article\",\"year\":\"2018\",\"keywords\":\"cesarean delivery,enhanced recovery,intraoperative,postoperative,preoperative,quality,safety\",\"pages\":\"523.e1-523.e15\",\"volume\":\"219\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/30240657/\",\"month\":\"12\",\"publisher\":\"Mosby Inc.\",\"day\":\"1\",\"id\":\"940da495-ea9e-3495-8e98-e0b73c312a23\",\"created\":\"2020-10-08T17:52:26.992Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.027Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation,), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.\",\"bibtype\":\"article\",\"author\":\"Wilson, R. Douglas and Caughey, Aaron B. and Wood, Stephen L. and Macones, George A. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg\",\"doi\":\"10.1016/j.ajog.2018.09.015\",\"journal\":\"American Journal of Obstetrics and Gynecology\",\"number\":\"6\",\"bibtex\":\"@article{\\n title = {Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)},\\n type = {article},\\n year = {2018},\\n keywords = {cesarean delivery,enhanced recovery,intraoperative,postoperative,preoperative,quality,safety},\\n pages = {523.e1-523.e15},\\n volume = {219},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/30240657/},\\n month = {12},\\n publisher = {Mosby Inc.},\\n day = {1},\\n id = {940da495-ea9e-3495-8e98-e0b73c312a23},\\n created = {2020-10-08T17:52:26.992Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.027Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation,), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.},\\n bibtype = {article},\\n author = {Wilson, R. Douglas and Caughey, Aaron B. and Wood, Stephen L. and Macones, George A. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg},\\n doi = {10.1016/j.ajog.2018.09.015},\\n journal = {American Journal of Obstetrics and Gynecology},\\n number = {6}\\n}\",\"author_short\":[\"Wilson,  R., D.\",\"Caughey,  A., B.\",\"Wood,  S., L.\",\"Macones,  G., A.\",\"Wrench,  I., J.\",\"Huang,  J.\",\"Norman,  M.\",\"Pettersson,  K.\",\"Fawcett,  W., J.\",\"Shalabi,  M., M.\",\"Metcalfe,  A.\",\"Gramlich,  L.\",\"Nelson,  G.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/30240657/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018\",\"role\":\"author\",\"keyword\":[\"cesarean delivery\",\"enhanced recovery\",\"intraoperative\",\"postoperative\",\"preoperative\",\"quality\",\"safety\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery\",\"type\":\"misc\",\"year\":\"2018\",\"source\":\"American Journal of Obstetrics and Gynecology\",\"keywords\":\"Agency for Healthcare Research and Quality,Improving Surgical Care and Recovery,enhanced recovery after surgery,enhanced recovery pathway,gynecologic surgery,patient safety,review\",\"pages\":\"563.e1-563.e19\",\"volume\":\"219\",\"issue\":\"6\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/30031749/\",\"month\":\"12\",\"publisher\":\"Mosby Inc.\",\"day\":\"1\",\"id\":\"6f9ea4b6-6266-3fe2-b6d8-c1170f55878f\",\"created\":\"2020-10-08T17:52:29.281Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.443Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective: The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design: We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results: Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion: Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.\",\"bibtype\":\"misc\",\"author\":\"Kalogera, Eleftheria and Nelson, Gregg and Liu, Jessica and Hu, Q. Lina and Ko, Clifford Y. and Wick, Elizabeth and Dowdy, Sean C.\",\"doi\":\"10.1016/j.ajog.2018.07.014\",\"bibtex\":\"@misc{\\n title = {Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery},\\n type = {misc},\\n year = {2018},\\n source = {American Journal of Obstetrics and Gynecology},\\n keywords = {Agency for Healthcare Research and Quality,Improving Surgical Care and Recovery,enhanced recovery after surgery,enhanced recovery pathway,gynecologic surgery,patient safety,review},\\n pages = {563.e1-563.e19},\\n volume = {219},\\n issue = {6},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/30031749/},\\n month = {12},\\n publisher = {Mosby Inc.},\\n day = {1},\\n id = {6f9ea4b6-6266-3fe2-b6d8-c1170f55878f},\\n created = {2020-10-08T17:52:29.281Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.443Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective: The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design: We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results: Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion: Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.},\\n bibtype = {misc},\\n author = {Kalogera, Eleftheria and Nelson, Gregg and Liu, Jessica and Hu, Q. Lina and Ko, Clifford Y. and Wick, Elizabeth and Dowdy, Sean C.},\\n doi = {10.1016/j.ajog.2018.07.014}\\n}\",\"author_short\":[\"Kalogera,  E.\",\"Nelson,  G.\",\"Liu,  J.\",\"Hu,  Q., L.\",\"Ko,  C., Y.\",\"Wick,  E.\",\"Dowdy,  S., C.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a8bd581-b033-0dd3-5c4b-c6e2768d50d5/full_text.pdf.pdf\",\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/30031749/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018\",\"role\":\"author\",\"keyword\":[\"Agency for Healthcare Research and Quality\",\"Improving Surgical Care and Recovery\",\"enhanced recovery after surgery\",\"enhanced recovery pathway\",\"gynecologic surgery\",\"patient safety\",\"review\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":1,\"html\":\"\"},{\"title\":\"The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada\",\"type\":\"article\",\"year\":\"2018\",\"keywords\":\"Adult,Aged,Alberta,Colorectal Surgery / statistics & numerical data*,Digestive System Surgical Procedures / statistics,Female,Finlay A McAlister,Humans,Leah Gramlich,Length of Stay / statistics & numerical data*,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Non-U.S. Gov't,Patient Readmission,Perioperative Care / methods,Perioperative Care / standards*,Postoperative Care / methods,Postoperative Care / standards*,Postoperative Complications / prevention & control,Program Evaluation,PubMed Abstract,Research Support,Retrospective Studies,Zaina AlBalawi,doi:10.1007/s00268-018-4559-0,pmid:29532139\",\"pages\":\"2691-2700\",\"volume\":\"42\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/29532139/\",\"month\":\"9\",\"publisher\":\"Springer New York LLC\",\"day\":\"1\",\"id\":\"b6ad9164-222a-3ae3-a7bf-166d9eff307b\",\"created\":\"2020-10-08T17:52:43.181Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.314Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. Methods: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery. Results: Of 2714 patients (mean age 60.4 years, 55% men) with similar demographics and comorbidity profiles in the pre/post-ERAS time periods, LOS was significantly shorter post-ERAS (8.5 vs. 9.5 days, p = 0.01; − 0.84 days [95% CI − 0.04 to − 1.64 days] after adjustment for age, sex, Charlson comorbidity score, procedure type, surgical approach, and hospital). However, interrupted time series demonstrated no significant level change (p = 0.30) or change in slope (p = 0.63) with ERAS implementation, consistent with continuation of an underlying secular trend of reductions in LOS over time. There were no significant differences (in multivariate analysis or ITS) in risk of 30-day death/readmission (14.3% post vs. 13.5% pre-ERAS, aOR 1.12, 95% CI 0.89–1.40), 30-day death/ED visit (27.2% post vs. 30.0% pre, aOR 0.93, 95% CI 0.78–1.10), or 30-day death/readmission/ED visit (27.8% post vs. 30.6% pre, aOR 0.93, 95% CI 0.78–1.10). The 428 patients with diabetes had longer LOS but exhibited no significant difference post- versus pre-ERAS (10.7 vs. 11.6 days, p = 0.53; p = 0.56 for level change and p = 0.66 for slope change on ITS). Conclusion: Although there was a secular trend toward decreasing LOS over time in Alberta, ERAS implementation was not associated with statistically significant changes in LOS or postoperative outcomes for all colorectal surgery patients or for those with diabetes. Our study highlights the importance of evaluating system changes (for both uptake and outcomes) rather than assuming trial benefits will translate directly into practice. Interventions to improve LOS and postoperative outcomes for patients with diabetes undergoing colorectal surgery are still needed even in the ERAS era.\",\"bibtype\":\"article\",\"author\":\"AlBalawi, Zaina and Gramlich, Leah and Nelson, Gregg and Senior, Peter and Youngson, Erik and McAlister, Finlay A.\",\"doi\":\"10.1007/s00268-018-4559-0\",\"journal\":\"World Journal of Surgery\",\"number\":\"9\",\"bibtex\":\"@article{\\n title = {The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada},\\n type = {article},\\n year = {2018},\\n keywords = {Adult,Aged,Alberta,Colorectal Surgery / statistics & numerical data*,Digestive System Surgical Procedures / statistics,Female,Finlay A McAlister,Humans,Leah Gramlich,Length of Stay / statistics & numerical data*,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Non-U.S. Gov't,Patient Readmission,Perioperative Care / methods,Perioperative Care / standards*,Postoperative Care / methods,Postoperative Care / standards*,Postoperative Complications / prevention & control,Program Evaluation,PubMed Abstract,Research Support,Retrospective Studies,Zaina AlBalawi,doi:10.1007/s00268-018-4559-0,pmid:29532139},\\n pages = {2691-2700},\\n volume = {42},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/29532139/},\\n month = {9},\\n publisher = {Springer New York LLC},\\n day = {1},\\n id = {b6ad9164-222a-3ae3-a7bf-166d9eff307b},\\n created = {2020-10-08T17:52:43.181Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.314Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. Methods: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery. Results: Of 2714 patients (mean age 60.4 years, 55% men) with similar demographics and comorbidity profiles in the pre/post-ERAS time periods, LOS was significantly shorter post-ERAS (8.5 vs. 9.5 days, p = 0.01; − 0.84 days [95% CI − 0.04 to − 1.64 days] after adjustment for age, sex, Charlson comorbidity score, procedure type, surgical approach, and hospital). However, interrupted time series demonstrated no significant level change (p = 0.30) or change in slope (p = 0.63) with ERAS implementation, consistent with continuation of an underlying secular trend of reductions in LOS over time. There were no significant differences (in multivariate analysis or ITS) in risk of 30-day death/readmission (14.3% post vs. 13.5% pre-ERAS, aOR 1.12, 95% CI 0.89–1.40), 30-day death/ED visit (27.2% post vs. 30.0% pre, aOR 0.93, 95% CI 0.78–1.10), or 30-day death/readmission/ED visit (27.8% post vs. 30.6% pre, aOR 0.93, 95% CI 0.78–1.10). The 428 patients with diabetes had longer LOS but exhibited no significant difference post- versus pre-ERAS (10.7 vs. 11.6 days, p = 0.53; p = 0.56 for level change and p = 0.66 for slope change on ITS). Conclusion: Although there was a secular trend toward decreasing LOS over time in Alberta, ERAS implementation was not associated with statistically significant changes in LOS or postoperative outcomes for all colorectal surgery patients or for those with diabetes. Our study highlights the importance of evaluating system changes (for both uptake and outcomes) rather than assuming trial benefits will translate directly into practice. Interventions to improve LOS and postoperative outcomes for patients with diabetes undergoing colorectal surgery are still needed even in the ERAS era.},\\n bibtype = {article},\\n author = {AlBalawi, Zaina and Gramlich, Leah and Nelson, Gregg and Senior, Peter and Youngson, Erik and McAlister, Finlay A.},\\n doi = {10.1007/s00268-018-4559-0},\\n journal = {World Journal of Surgery},\\n number = {9}\\n}\",\"author_short\":[\"AlBalawi,  Z.\",\"Gramlich,  L.\",\"Nelson,  G.\",\"Senior,  P.\",\"Youngson,  E.\",\"McAlister,  F., A.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/29532139/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018\",\"role\":\"author\",\"keyword\":[\"Adult\",\"Aged\",\"Alberta\",\"Colorectal Surgery / statistics & numerical data*\",\"Digestive System Surgical Procedures / statistics\",\"Female\",\"Finlay A McAlister\",\"Humans\",\"Leah Gramlich\",\"Length of Stay / statistics & numerical data*\",\"MEDLINE\",\"Male\",\"Middle Aged\",\"NCBI\",\"NIH\",\"NLM\",\"National Center for Biotechnology Information\",\"National Institutes of Health\",\"National Library of Medicine\",\"Non-U.S. Gov't\",\"Patient Readmission\",\"Perioperative Care / methods\",\"Perioperative Care / standards*\",\"Postoperative Care / methods\",\"Postoperative Care / standards*\",\"Postoperative Complications / prevention & control\",\"Program Evaluation\",\"PubMed Abstract\",\"Research Support\",\"Retrospective Studies\",\"Zaina AlBalawi\",\"doi:10.1007/s00268-018-4559-0\",\"pmid:29532139\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols\",\"type\":\"misc\",\"year\":\"2018\",\"source\":\"Current Opinion in Otolaryngology and Head and Neck Surgery\",\"keywords\":\"enhanced recovery after surgery,implementation,outcomes improvement\",\"pages\":\"71-77\",\"volume\":\"26\",\"issue\":\"2\",\"websites\":\"https://pubmed.ncbi.nlm.nih.gov/29432221/\",\"month\":\"4\",\"publisher\":\"Lippincott Williams and Wilkins\",\"day\":\"1\",\"id\":\"050e96ba-0a69-3e2b-9ab7-beb65c6fbbad\",\"created\":\"2020-10-08T17:52:59.150Z\",\"accessed\":\"2020-10-08\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.224Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.\",\"bibtype\":\"misc\",\"author\":\"Huber, Gerhard F. and Dort, Joseph C.\",\"doi\":\"10.1097/MOO.0000000000000442\",\"bibtex\":\"@misc{\\n title = {Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols},\\n type = {misc},\\n year = {2018},\\n source = {Current Opinion in Otolaryngology and Head and Neck Surgery},\\n keywords = {enhanced recovery after surgery,implementation,outcomes improvement},\\n pages = {71-77},\\n volume = {26},\\n issue = {2},\\n websites = {https://pubmed.ncbi.nlm.nih.gov/29432221/},\\n month = {4},\\n publisher = {Lippincott Williams and Wilkins},\\n day = {1},\\n id = {050e96ba-0a69-3e2b-9ab7-beb65c6fbbad},\\n created = {2020-10-08T17:52:59.150Z},\\n accessed = {2020-10-08},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.224Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.},\\n bibtype = {misc},\\n author = {Huber, Gerhard F. and Dort, Joseph C.},\\n doi = {10.1097/MOO.0000000000000442}\\n}\",\"author_short\":[\"Huber,  G., F.\",\"Dort,  J., C.\"],\"urls\":{\"Website\":\"https://pubmed.ncbi.nlm.nih.gov/29432221/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018\",\"role\":\"author\",\"keyword\":[\"enhanced recovery after surgery\",\"implementation\",\"outcomes improvement\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study\",\"type\":\"article\",\"year\":\"2018\",\"pages\":\"23651\",\"volume\":\"8\",\"websites\":\"http://bmjopen.bmj.com/\",\"month\":\"12\",\"publisher\":\"BMJ Publishing Group\",\"day\":\"1\",\"id\":\"d705b8c7-657f-3100-8825-18cfb9abc496\",\"created\":\"2020-10-08T17:55:50.898Z\",\"accessed\":\"2020-10-08\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:59.130Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. Methods: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. Ethics and dissemination: This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.\",\"bibtype\":\"article\",\"author\":\"Gibb, Ashleigh C.N. and Crosby, Megan A. and McDiarmid, Caraline and Urban, Denisa and Lam, Jennifer Y.K. and Wales, Paul W. and Brockel, Megan and Raval, Mehul and Offringa, Martin and Skarsgard, Erik D. and Wester, Tomas and Wong, Kenneth and De Beer, David and Nelson, Gregg and Brindle, Mary E.\",\"doi\":\"10.1136/bmjopen-2018-023651\",\"journal\":\"BMJ Open\",\"number\":\"12\",\"bibtex\":\"@article{\\n title = {Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study},\\n type = {article},\\n year = {2018},\\n pages = {23651},\\n volume = {8},\\n websites = {http://bmjopen.bmj.com/},\\n month = {12},\\n publisher = {BMJ Publishing Group},\\n day = {1},\\n id = {d705b8c7-657f-3100-8825-18cfb9abc496},\\n created = {2020-10-08T17:55:50.898Z},\\n accessed = {2020-10-08},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:59.130Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. Methods: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. Ethics and dissemination: This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.},\\n bibtype = {article},\\n author = {Gibb, Ashleigh C.N. and Crosby, Megan A. and McDiarmid, Caraline and Urban, Denisa and Lam, Jennifer Y.K. and Wales, Paul W. and Brockel, Megan and Raval, Mehul and Offringa, Martin and Skarsgard, Erik D. and Wester, Tomas and Wong, Kenneth and De Beer, David and Nelson, Gregg and Brindle, Mary E.},\\n doi = {10.1136/bmjopen-2018-023651},\\n journal = {BMJ Open},\\n number = {12}\\n}\",\"author_short\":[\"Gibb,  A., C.\",\"Crosby,  M., A.\",\"McDiarmid,  C.\",\"Urban,  D.\",\"Lam,  J., Y.\",\"Wales,  P., W.\",\"Brockel,  M.\",\"Raval,  M.\",\"Offringa,  M.\",\"Skarsgard,  E., D.\",\"Wester,  T.\",\"Wong,  K.\",\"De Beer,  D.\",\"Nelson,  G.\",\"Brindle,  M., E.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7d497b40-a90b-e645-460b-0abf5f7e30a9/full_text.pdf.pdf\",\"Website\":\"http://bmjopen.bmj.com/\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines\",\"type\":\"article\",\"year\":\"2020\",\"pages\":\"157-163\",\"volume\":\"4\",\"websites\":\"https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238\",\"month\":\"2\",\"publisher\":\"NLM (Medline)\",\"day\":\"2\",\"id\":\"cee84947-d7b4-3b51-a90d-959c8896f928\",\"created\":\"2020-10-14T16:02:14.429Z\",\"accessed\":\"2020-10-14\",\"file_attached\":\"true\",\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:59.090Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"BACKGROUND: ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS: The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION: There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.\",\"bibtype\":\"article\",\"author\":\"Brindle, M. and Nelson, G. and Lobo, D. N. and Ljungqvist, O. and Gustafsson, U. O.\",\"doi\":\"10.1002/bjs5.50238\",\"journal\":\"BJS open\",\"number\":\"1\",\"bibtex\":\"@article{\\n title = {Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines},\\n type = {article},\\n year = {2020},\\n pages = {157-163},\\n volume = {4},\\n websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238},\\n month = {2},\\n publisher = {NLM (Medline)},\\n day = {2},\\n id = {cee84947-d7b4-3b51-a90d-959c8896f928},\\n created = {2020-10-14T16:02:14.429Z},\\n accessed = {2020-10-14},\\n file_attached = {true},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:59.090Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {BACKGROUND: ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS: The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION: There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.},\\n bibtype = {article},\\n author = {Brindle, M. and Nelson, G. and Lobo, D. N. and Ljungqvist, O. and Gustafsson, U. O.},\\n doi = {10.1002/bjs5.50238},\\n journal = {BJS open},\\n number = {1}\\n}\",\"author_short\":[\"Brindle,  M.\",\"Nelson,  G.\",\"Lobo,  D., N.\",\"Ljungqvist,  O.\",\"Gustafsson,  U., O.\"],\"urls\":{\"Paper\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/11270540-7746-126d-5e8c-9704cfcf7639/full_text.pdf.pdf\",\"Website\":\"https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020\",\"role\":\"author\",\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Embracing change—the time for pediatric enhanced recovery after surgery is now\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Journal of Pediatric Urology\",\"pages\":\"491-493\",\"volume\":\"15\",\"issue\":\"5\",\"month\":\"10\",\"publisher\":\"Elsevier Ltd\",\"day\":\"1\",\"id\":\"9361d5fc-feba-3636-b243-06661a4b5dcf\",\"created\":\"2020-10-14T16:09:49.511Z\",\"accessed\":\"2020-10-14\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-20T15:18:36.448Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"bibtype\":\"misc\",\"author\":\"Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.\",\"doi\":\"10.1016/j.jpurol.2019.04.005\",\"bibtex\":\"@misc{\\n title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},\\n type = {misc},\\n year = {2019},\\n source = {Journal of Pediatric Urology},\\n pages = {491-493},\\n volume = {15},\\n issue = {5},\\n month = {10},\\n publisher = {Elsevier Ltd},\\n day = {1},\\n id = {9361d5fc-feba-3636-b243-06661a4b5dcf},\\n created = {2020-10-14T16:09:49.511Z},\\n accessed = {2020-10-14},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-20T15:18:36.448Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n bibtype = {misc},\\n author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},\\n doi = {10.1016/j.jpurol.2019.04.005}\\n}\",\"author_short\":[\"Rove,  K., O.\",\"Brockel,  M., A.\",\"Brindle,  M., E.\",\"Scott,  M., J.\",\"Herndon,  C., D.\",\"Ljungqvist,  O.\",\"Koyle,  M., A.\"],\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\",\"role\":\"author\",\"urls\":{},\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Embracing change: the era for pediatric ERAS is here\",\"type\":\"misc\",\"year\":\"2019\",\"source\":\"Pediatric Surgery International\",\"keywords\":\"Care pathways,ERAS,Enhanced recovery after surgery,Outcomes,Quality and safety\",\"pages\":\"631-634\",\"volume\":\"35\",\"issue\":\"6\",\"websites\":\"https://doi.org/10.1007/s00383-019-04476-3\",\"month\":\"6\",\"publisher\":\"Springer Verlag\",\"day\":\"7\",\"id\":\"65428606-10d0-317b-8805-4f1ea57513e4\",\"created\":\"2020-10-14T16:10:57.998Z\",\"accessed\":\"2020-10-14\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.906Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.\",\"bibtype\":\"misc\",\"author\":\"Brindle, Mary E. and Heiss, Kurt and Scott, Michael J. and Herndon, C. Anthony and Ljungqvist, Olle and Koyle, Martin A.\",\"doi\":\"10.1007/s00383-019-04476-3\",\"bibtex\":\"@misc{\\n title = {Embracing change: the era for pediatric ERAS is here},\\n type = {misc},\\n year = {2019},\\n source = {Pediatric Surgery International},\\n keywords = {Care pathways,ERAS,Enhanced recovery after surgery,Outcomes,Quality and safety},\\n pages = {631-634},\\n volume = {35},\\n issue = {6},\\n websites = {https://doi.org/10.1007/s00383-019-04476-3},\\n month = {6},\\n publisher = {Springer Verlag},\\n day = {7},\\n id = {65428606-10d0-317b-8805-4f1ea57513e4},\\n created = {2020-10-14T16:10:57.998Z},\\n accessed = {2020-10-14},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.906Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.},\\n bibtype = {misc},\\n author = {Brindle, Mary E. and Heiss, Kurt and Scott, Michael J. and Herndon, C. Anthony and Ljungqvist, Olle and Koyle, Martin A.},\\n doi = {10.1007/s00383-019-04476-3}\\n}\",\"author_short\":[\"Brindle,  M., E.\",\"Heiss,  K.\",\"Scott,  M., J.\",\"Herndon,  C., A.\",\"Ljungqvist,  O.\",\"Koyle,  M., A.\"],\"urls\":{\"Website\":\"https://doi.org/10.1007/s00383-019-04476-3\"},\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019\",\"role\":\"author\",\"keyword\":[\"Care pathways\",\"ERAS\",\"Enhanced recovery after surgery\",\"Outcomes\",\"Quality and safety\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"},{\"title\":\"Optimizing postoperative follow-up in pediatric surgery (OFIPS)\",\"type\":\"article\",\"year\":\"2019\",\"keywords\":\"Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up\",\"pages\":\"1013-1018\",\"volume\":\"54\",\"month\":\"5\",\"publisher\":\"W.B. Saunders\",\"day\":\"1\",\"id\":\"69e673a0-4046-37b1-b780-b2262fa3ff5d\",\"created\":\"2020-10-14T16:10:58.002Z\",\"accessed\":\"2020-10-14\",\"file_attached\":false,\"profile_id\":\"86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"group_id\":\"b341668a-8f3d-35d8-a220-ea63383761b6\",\"last_modified\":\"2020-10-14T16:12:58.992Z\",\"read\":false,\"starred\":false,\"authored\":false,\"confirmed\":\"true\",\"hidden\":false,\"private_publication\":false,\"abstract\":\"Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.\",\"bibtype\":\"article\",\"author\":\"Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.\",\"doi\":\"10.1016/j.jpedsurg.2019.01.045\",\"journal\":\"Journal of Pediatric Surgery\",\"number\":\"5\",\"bibtex\":\"@article{\\n title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},\\n type = {article},\\n year = {2019},\\n keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},\\n pages = {1013-1018},\\n volume = {54},\\n month = {5},\\n publisher = {W.B. Saunders},\\n day = {1},\\n id = {69e673a0-4046-37b1-b780-b2262fa3ff5d},\\n created = {2020-10-14T16:10:58.002Z},\\n accessed = {2020-10-14},\\n file_attached = {false},\\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\\n last_modified = {2020-10-14T16:12:58.992Z},\\n read = {false},\\n starred = {false},\\n authored = {false},\\n confirmed = {true},\\n hidden = {false},\\n private_publication = {false},\\n abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},\\n bibtype = {article},\\n author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},\\n doi = {10.1016/j.jpedsurg.2019.01.045},\\n journal = {Journal of Pediatric Surgery},\\n number = {5}\\n}\",\"author_short\":[\"Gimon,  T.\",\"Almosallam,  O.\",\"Lopushinsky,  S.\",\"Eccles,  R.\",\"Brindle,  M.\",\"Yanchar,  N., L.\"],\"biburl\":\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d\",\"bibbaseid\":\"gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\",\"role\":\"author\",\"urls\":{},\"keyword\":[\"Clinic value\",\"Costs\",\"Pediatric surgery\",\"Perceived value\",\"Postoperative follow-up\"],\"metadata\":{\"authorlinks\":{}},\"downloads\":0,\"html\":\"\"}],\n      metadata: {\"authorlinks\":{}},\n      ownerID: undefined\n    };\n  </script>\n\n  <script type=\"text/javascript\">\n  var site$;\n  if (typeof $ != 'undefined') {\n    console.log('existing jquery: storing and then restoring');\n    site$ = $;\n    $ = null;\n  }\n  </script>\n\n  <script src=\"https://ajax.googleapis.com/ajax/libs/jquery/2.2.4/jquery.min.js\">\n  </script>\n  <script type=\"text/javascript\">\n  if (site$) {\n    console.log('existing jquery: avoiding conflict and restoring');\n    bb$ = $.noConflict(true);\n    $ = site$;\n  } else {\n    bb$ = $;\n  }\n  </script>\n\n  <script src=\"//bibbase.org/js/bibbase.min.js\"\n          type=\"text/javascript\">\n  </script>\n\n  <script type=\"text/javascript\"\n          src=\"https://cdnjs.cloudflare.com/ajax/libs/mathjax/2.7.1/MathJax.js?config=TeX-AMS-MML_HTMLorMML\">\n  </script>\n  <script type=\"text/x-mathjax-config\">\n    MathJax.Hub.Config({tex2jax: {inlineMath: [['$','$'], ['\\\\(','\\\\)']]},\n                        skipTags: [\"body\"],\n                        processClass: \"bibbase_paper\"});\n  </script>\n\n  <style>\n  @media print {\n    .dontprint {\n        display: none !important;\n    }\n\n  .bibbase_group {\n    background-color: #E0E0E0;\n    font-style: italic;\n    font-size: larger;\n    text-shadow: 0px 0px 3px #FFFFFF;\n    border-radius: 4px 4px 4px 4px;\n    -moz-border-radius: 4px 4px 4px 4px;\n    -webkit-border-radius: 4px;\n    padding: 5px 40px 5px;\n    margin-top: 10px;\n    margin-bottom: 5px;\n    cursor: pointer;\n  }\n\n  .bibbase_paper {\n    margin-bottom: 5px;\n  }\n\n  }\n  </style>\n\n  \n  <div style=\"float: right; margin-right: 10px; margin-top: 10px; text-align: right; font-size: 12px\">\n    generated by\n    <a href=\"//bibbase.org\"\n       onclick=\"trackOutboundLink('bibbase', 'logo clicked', window.location.href, '//bibbase.org'); return false;\">\n      <img src=\"//bibbase.org/img/logo.svg\"\n           style=\"vertical-align: middle; margin-left: 3px; height: 16px;\"/\n           alt=\"bibbase.org\"\n           title=\"BibBase – The easiest way to maintain your publications page.\"\n        ></a>\n    \n  </div>\n  \n\n  <div id=\"bibbase_header\" class=\"dontprint\" style=\"\">\n\n    <ul class=\"nav nav-pills\" style=\"margin: 0px;\">\n\n      <li class=\"dropdown\" id=\"groupby_dropdown\">\n      <a class=\"dropdown-toggle\"\n         data-toggle=\"dropdown\"\n         href=\"#\">\n          Group by\n          <b class=\"caret\"></b>\n      </a>\n      <ul class=\"dropdown-menu\">\n        <li class=\"groupby year\"><a onclick=\"groupby('year')\">\n            Year</a>\n        </li>\n        <li class=\"groupby author\"><a onclick=\"groupby('author_short')\">\n            Author</a>\n        </li>\n        <li class=\"groupby type\"><a onclick=\"groupby('type')\">\n            Type</a>\n        </li>\n        <li class=\"groupby keyword\"><a onclick=\"groupby('keyword')\">\n            Keyword</a>\n        </li>\n        <li class=\"groupby downloads\"><a onclick=\"groupby('downloads')\">\n            Downloads</a>\n        </li>\n      </ul>\n      </li>\n\n\n      <li class=\"dropdown\" id=\"menu_dropdown\">\n      <a class=\"dropdown-toggle\"\n         data-toggle=\"dropdown\"\n         href=\"#\" alt=\"controls\">\n          <i class=\"fa fa-reorder\" alt=\"controls\"></i>\n          <b class=\"caret\"></b>\n      </a>\n      <ul class=\"dropdown-menu\">\n        <li>\n          <a onclick=\"toggleAll()\">\n            <i class=\"fa fa-chevron-down fa-fw\"></i> Expand/Collapse All\n          </a>\n        </li>\n        <li>\n          <a download=\"all.bib\" href=\"data:text/bibtex;base64,@misc{
 title = {Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores},
 type = {misc},
 year = {2020},
 source = {International Journal of Obstetric Anesthesia},
 pages = {36-38},
 volume = {43},
 id = {9a9eafa6-0a0c-35f3-8003-9b7cd7b700af},
 created = {2020-10-01T19:23:24.586Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-01T21:17:39.244Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {misc},
 author = {Bollag, L. and Nelson, G.},
 doi = {10.1016/j.ijoa.2020.05.006}
}

@article{
 title = {Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations},
 type = {article},
 year = {2020},
 keywords = {ERAS,Enhanced Recovery After Surgery,gynecology,vaginal surgery,vulvar surgery},
 pages = {475-485},
 volume = {223},
 websites = {https://doi.org/10.1016/j.ajog.2020.07.039},
 publisher = {Elsevier Inc.},
 id = {c86c1863-ca22-3f95-bf7f-dcf8aa465eb7},
 created = {2020-10-05T20:47:07.487Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-05T20:47:40.984Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.},
 bibtype = {article},
 author = {Altman, Alon D. and Robert, Magali and Armbrust, Robert and Fawcett, William J. and Nihira, Mikio and Jones, Chris N. and Tamussino, Karl and Sehouli, Jalid and Dowdy, Sean C. and Nelson, Gregg},
 doi = {10.1016/j.ajog.2020.07.039},
 journal = {American Journal of Obstetrics and Gynecology},
 number = {4}
}

@article{
 title = {Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study},
 type = {article},
 year = {2020},
 pages = {252},
 volume = {8},
 id = {dd602a16-e91e-3bcc-aa92-ed38c2d239b0},
 created = {2020-10-05T20:47:07.734Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.534Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.},
 bibtype = {article},
 author = {Johnson, Eric and Parrish II, Richard and Nelson, Gregg and Elias, Kevin and Kramer, Brian and Gaviola, Marian},
 doi = {10.3390/healthcare8030252},
 journal = {Healthcare},
 number = {3}
}

@article{
 title = {Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management},
 type = {article},
 year = {2020},
 keywords = {Cytoreductive surgery,Enhanced recovery,Guidelines,HIPEC,Perioperative care},
 id = {00838a02-8933-3411-8ab6-7db42183e222},
 created = {2020-10-05T20:47:07.745Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-05T20:47:23.451Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.},
 bibtype = {article},
 author = {Hübner, Martin and Kusamura, Shigeki and Villeneuve, Laurent and Al-Niaimi, Ahmed and Alyami, Mohammad and Balonov, Konstantin and Bell, John and Bristow, Robert and Guiral, Delia Cortés and Fagotti, Anna and Falcão, Luiz Fernando R. and Glehen, Olivier and Lambert, Laura and Mack, Lloyd and Muenster, Tino and Piso, Pompiliu and Pocard, Marc and Rau, Beate and Sgarbura, Olivia and somashekhar, S. P. and Wadhwa, Anupama and Altman, Alon and Fawcett, William and Veerapong, Jula and Nelson, Gregg},
 doi = {10.1016/j.ejso.2020.07.041},
 journal = {European Journal of Surgical Oncology},
 number = {xxxx}
}

@article{
 title = {Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice},
 type = {article},
 year = {2020},
 keywords = {gynecologic surgical procedures,ovarian cancer,postoperative care,postoperative complications,surgical procedures, operative},
 pages = {1471-1478},
 volume = {30},
 id = {cc678440-9358-3472-8652-2422b7d047b2},
 created = {2020-10-05T20:47:07.785Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.123Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.},
 bibtype = {article},
 author = {Bhandoria, Geetu Prakash and Bhandarkar, Prashant and Ahuja, Vijay and Maheshwari, Amita and Sekhon, Rupinder K. and Gultekin, Murat and Ayhan, Ali and Demirkiran, Fuat and Kahramanoglu, Ilker and Wan, Yee Loi Louise and Knapp, Pawel and Dobroch, Jakub and Zmaczyński, Andrzej and Jach, Robert and Nelson, Gregg},
 doi = {10.1136/ijgc-2020-001683},
 journal = {International Journal of Gynecological Cancer},
 number = {10}
}

@article{
 title = {Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes},
 type = {article},
 year = {2020},
 volume = {000},
 websites = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/},
 id = {b4c3ef8d-ecdd-3bae-993f-c962d2512c79},
 created = {2020-10-05T20:47:07.792Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-05T20:47:15.943Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {article},
 author = {Gregory, Alexander J. and Grant, Michael C. and Boyle, Edward and Arora, Rakesh C. and Williams, Judson B. and Salenger, Rawn and Chatterjee, Subhasis and Lobdell, Kevin W. and Jahangiri, Marjan and Engelman, Daniel T.},
 doi = {10.1053/j.jvca.2020.08.007},
 journal = {Journal of Cardiothoracic and Vascular Anesthesia}
}

@article{
 title = {The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)},
 type = {article},
 year = {2020},
 pages = {3197-3198},
 volume = {44},
 websites = {https://doi.org/10.1007/s00268-020-05734-5},
 publisher = {Springer International Publishing},
 id = {f213822b-9c4a-3af4-ad2f-263a60cb65d3},
 created = {2020-10-05T20:47:07.968Z},
 file_attached = {true},
 profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-05T20:47:18.108Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {article},
 author = {Ljungqvist, Olle and Nelson, Gregg and Demartines, Nicolas},
 doi = {10.1007/s00268-020-05734-5},
 journal = {World Journal of Surgery},
 number = {10}
}

@article{
 title = {Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration},
 type = {article},
 year = {2020},
 pages = {E19-E20},
 volume = {63},
 websites = {http://canjsurg.ca/vol63-issue1/63-1-E19/},
 month = {10},
 day = {8},
 id = {54e6843d-4d50-3fae-8d30-bfd82209d138},
 created = {2020-10-08T17:27:28.414Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.557Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 private_publication = {false},
 abstract = {Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute's Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.},
 bibtype = {article},
 author = {Gramlich, Leah M. and Surgeoner, Brae and Baldini, Gabriele and Ballah, Erin and Baum, Melinda and Carli, Franco and Karimuddin, Ahmer A. and Nelson, Gregg and Richebé, Philippe and Watson, Deborah and Williams, Carla and LaFlamme, Claude},
 doi = {10.1503/cjs.006819},
 journal = {Canadian Journal of Surgery},
 number = {1}
}

@article{
 title = {Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations},
 type = {article},
 year = {2020},
 pages = {2482-2492},
 volume = {44},
 websites = {http://link.springer.com/10.1007/s00268-020-05530-1},
 month = {10},
 day = {8},
 id = {71a8673b-a631-39b2-8eaf-d6ffe7611e3d},
 created = {2020-10-08T17:27:28.433Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.108Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {Background: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.},
 bibtype = {article},
 author = {Brindle, Mary E. and McDiarmid, Caraline and Short, Kristin and Miller, Kathleen and MacRobie, Ali and Lam, Jennifer Y.K. and Brockel, Megan and Raval, Mehul V. and Howlett, Alexandra and Lee, Kyong Soon and Offringa, Martin and Wong, Kenneth and de Beer, David and Wester, Tomas and Skarsgard, Erik D. and Wales, Paul W. and Fecteau, Annie and Haliburton, Beth and Goobie, Susan M. and Nelson, Gregg},
 doi = {10.1007/s00268-020-05530-1},
 journal = {World Journal of Surgery},
 number = {8}
}

@article{
 title = {Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting},
 type = {article},
 year = {2019},
 keywords = {enhanced recovery after surgery,food,nutrition therapy,patient satisfaction,qualitative research},
 pages = {606-615},
 volume = {34},
 websites = {http://doi.wiley.com/10.1002/ncp.10215},
 month = {10},
 day = {8},
 id = {d0b9fc81-d257-318e-844e-687913c6d9b6},
 created = {2020-10-08T17:27:28.632Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.547Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {Background: Close adherence to the Enhanced Recovery After Surgery (ERAS) program is associated with improved outcomes. A nutrition-focused qualitative analysis of patient experience and of ERAS implementation across our province was conducted to better understand the barriers to successful adoption of ERAS nutrition elements. Methods: Enrolled colorectal patients (n = 27) were asked to describe their surgical experience. Narrative interviews (n = 20) and focus groups (n = 7) were transcribed verbatim and analyzed inductively for food and nutrition themes. Qualitative data sources (n = 198 documents) collected throughout our implementation of ERAS were categorized as institutional barriers that impeded the successful adoption of ERAS nutrition practices. Results: We identified patient barriers related to 3 main themes. The first theme, Mistaken nutrition facts & beliefs, describes how information provision was a key barrier to the successful adoption of nutrition elements. Patients held misconceptions and providers tended to provide them with contradictory nutrition messages, ultimately impeding adequate food intake and adherence to ERAS elements. The second theme, White bread is good for the soul?, represents a mismatch between prescribed medical diets and patient priorities. The third theme, Food is medicine, details patient beliefs that food is healing; the perception that nutritious food and dietary support was lacking produced dissatisfaction among patients. Overall, the most important institutional barrier limiting successful adoption of nutrition practices was the lack of education for patients and providers. Conclusion: Applying a patient-centered model of care that focuses on personalizing the ERAS nutrition elements might be a useful strategy to improve patient satisfaction, encourage food intake, correct previously held beliefs, and promote care adherence.},
 bibtype = {article},
 author = {Gillis, Chelsia and Martin, Lisa and Gill, Marlyn and Gilmour, Loreen and Nelson, Gregg and Gramlich, Leah},
 doi = {10.1002/ncp.10215},
 journal = {Nutrition in Clinical Practice},
 number = {4}
}

@article{
 title = {A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery},
 type = {article},
 year = {2019},
 keywords = {Caesarean section,Enhanced Recovery After Surgery (ERAS),obstetrical surgery,perioperative care},
 pages = {1775-1788},
 volume = {41},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164},
 month = {10},
 day = {8},
 id = {1b4f2bc0-880f-3284-aef5-67b85a886171},
 created = {2020-10-08T17:27:28.689Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.130Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {There is an increasing body of evidence to support the success of Enhanced Recovery After Surgery (ERAS) for a wide range of surgical procedures. There has been little formalized application, however, of ERAS principles in obstetrical surgery. The aim of this review was to examine the evidence base of perioperative care for patients undergoing Caesarean delivery (CD) and to determine the feasibility of developing an ERAS Society guideline for this obstetrical care plan. The literature on enhanced recovery programs was reviewed, including fast-track surgery and perioperative care components in the preoperative, intraoperative, and postoperative phases of CD. These studies included randomized controlled trials (RCTs), prospective cohort studies, non-RCT studies, meta-analyses, systematic reviews, reviews, and case studies. This is not a systematic review because each ERAS topic area would require a new question. Certain ERAS elements have the potential to benefit patients undergoing CD. These elements include patient education, preoperative optimization, prophylaxis against thromboembolism, antimicrobial prophylaxis, postoperative nausea and vomiting prevention, hypothermia prevention, perioperative fluid management, postoperative analgesia, ileus prevention, breastfeeding promotion, and early mobilization. ERAS has the potential to be successfully implemented in CD on the basis of the evidence obtained from this review. Knowledge transfer and implementation will require multidisciplinary coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS guideline.},
 bibtype = {article},
 author = {Huang, Jeffrey and Cao, Cathy and Nelson, Gregg and Wilson, R. Douglas},
 doi = {10.1016/j.jogc.2018.05.043},
 journal = {Journal of Obstetrics and Gynaecology Canada},
 number = {12}
}

@article{
 title = {Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives},
 type = {article},
 year = {2020},
 keywords = {Enhanced recovery after surgery,Implementation,Leadership perspectives,Sustainability},
 pages = {361},
 volume = {20},
 websites = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0},
 month = {10},
 day = {8},
 id = {e01cf6f2-4454-3c64-ba53-cbde2973aa33},
 created = {2020-10-08T17:27:28.771Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.123Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {Background: Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system. Methods: Alberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple's, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12. Results: Forty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines. Conclusions: Health care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.},
 bibtype = {article},
 author = {Gramlich, Leah and Nelson, Gregg and Nelson, Alison and Lagendyk, Laura and Gilmour, Loreen E. and Wasylak, Tracy},
 doi = {10.1186/s12913-020-05227-0},
 journal = {BMC Health Services Research},
 number = {1}
}

@article{
 title = {Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)},
 type = {article},
 year = {2019},
 keywords = {cesarean delivery,enhanced recovery},
 pages = {247.e1-247.e9},
 volume = {221},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721},
 month = {10},
 day = {8},
 id = {2751aba3-c6e2-3959-8819-9c45b1bb0677},
 created = {2020-10-08T17:27:28.775Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.555Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {Background: This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. Objective: The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. Study Design: The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Delivery,” “Cesarean Section Delivery,” and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. Results: The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. Conclusion: As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.},
 bibtype = {article},
 author = {Macones, George A. and Caughey, Aaron B. and Wood, Stephen L. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg and Wilson, R. Douglas},
 doi = {10.1016/j.ajog.2019.04.012},
 journal = {American Journal of Obstetrics and Gynecology},
 number = {3}
}

@article{
 title = {Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs},
 type = {article},
 year = {2019},
 pages = {3020-3021},
 volume = {33},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750},
 month = {10},
 day = {8},
 id = {2500df8a-cb08-3514-869b-9f2b5ed9be0c},
 created = {2020-10-08T17:27:28.775Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.105Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 bibtype = {article},
 author = {Gregory, Alexander J.},
 doi = {10.1053/j.jvca.2019.06.022},
 journal = {Journal of Cardiothoracic and Vascular Anesthesia},
 number = {11}
}

@article{
 title = {International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery},
 type = {article},
 year = {2019},
 keywords = {ERAS,compliance,gynecologic oncology,gynecologic surgery,length of stay,perioperative care},
 pages = {237.e1-237.e11},
 volume = {221},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131},
 month = {10},
 day = {8},
 id = {858a502a-ffac-3b05-ac1e-e7d950fb3be3},
 created = {2020-10-08T17:27:28.807Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.821Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 abstract = {Background: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. Objective: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. Study Design: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. Results: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4–11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90–0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82–0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. Conclusion: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.},
 bibtype = {article},
 author = {Wijk, Lena and Udumyan, Ruzan and Pache, Basile and Altman, Alon D. and Williams, Laura L. and Elias, Kevin M. and McGee, Jake and Wells, Tiffany and Gramlich, Leah and Holcomb, Kevin and Achtari, Chahin and Ljungqvist, Olle and Dowdy, Sean C. and Nelson, Gregg},
 doi = {10.1016/j.ajog.2019.04.028},
 journal = {American Journal of Obstetrics and Gynecology},
 number = {3}
}

@article{
 title = {Efficacy of TAP blocks following ovarian cancer surgery},
 type = {article},
 year = {2019},
 pages = {151},
 volume = {154},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546},
 month = {10},
 day = {8},
 id = {9a1fa7e0-bcef-32ca-9fca-140e96afff7a},
 created = {2020-10-08T17:27:28.852Z},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.126Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 source_type = {JOUR},
 language = {en},
 private_publication = {false},
 bibtype = {article},
 author = {Bisch, S.P. and Glaze, S.J. and Cameron, A. and Nation, J. and Nelson, G.},
 doi = {10.1016/j.ygyno.2019.04.356},
 journal = {Gynecologic Oncology}
}

@misc{
 title = {Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology},
 type = {misc},
 year = {2019},
 source = {Nutrients},
 keywords = {ERAS,Enhanced recovery after surgery,Gynecologic/oncology,Nutrition},
 volume = {11},
 issue = {5},
 websites = {/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/},
 month = {5},
 publisher = {MDPI AG},
 day = {1},
 id = {199ba733-8435-31d1-a2dd-b25546021c22},
 created = {2020-10-08T17:33:58.219Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.800Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Enhanced recovery after surgery (ERAS) pathways aim to improve surgical outcomes by applying evidence-based practices before, during, and after surgery. Patients undergoing surgery for gynecologic malignancies are at high risk of complications due to population, patient, disease, and surgical factors. The nutritional status of the patient provides the foundation for recovery after surgery, and opportunities to optimize outcomes exist from the first patient assessment to the early days after surgery. This review highlights the importance of nutritional assessment and intervention during the pre-operative and post-operative periods in the context of ERAS in gynecologic oncology surgery. The emerging role of immunonutrition, carbohydrate loading, and the importance of individualized care are explored. Evidence from studies in gynecologic oncology is presented, where available, and extrapolated from colorectal and other cancer surgery trials when applicable.},
 bibtype = {misc},
 author = {Bisch, Steven and Nelson, Gregg and Altman, Alon},
 doi = {10.3390/nu11051088}
}

@misc{
 title = {Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta},
 type = {misc},
 year = {2019},
 source = {Cmaj},
 pages = {S27-S29},
 volume = {191},
 issue = {1},
 websites = {https://tableau.albertahealth},
 month = {12},
 publisher = {Canadian Medical Association},
 day = {4},
 id = {390e1916-451f-3b6b-9593-25d68c0ee5f4},
 created = {2020-10-08T17:34:26.075Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.804Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {CMAJ | VOLUME 191 | SUPPLEMENT 1 S27 P ublicly funded surgical care in Alberta is delivered at 55 hospitals and 42 nonhospital surgical facilities, with more than 293 000 surgeries completed per year at an annual budget of about $2 billion. 1 However, about 1.6% of Alber-ta's population is on a surgical wait list (70 000 out of 4.3 million Albertans), and about 50% of these patients are waiting longer than clinically recommended. 2,3 The number of Albertans waiting for an initial consultation with a surgical specialist is unknown. In August 2019, the Blue Ribbon Panel on Alberta's Finances reported that per capita health care expenditures in Alberta ($5077) were higher than other provinces (e.g., British Columbia, $4267; Ontario, $4080; and Quebec, $4370), but Alberta lagged behind these provinces on several key performance indicators, such as wait times, lengths of stay and readmission rates. 4 The needs of these patients are diverse, and root causes for untimely access and outcomes are complex and require system-level solutions that address fundamental and recurring challenges such as inefficient referral pathways , increasing disease chronicity, variation in surgical outcomes , antiquated models of care that are provider centric and a mismatch between demand and system capacity. Recognizing the need to address these challenges at a systems level, Alberta Health Services created the Surgery Strategic Clinical Network (SCN; www.ahs.ca/surgeryscn) in 2013 with the goal of bringing together front-line health care professionals, operational leaders, academic partners and the community to identify priorities and develop novel solutions to transform the surgical landscape in Alberta. At the time, common metrics, processes and approaches to explicate surgical care were lacking. Although there were several quality-improvement initiatives at local sites, they were not centrally coordinated, integrated or widely shared. The creation of the Surgery SCN sparked a paradigm shift toward system innovation and learning, with a focus on using objective data to drive change and improve outcomes. From the beginning, it was imperative that the Surgery SCN balance local, facility-based needs and priorities for efficient and effective service delivery (the operational business) while also identifying areas for collective action, improvement and innovation (the strategic business). In its first 3 years (2013-2016), the network focused on specific actions, tools and processes that would improve access, safety and quality of surgical care, and enable ongoing measurement and improvement. Three examples of this work include developing a standardized measurement system, the Alberta Coding Access Targets for Surgery tool to elucidate scheduled wait times, customizing and implementing the Safe Surgery Checklist to reduce surgical errors and implementing care pathways on a provincial scale (e.g., Enhanced Recovery After Surgery guidelines) to standardize care and improve patient outcomes and experience. These initiatives have provided considerable value to the people of Alberta through improved outcomes, patient experience and access to surgical care, system-wide learning and quality improvement on a provincial scale. The network has contributed to the successful implementation of this work and its ongoing evaluation. For example, the Alberta Coding Access Targets for Surgery 5 has improved transparency for surgical wait lists and how they are managed. When a surgery is booked, each patient is assigned 1 of around 2000 diagnostic codes, with a recommended maximum wait time and a "ready-to-treat" date. These data are used to optimize wait lists for surgeons to ensure that urgent cases are prioritized and patients who have been waiting the longest are operated on first. The common measurement system was developed and is adjudicated through consensus by surgeons, bringing together the subspecialties across the province. The implementation was coordin ated through a provincial team working directly with surgeons , their medical office assistants, medical and administrative COMMENTARY KEY POINTS • Timely and equitable access to surgical care continues to feature prominently in public discourse and policy debates across Canada and is currently under scrutiny by Alberta decision-makers. • The first 4 years of the Surgery Strategic Clinical Network (SCN), which was created in 2013 with a mandate to address gaps in care and unwarranted variation, were a "learning-and-doing" period, after which it shifted to a more strategic focus and approach. • Comprising operational leaders, clinicians, academic partners and patient advisors, the Surgery SCN has successfully co-designed, tested, validated and implemented major surgical quality-improvement programs with substantial returns on investment.},
 bibtype = {misc},
 author = {Beesoon, Sanjay and Robert, Jill and White, Jonathan},
 doi = {10.1503/cmaj.190590}
}

@misc{
 title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},
 type = {misc},
 year = {2019},
 source = {Journal of Pediatric Urology},
 pages = {491-493},
 volume = {15},
 issue = {5},
 websites = {http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract},
 month = {10},
 publisher = {Elsevier Ltd},
 day = {1},
 id = {6b29f139-a8d8-3ccd-a84c-28e194040667},
 created = {2020-10-08T17:35:24.711Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:27:59.790Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {misc},
 author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},
 doi = {10.1016/j.jpurol.2019.04.005}
}

@article{
 title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},
 type = {article},
 year = {2019},
 keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},
 pages = {1013-1018},
 volume = {54},
 websites = {https://pubmed.ncbi.nlm.nih.gov/30826120/},
 month = {5},
 publisher = {W.B. Saunders},
 day = {1},
 id = {892d3444-ad4a-380e-834a-59c2bbd4a828},
 created = {2020-10-08T17:36:34.845Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.306Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},
 bibtype = {article},
 author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},
 doi = {10.1016/j.jpedsurg.2019.01.045},
 journal = {Journal of Pediatric Surgery},
 number = {5}
}

@misc{
 title = {Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update},
 type = {misc},
 year = {2019},
 source = {International Journal of Gynecological Cancer},
 keywords = {Enhanced Recovery After Surger,intraoperative care,postoperative care,preoperative care,surgery},
 pages = {651-668},
 volume = {29},
 issue = {4},
 websites = {http://ijgc.bmj.com/},
 month = {5},
 publisher = {BMJ Publishing Group},
 day = {1},
 id = {10daa046-8542-38e1-bd4a-a47d5a71b9ae},
 created = {2020-10-08T17:37:30.029Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2021-08-30T16:28:00.339Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.},
 bibtype = {misc},
 author = {Nelson, Gregg and Bakkum-Gamez, Jamie and Kalogera, Eleftheria and Glaser, Gretchen and Altman, Alon and Meyer, Larissa A. and Taylor, Jolyn S. and Iniesta, Maria and Lasala, Javier and Mena, Gabriel and Scott, Michael and Gillis, Chelsia and Elias, Kevin and Wijk, Lena and Huang, Jeffrey and Nygren, Jonas and Ljungqvist, Olle and Ramirez, Pedro T. and Dowdy, Sean C.},
 doi = {10.1136/ijgc-2019-000356}
}

@misc{
 title = {Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations},
 type = {misc},
 year = {2019},
 source = {JAMA Surgery},
 keywords = {The JAMA Network},
 pages = {755-766},
 volume = {154},
 issue = {8},
 websites = {https://jamanetwork.com/},
 month = {8},
 publisher = {American Medical Association},
 day = {1},
 id = {ae82a777-0785-33cc-8174-8ea7f357182a},
 created = {2020-10-08T17:38:01.095Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.928Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.},
 bibtype = {misc},
 author = {Engelman, Daniel T. and Ben Ali, Walid and Williams, Judson B. and Perrault, Louis P. and Reddy, V. Seenu and Arora, Rakesh C. and Roselli, Eric E. and Khoynezhad, Ali and Gerdisch, Marc and Levy, Jerrold H. and Lobdell, Kevin and Fletcher, Nick and Kirsch, Matthias and Nelson, Gregg and Engelman, Richard M. and Gregory, Alexander J. and Boyle, Edward M.},
 doi = {10.1001/jamasurg.2019.1153}
}

@misc{
 title = {Enhanced recovery after surgery: Implementing a new standard of surgical care},
 type = {misc},
 year = {2019},
 source = {Cmaj},
 pages = {E469-E475},
 volume = {191},
 issue = {17},
 websites = {www.erassociety.org},
 month = {4},
 publisher = {Canadian Medical Association},
 day = {29},
 id = {b3a9d3a0-05fc-3483-8721-9fa01c288c16},
 created = {2020-10-08T17:38:10.939Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.970Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {KEY POINTS
Enhanced recovery after surgery (ERAS) is an evidence-based and multidisciplinary perioperative care pathway and a surgical quality improvement initiative, which has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital length of stay and},
 bibtype = {misc},
 author = {Altman, Alon D. and Helpman, Limor and McGee, Jacob and Samouëlian, Vanessa and Auclair, Marie Hélène and Brar, Harinder and Nelson, Gregg S.},
 doi = {10.1503/cmaj.180635}
}

@misc{
 title = {Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs},
 type = {misc},
 year = {2019},
 source = {International Journal of Surgery},
 keywords = {Cost Savings,Humans,Jenna K Lovely,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care*,Pharmacists*,Postoperative Complications / prevention & control,PubMed Abstract,Recovery of Function,Review,Richard H Parrish,Sara Jordan Hyland,doi:10.1016/j.ijsu.2019.01.006,pmid:30665004},
 pages = {58-62},
 volume = {63},
 websites = {https://pubmed.ncbi.nlm.nih.gov/30665004/},
 month = {3},
 publisher = {Elsevier Ltd},
 day = {1},
 id = {164da341-3fdd-3c56-b8f4-2c3e437dfdee},
 created = {2020-10-08T17:38:34.220Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.869Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.},
 bibtype = {misc},
 author = {Lovely, Jenna K. and Hyland, Sara Jordan and Smith, April N. and Nelson, Gregg and Ljungqvist, Olle and Parrish, Richard H.},
 doi = {10.1016/j.ijsu.2019.01.006}
}

@article{
 title = {Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery},
 type = {article},
 year = {2019},
 keywords = {compliance,elective colorectal surgery,enhanced recovery after surgery,nutrition risk screening,perioperative nutrition care},
 pages = {206-219},
 volume = {43},
 websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417},
 month = {2},
 publisher = {John Wiley and Sons Inc.},
 day = {23},
 id = {eba90cba-dacf-32a5-9321-a96b3e8c9d85},
 created = {2020-10-08T17:39:15.041Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.778Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes. Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013–2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications. Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%–61%), early postoperative oral feeding (P <.001), and mobilization (P <.001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (<70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11–3.64; P <.001) and a trend for LOS >5 days (OR 1.40; 95% CI, 1.00–1.96; P =.052). Low compliance to ERAS (<70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23–3.24; P <.001). Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.},
 bibtype = {article},
 author = {Martin, Lisa and Gillis, Chelsia and Atkins, Marlis and Gillam, Melani and Sheppard, Caroline and Buhler, Sue and Hammond, Carlota Basualdo and Nelson, Gregg and Gramlich, Leah},
 doi = {10.1002/jpen.1417},
 journal = {Journal of Parenteral and Enteral Nutrition},
 number = {2}
}

@article{
 title = {Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience},
 type = {article},
 year = {2016},
 keywords = {Aged,Alberta,Clinical Protocols,Colon / surgery*,Female,Gregg Nelson,Guideline Adherence / economics,Guideline Adherence / statistics & numerical data,Humans,Lawrence N Kiyang,Leah M Gramlich,Length of Stay / statistics & numerical data,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Patient Readmission / statistics & numerical data,Perioperative Care / standards*,Postoperative Complications,PubMed Abstract,Rectum / surgery*,doi:10.1007/s00268-016-3472-7,pmid:26928854},
 pages = {1092-1103},
 volume = {40},
 websites = {https://pubmed.ncbi.nlm.nih.gov/26928854/},
 month = {5},
 publisher = {Springer New York LLC},
 day = {1},
 id = {c988171f-cbb2-3cb4-ad58-be400e3abff0},
 created = {2020-10-08T17:41:13.178Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.325Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system. Methods: We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts. Results: A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value <0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient. Conclusion: The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.},
 bibtype = {article},
 author = {Nelson, Gregg and Kiyang, Lawrence N. and Crumley, Ellen T. and Chuck, Anderson and Nguyen, Thanh and Faris, Peter and Wasylak, Tracy and Basualdo-Hammond, Carlota and McKay, Susan and Ljungqvist, Olle and Gramlich, Leah M.},
 doi = {10.1007/s00268-016-3472-7},
 journal = {World Journal of Surgery},
 number = {5}
}

@article{
 title = {An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta},
 type = {article},
 year = {2016},
 keywords = {Anderson W. Chuck,Leah M. Gramlich,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Nguyen X. Thanh,PMC5125924,PubMed Abstract,doi:10.1503/cjs.006716,pmid:28445024},
 pages = {415-421},
 volume = {59},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28445024/},
 month = {12},
 publisher = {Canadian Medical Association},
 day = {1},
 id = {04defe8f-0779-324a-af01-ee10c7a5be70},
 created = {2020-10-08T17:41:55.193Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.443Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return. Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.},
 bibtype = {article},
 author = {Thanh, Nguyen X. and Chuck, Anderson W. and Wasylak, Tracy and Lawrence, Jeannette and Faris, Peter and Ljungqvist, Olle and Nelson, Gregg and Gramlich, Leah M.},
 doi = {10.1503/cjs.006716},
 journal = {Canadian Journal of Surgery},
 number = {6}
}

@misc{
 title = {Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society},
 type = {misc},
 year = {2017},
 source = {JAMA Otolaryngology - Head and Neck Surgery},
 keywords = {The JAMA Network},
 pages = {292-303},
 volume = {143},
 issue = {3},
 websites = {http://www.erassociety.org},
 month = {3},
 publisher = {American Medical Association},
 day = {1},
 id = {a36721d5-88c7-36e5-8ad6-e4699bada3cf},
 created = {2020-10-08T17:42:34.613Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.616Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection,""parotid lymphadenectomy,""thyroidectomy,""oral cavity resection,""glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.},
 bibtype = {misc},
 author = {Dort, Joseph C. and Farwell, D. Gregory and Findlay, Merran and Huber, Gerhard F. and Kerr, Paul and Shea-Budgell, Melissa A. and Simon, Christian and Uppington, Jeffrey and Zygun, David and Ljungqvist, Olle and Harris, Jeffrey},
 doi = {10.1001/jamaoto.2016.2981}
}

@article{
 title = {Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system},
 type = {article},
 year = {2017},
 keywords = {Enhanced Recovery After Surgery,Implementation,QUERI,Theoretical Domains Framework},
 pages = {67},
 volume = {12},
 websites = {http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5},
 month = {5},
 publisher = {BioMed Central Ltd.},
 day = {19},
 id = {a1961964-3924-3b25-b4c0-57aa038478e5},
 created = {2020-10-08T17:42:36.845Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.382Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). Methods: ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Results: Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Conclusions: Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.},
 bibtype = {article},
 author = {Gramlich, Leah M. and Sheppard, Caroline E. and Wasylak, Tracy and Gilmour, Loreen E. and Ljungqvist, Olle and Basualdo-Hammond, Carlota and Nelson, Gregg},
 doi = {10.1186/s13012-017-0597-5},
 journal = {Implementation Science},
 number = {1}
}

@inproceedings{
 title = {Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations},
 type = {inproceedings},
 year = {2017},
 keywords = {Claire Temple-Oberle,Consensus Development Conference,ERAS Society,Female,Humans,MEDLINE,Mammaplasty*,Melissa A Shea-Budgell,Meta-Analysis as Topic,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / standards*,Practice Guideline,Prospective Studies,PubMed Abstract,Randomized Controlled Trials as Topic,Review,Systematic Review,doi:10.1097/PRS.0000000000003242,pmid:28445352},
 pages = {1056e-1071e},
 volume = {139},
 issue = {5},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28445352/},
 month = {5},
 publisher = {Lippincott Williams and Wilkins},
 day = {1},
 id = {4ffc228a-b7ca-33b7-92a0-18076980d130},
 created = {2020-10-08T17:43:00.105Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.659Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.},
 bibtype = {inproceedings},
 author = {Temple-Oberle, Claire and Shea-Budgell, Melissa A. and Tan, Mark and Semple, John L. and Schrag, Christiaan and Barreto, Marcio and Blondeel, Phillip and Hamming, Jeremy and Dayan, Joseph and Ljungqvist, Olle},
 doi = {10.1097/PRS.0000000000003242},
 booktitle = {Plastic and Reconstructive Surgery}
}

@article{
 title = {Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery},
 type = {article},
 year = {2017},
 keywords = {Bowel surgery,Colorectal surgery,Diet,Dietary protein,Energy,Enhanced Recovery After Surgery,Length of stay,Malnutrition screening tool,Nutrition,Oral nutrition supplement},
 pages = {44-51},
 volume = {106},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28468890/},
 month = {7},
 publisher = {American Society for Nutrition},
 day = {1},
 id = {8c303c6e-f852-3849-934c-d0952ea1804c},
 created = {2020-10-08T17:43:28.938Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.547Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of $60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: 26.8, 22.0 d; P < 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS.},
 bibtype = {article},
 author = {Yeung, Sophia E. and Hilkewich, Leslee and Gillis, Chelsia and Heine, John A. and Fenton, Tanis R.},
 doi = {10.3945/ajcn.116.148619},
 journal = {American Journal of Clinical Nutrition},
 number = {1}
}

@article{
 title = {Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study},
 type = {article},
 year = {2017},
 keywords = {Colorectal surgery,Quality in healthcare},
 volume = {7},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28647727/},
 month = {6},
 publisher = {BMJ Publishing Group},
 day = {1},
 id = {43fb09fc-36cf-3715-bbea-f27413387b6f},
 created = {2020-10-08T17:43:40.924Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.680Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.},
 bibtype = {article},
 author = {Gillis, Chelsia and Gill, Marlyn and Marlett, Nancy and Mackean, Gail and Germann, Kathy and Gilmour, Loreen and Nelson, Gregg and Wasylak, Tracy and Nguyen, Susan and Araujo, Edamil and Zelinsky, Sandra and Gramlich, Leah},
 doi = {10.1136/bmjopen-2017-017002},
 journal = {BMJ Open},
 number = {6}
}

@misc{
 title = {Enhanced recovery in gynecologic oncology – A sea change in perioperative management},
 type = {misc},
 year = {2017},
 source = {Gynecologic Oncology},
 keywords = {Editorial,Female,Female / surgery*,Genital Neoplasms,Gregg Nelson,Gynecologic Surgical Procedures / methods*,Humans,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / methods*,PubMed Abstract,Randomized Controlled Trials as Topic,Sean C Dowdy,doi:10.1016/j.ygyno.2017.06.015,pmid:28645426},
 pages = {225-227},
 volume = {146},
 issue = {2},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28645426/},
 month = {8},
 publisher = {Academic Press Inc.},
 day = {1},
 id = {d9f6d109-93f5-3d15-a27b-5b978231e0fb},
 created = {2020-10-08T17:44:02.463Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.651Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {misc},
 author = {Dowdy, Sean C. and Nelson, Gregg},
 doi = {10.1016/j.ygyno.2017.06.015}
}

@misc{
 title = {ERAS—Value based surgery},
 type = {misc},
 year = {2017},
 source = {Journal of Surgical Oncology},
 keywords = {ERAS,clinical outcomes,cost of care,implementation},
 pages = {608-612},
 volume = {116},
 issue = {5},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28873501/},
 month = {10},
 publisher = {John Wiley and Sons Inc.},
 day = {1},
 id = {5d77dee8-99d2-3783-beba-eca6bffb5797},
 created = {2020-10-08T17:44:10.582Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.536Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.},
 bibtype = {misc},
 author = {Ljungqvist, Olle and Thanh, Nguyen X. and Nelson, Gregg},
 doi = {10.1002/jso.24820}
}

@article{
 title = {Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development},
 type = {article},
 year = {2017},
 keywords = {ERAS®,Enhanced recovery after surgery,Guidelines,Surgery},
 pages = {617-620},
 volume = {147},
 websites = {https://pubmed.ncbi.nlm.nih.gov/28947172/},
 month = {12},
 publisher = {Academic Press Inc.},
 day = {1},
 id = {c78d5930-6ee1-3269-8d4f-34cd457ba7ff},
 created = {2020-10-08T17:45:16.839Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.767Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {article},
 author = {Nelson, G. and Dowdy, S. C. and Lasala, J. and Mena, G. and Bakkum-Gamez, J. and Meyer, L. A. and Iniesta, M. D. and Ramirez, P. T.},
 doi = {10.1016/j.ygyno.2017.09.023},
 journal = {Gynecologic Oncology},
 number = {3}
}

@misc{
 title = {Enhanced Recovery for Cardiac Surgery},
 type = {misc},
 year = {2018},
 source = {Journal of Cardiothoracic and Vascular Anesthesia},
 keywords = {ERAS,ERCS,enhanced recovery},
 pages = {2760-2770},
 volume = {32},
 issue = {6},
 websites = {http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract},
 month = {12},
 publisher = {W.B. Saunders},
 day = {1},
 id = {3ec38b68-38ee-335b-b415-ab9a9c00caaf},
 created = {2020-10-08T17:51:54.574Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.456Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest.},
 bibtype = {misc},
 author = {Noss, Christopher and Prusinkiewicz, Christopher and Nelson, Gregg and Patel, Prakash A. and Augoustides, John G. and Gregory, Alexander J.},
 doi = {10.1053/j.jvca.2018.01.045}
}

@article{
 title = {Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes},
 type = {article},
 year = {2018},
 keywords = {Clinical outcomes,Cost savings,ERAS,Gynecologic oncology},
 pages = {117-123},
 volume = {151},
 websites = {https://pubmed.ncbi.nlm.nih.gov/30100053/},
 month = {10},
 publisher = {Academic Press Inc.},
 day = {1},
 id = {1ad19dc3-c581-3887-932d-dd5a5787016a},
 created = {2020-10-08T17:52:24.945Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.025Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Objective: Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system. Methods: We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics. Results: We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p < 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p < 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p < 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636). Conclusions: Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.},
 bibtype = {article},
 author = {Bisch, S. P. and Wells, T. and Gramlich, L. and Faris, P. and Wang, X. and Tran, D. T. and Thanh, N. X. and Glaze, S. and Chu, P. and Ghatage, P. and Nation, J. and Capstick, V. and Steed, H. and Sabourin, J. and Nelson, G.},
 doi = {10.1016/j.ygyno.2018.08.007},
 journal = {Gynecologic Oncology},
 number = {1}
}

@article{
 title = {Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)},
 type = {article},
 year = {2018},
 keywords = {cesarean delivery,enhanced recovery,intraoperative,postoperative,preoperative,quality,safety},
 pages = {523.e1-523.e15},
 volume = {219},
 websites = {https://pubmed.ncbi.nlm.nih.gov/30240657/},
 month = {12},
 publisher = {Mosby Inc.},
 day = {1},
 id = {940da495-ea9e-3495-8e98-e0b73c312a23},
 created = {2020-10-08T17:52:26.992Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.027Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation,), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.},
 bibtype = {article},
 author = {Wilson, R. Douglas and Caughey, Aaron B. and Wood, Stephen L. and Macones, George A. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg},
 doi = {10.1016/j.ajog.2018.09.015},
 journal = {American Journal of Obstetrics and Gynecology},
 number = {6}
}

@misc{
 title = {Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery},
 type = {misc},
 year = {2018},
 source = {American Journal of Obstetrics and Gynecology},
 keywords = {Agency for Healthcare Research and Quality,Improving Surgical Care and Recovery,enhanced recovery after surgery,enhanced recovery pathway,gynecologic surgery,patient safety,review},
 pages = {563.e1-563.e19},
 volume = {219},
 issue = {6},
 websites = {https://pubmed.ncbi.nlm.nih.gov/30031749/},
 month = {12},
 publisher = {Mosby Inc.},
 day = {1},
 id = {6f9ea4b6-6266-3fe2-b6d8-c1170f55878f},
 created = {2020-10-08T17:52:29.281Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.443Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective: The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design: We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results: Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion: Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.},
 bibtype = {misc},
 author = {Kalogera, Eleftheria and Nelson, Gregg and Liu, Jessica and Hu, Q. Lina and Ko, Clifford Y. and Wick, Elizabeth and Dowdy, Sean C.},
 doi = {10.1016/j.ajog.2018.07.014}
}

@article{
 title = {The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada},
 type = {article},
 year = {2018},
 keywords = {Adult,Aged,Alberta,Colorectal Surgery / statistics & numerical data*,Digestive System Surgical Procedures / statistics,Female,Finlay A McAlister,Humans,Leah Gramlich,Length of Stay / statistics & numerical data*,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Non-U.S. Gov't,Patient Readmission,Perioperative Care / methods,Perioperative Care / standards*,Postoperative Care / methods,Postoperative Care / standards*,Postoperative Complications / prevention & control,Program Evaluation,PubMed Abstract,Research Support,Retrospective Studies,Zaina AlBalawi,doi:10.1007/s00268-018-4559-0,pmid:29532139},
 pages = {2691-2700},
 volume = {42},
 websites = {https://pubmed.ncbi.nlm.nih.gov/29532139/},
 month = {9},
 publisher = {Springer New York LLC},
 day = {1},
 id = {b6ad9164-222a-3ae3-a7bf-166d9eff307b},
 created = {2020-10-08T17:52:43.181Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.314Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. Methods: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery. Results: Of 2714 patients (mean age 60.4 years, 55% men) with similar demographics and comorbidity profiles in the pre/post-ERAS time periods, LOS was significantly shorter post-ERAS (8.5 vs. 9.5 days, p = 0.01; − 0.84 days [95% CI − 0.04 to − 1.64 days] after adjustment for age, sex, Charlson comorbidity score, procedure type, surgical approach, and hospital). However, interrupted time series demonstrated no significant level change (p = 0.30) or change in slope (p = 0.63) with ERAS implementation, consistent with continuation of an underlying secular trend of reductions in LOS over time. There were no significant differences (in multivariate analysis or ITS) in risk of 30-day death/readmission (14.3% post vs. 13.5% pre-ERAS, aOR 1.12, 95% CI 0.89–1.40), 30-day death/ED visit (27.2% post vs. 30.0% pre, aOR 0.93, 95% CI 0.78–1.10), or 30-day death/readmission/ED visit (27.8% post vs. 30.6% pre, aOR 0.93, 95% CI 0.78–1.10). The 428 patients with diabetes had longer LOS but exhibited no significant difference post- versus pre-ERAS (10.7 vs. 11.6 days, p = 0.53; p = 0.56 for level change and p = 0.66 for slope change on ITS). Conclusion: Although there was a secular trend toward decreasing LOS over time in Alberta, ERAS implementation was not associated with statistically significant changes in LOS or postoperative outcomes for all colorectal surgery patients or for those with diabetes. Our study highlights the importance of evaluating system changes (for both uptake and outcomes) rather than assuming trial benefits will translate directly into practice. Interventions to improve LOS and postoperative outcomes for patients with diabetes undergoing colorectal surgery are still needed even in the ERAS era.},
 bibtype = {article},
 author = {AlBalawi, Zaina and Gramlich, Leah and Nelson, Gregg and Senior, Peter and Youngson, Erik and McAlister, Finlay A.},
 doi = {10.1007/s00268-018-4559-0},
 journal = {World Journal of Surgery},
 number = {9}
}

@misc{
 title = {Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols},
 type = {misc},
 year = {2018},
 source = {Current Opinion in Otolaryngology and Head and Neck Surgery},
 keywords = {enhanced recovery after surgery,implementation,outcomes improvement},
 pages = {71-77},
 volume = {26},
 issue = {2},
 websites = {https://pubmed.ncbi.nlm.nih.gov/29432221/},
 month = {4},
 publisher = {Lippincott Williams and Wilkins},
 day = {1},
 id = {050e96ba-0a69-3e2b-9ab7-beb65c6fbbad},
 created = {2020-10-08T17:52:59.150Z},
 accessed = {2020-10-08},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.224Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.},
 bibtype = {misc},
 author = {Huber, Gerhard F. and Dort, Joseph C.},
 doi = {10.1097/MOO.0000000000000442}
}

@article{
 title = {Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study},
 type = {article},
 year = {2018},
 pages = {23651},
 volume = {8},
 websites = {http://bmjopen.bmj.com/},
 month = {12},
 publisher = {BMJ Publishing Group},
 day = {1},
 id = {d705b8c7-657f-3100-8825-18cfb9abc496},
 created = {2020-10-08T17:55:50.898Z},
 accessed = {2020-10-08},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:59.130Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. Methods: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. Ethics and dissemination: This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.},
 bibtype = {article},
 author = {Gibb, Ashleigh C.N. and Crosby, Megan A. and McDiarmid, Caraline and Urban, Denisa and Lam, Jennifer Y.K. and Wales, Paul W. and Brockel, Megan and Raval, Mehul and Offringa, Martin and Skarsgard, Erik D. and Wester, Tomas and Wong, Kenneth and De Beer, David and Nelson, Gregg and Brindle, Mary E.},
 doi = {10.1136/bmjopen-2018-023651},
 journal = {BMJ Open},
 number = {12}
}

@article{
 title = {Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines},
 type = {article},
 year = {2020},
 pages = {157-163},
 volume = {4},
 websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238},
 month = {2},
 publisher = {NLM (Medline)},
 day = {2},
 id = {cee84947-d7b4-3b51-a90d-959c8896f928},
 created = {2020-10-14T16:02:14.429Z},
 accessed = {2020-10-14},
 file_attached = {true},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:59.090Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {BACKGROUND: ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS: The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION: There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.},
 bibtype = {article},
 author = {Brindle, M. and Nelson, G. and Lobo, D. N. and Ljungqvist, O. and Gustafsson, U. O.},
 doi = {10.1002/bjs5.50238},
 journal = {BJS open},
 number = {1}
}

@misc{
 title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},
 type = {misc},
 year = {2019},
 source = {Journal of Pediatric Urology},
 pages = {491-493},
 volume = {15},
 issue = {5},
 month = {10},
 publisher = {Elsevier Ltd},
 day = {1},
 id = {9361d5fc-feba-3636-b243-06661a4b5dcf},
 created = {2020-10-14T16:09:49.511Z},
 accessed = {2020-10-14},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-20T15:18:36.448Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {misc},
 author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},
 doi = {10.1016/j.jpurol.2019.04.005}
}

@misc{
 title = {Embracing change: the era for pediatric ERAS is here},
 type = {misc},
 year = {2019},
 source = {Pediatric Surgery International},
 keywords = {Care pathways,ERAS,Enhanced recovery after surgery,Outcomes,Quality and safety},
 pages = {631-634},
 volume = {35},
 issue = {6},
 websites = {https://doi.org/10.1007/s00383-019-04476-3},
 month = {6},
 publisher = {Springer Verlag},
 day = {7},
 id = {65428606-10d0-317b-8805-4f1ea57513e4},
 created = {2020-10-14T16:10:57.998Z},
 accessed = {2020-10-14},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.906Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.},
 bibtype = {misc},
 author = {Brindle, Mary E. and Heiss, Kurt and Scott, Michael J. and Herndon, C. Anthony and Ljungqvist, Olle and Koyle, Martin A.},
 doi = {10.1007/s00383-019-04476-3}
}

@article{
 title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},
 type = {article},
 year = {2019},
 keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},
 pages = {1013-1018},
 volume = {54},
 month = {5},
 publisher = {W.B. Saunders},
 day = {1},
 id = {69e673a0-4046-37b1-b780-b2262fa3ff5d},
 created = {2020-10-14T16:10:58.002Z},
 accessed = {2020-10-14},
 file_attached = {false},
 profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},
 group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},
 last_modified = {2020-10-14T16:12:58.992Z},
 read = {false},
 starred = {false},
 authored = {false},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},
 bibtype = {article},
 author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},
 doi = {10.1016/j.jpedsurg.2019.01.045},
 journal = {Journal of Pediatric Surgery},
 number = {5}
}\">\n            <i class=\"fa fa-download fa-fw\"></i> Download BibTeX\n          </a>\n        </li>\n        <li>\n          <a href=\"//bibbase.org/rss?bib=\">\n            <i class=\"fa fa-rss fa-fw\"></i> RSS Feed\n          </a>\n          </li>\n      </ul>\n      </li>\n\n      \n\n\n      \n    </ul>\n\n\n    <div class=\"alert alert-success bibbase_msg\" id=\"bibbase_msg_embed\"\n         style=\"display: none;\">\n\n      Excellent! Next you can\n      <a href=\"/network/register?next=/network/newSiteFromTemplate%3Fbiburl=\"\n      >create a new website with this list</a>, or\n      embed it in an existing web page by copying &amp; pasting\n      any of the following snippets.\n\n      <div style=\"text-align: left; margin-top: 1em;\">\n        <strong>JavaScript</strong>\n        <span class=\"comment recommended\">(easiest)</span>\n        <div class=\"well well-small\">\n          <code>\n            &lt;script src=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/group/b341668a-8f3d-35d8-a220-ea63383761b6?folding=1&amp;jsonp=1&amp;jsonp=1\"&gt;&lt;/script&gt;\n          </code>\n        </div>\n\n        <strong>PHP</strong>\n        <div class=\"well well-small\">\n          <code>\n            &lt;?php\n            $contents = file_get_contents(\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/group/b341668a-8f3d-35d8-a220-ea63383761b6?folding=1&amp;jsonp=1\");\n            print_r($contents);\n            ?&gt;\n          </code>\n        </div>\n\n        <strong>iFrame</strong>\n        <span class=\"comment\">(not recommended)</span>\n        <div class=\"well well-small\">\n          <code>\n            &lt;iframe src=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/group/b341668a-8f3d-35d8-a220-ea63383761b6?folding=1&amp;jsonp=1\"&gt;&lt;/iframe&gt;\n          </code>\n        </div>\n\n        <p>\n          For more details see the <a href=\"//bibbase.org/help\">documention</a>.\n        </p>\n      </div>\n    </div>\n\n    <div class=\"alert alert-success bibbase_msg\" id=\"bibbase_msg_preview\"\n         style=\"display: none;\">\n\n      This is a preview! To use this list on your own web site\n      or create a new web site from it,\n      <a href=\"/network/register?next=/network/newAccountWithFile%3FfileId=\"\n      >create a free account</a>. The file will be added\n      and you will be able to edit it in the File Manager.\n      We will show you instructions once you've created your account.\n    </div>\n\n    <div class=\"alert alert-warning bibbase_msg\" id=\"bibbase_msg_mendeley1\"\n         style=\"display: none;\">\n\n      <p>To the site owner:</p>\n\n      <p><strong>Action required!</strong> Mendeley is changing its\n        API. In order to keep using Mendeley with BibBase past April\n        14th, you need to:\n        <ol>\n          <li>renew the authorization for BibBase on Mendeley, and</li>\n          <li>update the BibBase URL\n            in your page the same way you did when you initially set up\n            this page.\n          </li>\n        </ol>\n      </p>\n\n      <p>\n        <a href=\"http://bibbase.org/cgi-bin/mendeley2/get.py\">\n          <i class=\"fa fa-angle-double-right\"></i>\n          Fix it now</a>\n      </p>\n    </div>\n\n  </div>\n\n\n  <div id=\"bibbase_body\">\n    \n  \n  <div class=\"bibbase_group_whole\" id=\"group_2020\">\n    <div class=\"bibbase_group\"\n      onclick=\"toggleGroup('group_2020')\"\n      onkeypress=\"toggleGroup('group_2020')\"\n      tabindex=\"0\">\n      <i class=\"fa fa-angle-down bibbase_group_head_icon\"></i>&nbsp;\n      <span>2020</span>\n      <span class=\"bibbase_group_count\">\n        \n        (11)\n        \n      </span>\n    </div>\n    <div class=\"bibbase_group_body\">\n      \n  \n  <div class=\"bibbase_paper\" id=\"bollag-nelson-enhancedrecoveryaftercesareaneracbeyondthepainscores-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores.\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Bollag,  L.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n   2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ijoa.2020.05.006\"\n     onclick=\"log_download('bollag-nelson-enhancedrecoveryaftercesareaneracbeyondthepainscores-2020', 'http://doi.org/10.1016/j.ijoa.2020.05.006', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/bollag-nelson-enhancedrecoveryaftercesareaneracbeyondthepainscores-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('bollag-nelson-enhancedrecoveryaftercesareaneracbeyondthepainscores-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Enhanced Recovery After Cesarean (ERAC) – Beyond The Pain Scores},\n type = {misc},\n year = {2020},\n source = {International Journal of Obstetric Anesthesia},\n pages = {36-38},\n volume = {43},\n id = {9a9eafa6-0a0c-35f3-8003-9b7cd7b700af},\n created = {2020-10-01T19:23:24.586Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-01T21:17:39.244Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {misc},\n author = {Bollag, L. and Nelson, G.},\n doi = {10.1016/j.ijoa.2020.05.006}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2bf62eaf-bfb4-e613-0b8f-0e44da64c301/ERAS_Vulva_Vagina.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2bf62eaf-bfb4-e613-0b8f-0e44da64c301/ERAS_Vulva_Vagina.pdf.pdf', event);\">\n    Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Altman,  A., D.; Robert,  M.; Armbrust,  R.; Fawcett,  W., J.; Nihira,  M.; Jones,  C., N.; Tamussino,  K.; Sehouli,  J.; Dowdy,  S., C.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>American Journal of Obstetrics and Gynecology</i>, 223(4): 475-485.  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2bf62eaf-bfb4-e613-0b8f-0e44da64c301/ERAS_Vulva_Vagina.pdf.pdf\"\n     onclick=\"log_download('altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2bf62eaf-bfb4-e613-0b8f-0e44da64c301/ERAS_Vulva_Vagina.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://doi.org/10.1016/j.ajog.2020.07.039\"\n     onclick=\"log_download('altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020', 'https://doi.org/10.1016/j.ajog.2020.07.039', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ajog.2020.07.039\"\n     onclick=\"log_download('altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020', 'http://doi.org/10.1016/j.ajog.2020.07.039', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('altman-robert-armbrust-fawcett-nihira-jones-tamussino-sehouli-etal-guidelinesforvulvarandvaginalsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations},\n type = {article},\n year = {2020},\n keywords = {ERAS,Enhanced Recovery After Surgery,gynecology,vaginal surgery,vulvar surgery},\n pages = {475-485},\n volume = {223},\n websites = {https://doi.org/10.1016/j.ajog.2020.07.039},\n publisher = {Elsevier Inc.},\n id = {c86c1863-ca22-3f95-bf7f-dcf8aa465eb7},\n created = {2020-10-05T20:47:07.487Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-05T20:47:40.984Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.},\n bibtype = {article},\n author = {Altman, Alon D. and Robert, Magali and Armbrust, Robert and Fawcett, William J. and Nihira, Mikio and Jones, Chris N. and Tamussino, Karl and Sehouli, Jalid and Dowdy, Sean C. and Nelson, Gregg},\n doi = {10.1016/j.ajog.2020.07.039},\n journal = {American Journal of Obstetrics and Gynecology},\n number = {4}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/294ae642-d1f4-e343-631d-ca9fa084c559/ERAS_Pharmacy.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/294ae642-d1f4-e343-631d-ca9fa084c559/ERAS_Pharmacy.pdf.pdf', event);\">\n    Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Johnson,  E.; Parrish II,  R.; Nelson,  G.; Elias,  K.; Kramer,  B.;  and Gaviola,  M.\n</span>\n\n  \n\n</span>\n\n  <i>Healthcare</i>, 8(3): 252.  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/294ae642-d1f4-e343-631d-ca9fa084c559/ERAS_Pharmacy.pdf.pdf\"\n     onclick=\"log_download('johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/294ae642-d1f4-e343-631d-ca9fa084c559/ERAS_Pharmacy.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.3390/healthcare8030252\"\n     onclick=\"log_download('johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020', 'http://doi.org/10.3390/healthcare8030252', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('johnson-parrishii-nelson-elias-kramer-gaviola-expandingpharmacotherapydatacollectionanalysisandimplementationinerasprogramsthemethodologyofanexploratoryfeasibilitystudy-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study},\n type = {article},\n year = {2020},\n pages = {252},\n volume = {8},\n id = {dd602a16-e91e-3bcc-aa92-ed38c2d239b0},\n created = {2020-10-05T20:47:07.734Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.534Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.},\n bibtype = {article},\n author = {Johnson, Eric and Parrish II, Richard and Nelson, Gregg and Elias, Kevin and Kramer, Brian and Gaviola, Marian},\n doi = {10.3390/healthcare8030252},\n journal = {Healthcare},\n number = {3}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1d482058-a414-d69b-4ee5-28cd0394c685/ERAS_CRS_HIPEC_Part_I.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1d482058-a414-d69b-4ee5-28cd0394c685/ERAS_CRS_HIPEC_Part_I.pdf.pdf', event);\">\n    Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Hübner,  M.; Kusamura,  S.; Villeneuve,  L.; Al-Niaimi,  A.; Alyami,  M.; Balonov,  K.; Bell,  J.; Bristow,  R.; Guiral,  D., C.; Fagotti,  A.; Falcão,  L., F., R.; Glehen,  O.; Lambert,  L.; Mack,  L.; Muenster,  T.; Piso,  P.; Pocard,  M.; Rau,  B.; Sgarbura,  O.; somashekhar,  S., P.; Wadhwa,  A.; Altman,  A.; Fawcett,  W.; Veerapong,  J.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>European Journal of Surgical Oncology</i>, (xxxx).  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1d482058-a414-d69b-4ee5-28cd0394c685/ERAS_CRS_HIPEC_Part_I.pdf.pdf\"\n     onclick=\"log_download('hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1d482058-a414-d69b-4ee5-28cd0394c685/ERAS_CRS_HIPEC_Part_I.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ejso.2020.07.041\"\n     onclick=\"log_download('hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020', 'http://doi.org/10.1016/j.ejso.2020.07.041', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n  &nbsp;\n  <span class=\"bibbase_stats_paper\" style=\"color: #777;\">\n    <span>1 download</span>\n  </span>\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('hbner-kusamura-villeneuve-alniaimi-alyami-balonov-bell-bristow-etal-guidelinesforperioperativecareincytoreductivesurgerycrswithorwithouthyperthermicintraperitonealchemotherapyhipecenhancedrecoveryaftersurgeryerassocietyrecommendationspartipreoperativeandintraoperativemanagement-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations — Part I: Preoperative and intraoperative management},\n type = {article},\n year = {2020},\n keywords = {Cytoreductive surgery,Enhanced recovery,Guidelines,HIPEC,Perioperative care},\n id = {00838a02-8933-3411-8ab6-7db42183e222},\n created = {2020-10-05T20:47:07.745Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-05T20:47:23.451Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.},\n bibtype = {article},\n author = {Hübner, Martin and Kusamura, Shigeki and Villeneuve, Laurent and Al-Niaimi, Ahmed and Alyami, Mohammad and Balonov, Konstantin and Bell, John and Bristow, Robert and Guiral, Delia Cortés and Fagotti, Anna and Falcão, Luiz Fernando R. and Glehen, Olivier and Lambert, Laura and Mack, Lloyd and Muenster, Tino and Piso, Pompiliu and Pocard, Marc and Rau, Beate and Sgarbura, Olivia and somashekhar, S. P. and Wadhwa, Anupama and Altman, Alon and Fawcett, William and Veerapong, Jula and Nelson, Gregg},\n doi = {10.1016/j.ejso.2020.07.041},\n journal = {European Journal of Surgical Oncology},\n number = {xxxx}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced recovery after surgery (ERAS) pathways have been shown to considerably reduce complications, length of stay and costs after most of surgical procedures by standardised application of best evidence-based perioperative care. The aim was to elaborate dedicated recommendations for cytoreductive surgery (CRS) ± hyperthermic intraperitoneal chemotherapy (HIPEC) in a two-part series of guidelines based on expert consensus. The present part I of the guidelines highlights preoperative and intraoperative management. Methods: The core group assembled a multidisciplinary panel of 24 experts involved in peritoneal surface malignancy surgery representing the fields of general surgery (n = 12), gynaecological surgery (n = 6), and anaesthesia (n = 6). Experts systematically reviewed and summarized the available evidence on 72 identified perioperative care items, following the GRADE (grading of recommendations, assessment, development, evaluation) system. Final consensus (defined as ≥50%, or ≥70% of weak/strong recommendations combined) was reached by a standardised 2-round Delphi process, regarding the strength of recommendations. Results: Response rates were 100% for both Delphi rounds. Quality of evidence was evaluated high, moderate low and very low, for 15 (21%), 26 (36%), 29 (40%) and 2 items, respectively. Consensus was reached for 71/72(98.6%) items. Strong recommendations were defined for 37 items, No consensus could be reached regarding the preemptive use of fresh frozen plasma. Conclusion: The present ERAS recommendations for CRS±HIPEC are based on a standardised expert consensus process providing clinicians with valuable guidance. There is an urgent need to produce high quality studies for CRS±HIPEC and to prospectively evaluate recommendations in clinical practice.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/506685b1-94f4-df83-2673-e527c9b4c8dd/ERAS_Gyne_Onc_Peri_op.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/506685b1-94f4-df83-2673-e527c9b4c8dd/ERAS_Gyne_Onc_Peri_op.pdf.pdf', event);\">\n    Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Bhandoria,  G., P.; Bhandarkar,  P.; Ahuja,  V.; Maheshwari,  A.; Sekhon,  R., K.; Gultekin,  M.; Ayhan,  A.; Demirkiran,  F.; Kahramanoglu,  I.; Wan,  Y., L., L.; Knapp,  P.; Dobroch,  J.; Zmaczyński,  A.; Jach,  R.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>International Journal of Gynecological Cancer</i>, 30(10): 1471-1478.  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/506685b1-94f4-df83-2673-e527c9b4c8dd/ERAS_Gyne_Onc_Peri_op.pdf.pdf\"\n     onclick=\"log_download('bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/506685b1-94f4-df83-2673-e527c9b4c8dd/ERAS_Gyne_Onc_Peri_op.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1136/ijgc-2020-001683\"\n     onclick=\"log_download('bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020', 'http://doi.org/10.1136/ijgc-2020-001683', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('bhandoria-bhandarkar-ahuja-maheshwari-sekhon-gultekin-ayhan-demirkiran-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologyaninternationalsurveyofperioperativepractice-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Enhanced Recovery after Surgery (ERAS) in gynecologic oncology: An international survey of peri-operative practice},\n type = {article},\n year = {2020},\n keywords = {gynecologic surgical procedures,ovarian cancer,postoperative care,postoperative complications,surgical procedures, operative},\n pages = {1471-1478},\n volume = {30},\n id = {cc678440-9358-3472-8652-2422b7d047b2},\n created = {2020-10-05T20:47:07.785Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.123Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (&gt;80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.},\n bibtype = {article},\n author = {Bhandoria, Geetu Prakash and Bhandarkar, Prashant and Ahuja, Vijay and Maheshwari, Amita and Sekhon, Rupinder K. and Gultekin, Murat and Ayhan, Ali and Demirkiran, Fuat and Kahramanoglu, Ilker and Wan, Yee Loi Louise and Knapp, Pawel and Dobroch, Jakub and Zmaczyński, Andrzej and Jach, Robert and Nelson, Gregg},\n doi = {10.1136/ijgc-2020-001683},\n journal = {International Journal of Gynecological Cancer},\n number = {10}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns. Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods. Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 38%, Americas 33%, Asia 19%, and Africa 10%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding. Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/200d6a16-64bc-ce49-7e02-a1828fd4cb35/Gregory_et_al_2020_Journal_of_Cardiothoracic_Vascular_Anesthesia.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/200d6a16-64bc-ce49-7e02-a1828fd4cb35/Gregory_et_al_2020_Journal_of_Cardiothoracic_Vascular_Anesthesia.pdf.pdf', event);\">\n    Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gregory,  A., J.; Grant,  M., C.; Boyle,  E.; Arora,  R., C.; Williams,  J., B.; Salenger,  R.; Chatterjee,  S.; Lobdell,  K., W.; Jahangiri,  M.;  and Engelman,  D., T.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Cardiothoracic and Vascular Anesthesia</i>, 000.  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/200d6a16-64bc-ce49-7e02-a1828fd4cb35/Gregory_et_al_2020_Journal_of_Cardiothoracic_Vascular_Anesthesia.pdf.pdf\"\n     onclick=\"log_download('gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/200d6a16-64bc-ce49-7e02-a1828fd4cb35/Gregory_et_al_2020_Journal_of_Cardiothoracic_Vascular_Anesthesia.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/\"\n     onclick=\"log_download('gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020', 'https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1053/j.jvca.2020.08.007\"\n     onclick=\"log_download('gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020', 'http://doi.org/10.1053/j.jvca.2020.08.007', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gregory-grant-boyle-arora-williams-salenger-chatterjee-lobdell-etal-cardiacsurgeryenhancedrecoveryprogramsmodifiedforcovid19keystepstopreserveresourcesmanagecaseloadbacklogandimprovepatientoutcomes-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Cardiac Surgery-Enhanced Recovery Programs Modified for COVID-19: Key Steps to Preserve Resources, Manage Caseload Backlog, and Improve Patient Outcomes},\n type = {article},\n year = {2020},\n volume = {000},\n websites = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416680/},\n id = {b4c3ef8d-ecdd-3bae-993f-c962d2512c79},\n created = {2020-10-05T20:47:07.792Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-05T20:47:15.943Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {article},\n author = {Gregory, Alexander J. and Grant, Michael C. and Boyle, Edward and Arora, Rakesh C. and Williams, Judson B. and Salenger, Rawn and Chatterjee, Subhasis and Lobdell, Kevin W. and Jahangiri, Marjan and Engelman, Daniel T.},\n doi = {10.1053/j.jvca.2020.08.007},\n journal = {Journal of Cardiothoracic and Vascular Anesthesia}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/62b827bb-5fff-5fa7-69c9-ffaff2e4cc61/Ljungqvist2020_Article_ThePostCOVID_19SurgicalBacklog.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/62b827bb-5fff-5fa7-69c9-ffaff2e4cc61/Ljungqvist2020_Article_ThePostCOVID_19SurgicalBacklog.pdf.pdf', event);\">\n    The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS).\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Ljungqvist,  O.; Nelson,  G.;  and Demartines,  N.\n</span>\n\n  \n\n</span>\n\n  <i>World Journal of Surgery</i>, 44(10): 3197-3198.  2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/62b827bb-5fff-5fa7-69c9-ffaff2e4cc61/Ljungqvist2020_Article_ThePostCOVID_19SurgicalBacklog.pdf.pdf\"\n     onclick=\"log_download('ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/62b827bb-5fff-5fa7-69c9-ffaff2e4cc61/Ljungqvist2020_Article_ThePostCOVID_19SurgicalBacklog.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS) [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://doi.org/10.1007/s00268-020-05734-5\"\n     onclick=\"log_download('ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020', 'https://doi.org/10.1007/s00268-020-05734-5', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS) [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1007/s00268-020-05734-5\"\n     onclick=\"log_download('ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020', 'http://doi.org/10.1007/s00268-020-05734-5', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('ljungqvist-nelson-demartines-thepostcovid19surgicalbacklognowisthetimetoimplementenhancedrecoveryaftersurgeryeras-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {The Post COVID-19 Surgical Backlog: Now is the Time to Implement Enhanced Recovery After Surgery (ERAS)},\n type = {article},\n year = {2020},\n pages = {3197-3198},\n volume = {44},\n websites = {https://doi.org/10.1007/s00268-020-05734-5},\n publisher = {Springer International Publishing},\n id = {f213822b-9c4a-3af4-ad2f-263a60cb65d3},\n created = {2020-10-05T20:47:07.968Z},\n file_attached = {true},\n profile_id = {cc3590e9-225c-33d0-b4a2-69b4f662f67d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-05T20:47:18.108Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {article},\n author = {Ljungqvist, Olle and Nelson, Gregg and Demartines, Nicolas},\n doi = {10.1007/s00268-020-05734-5},\n journal = {World Journal of Surgery},\n number = {10}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://canjsurg.ca/vol63-issue1/63-1-E19/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020', 'http://canjsurg.ca/vol63-issue1/63-1-E19/', event);\">\n    Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gramlich,  L., M.; Surgeoner,  B.; Baldini,  G.; Ballah,  E.; Baum,  M.; Carli,  F.; Karimuddin,  A., A.; Nelson,  G.; Richebé,  P.; Watson,  D.; Williams,  C.;  and LaFlamme,  C.\n</span>\n\n  \n\n</span>\n\n  <i>Canadian Journal of Surgery</i>, 63(1): E19-E20. 10 2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://canjsurg.ca/vol63-issue1/63-1-E19/\"\n     onclick=\"log_download('gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020', 'http://canjsurg.ca/vol63-issue1/63-1-E19/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1503/cjs.006819\"\n     onclick=\"log_download('gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020', 'http://doi.org/10.1503/cjs.006819', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gramlich-surgeoner-baldini-ballah-baum-carli-karimuddin-nelson-etal-developmentofaclinicalpathwayforenhancedrecoveryincolorectalsurgeryacanadiancollaboration-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Development of a clinical pathway for enhanced recovery in colorectal surgery: A Canadian collaboration},\n type = {article},\n year = {2020},\n pages = {E19-E20},\n volume = {63},\n websites = {http://canjsurg.ca/vol63-issue1/63-1-E19/},\n month = {10},\n day = {8},\n id = {54e6843d-4d50-3fae-8d30-bfd82209d138},\n created = {2020-10-08T17:27:28.414Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.557Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n private_publication = {false},\n abstract = {Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute&#x27;s Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.},\n bibtype = {article},\n author = {Gramlich, Leah M. and Surgeoner, Brae and Baldini, Gabriele and Ballah, Erin and Baum, Melinda and Carli, Franco and Karimuddin, Ahmer A. and Nelson, Gregg and Richebé, Philippe and Watson, Deborah and Williams, Carla and LaFlamme, Claude},\n doi = {10.1503/cjs.006819},\n journal = {Canadian Journal of Surgery},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute's Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://link.springer.com/10.1007/s00268-020-05530-1\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020', 'http://link.springer.com/10.1007/s00268-020-05530-1', event);\">\n    Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Brindle,  M., E.; McDiarmid,  C.; Short,  K.; Miller,  K.; MacRobie,  A.; Lam,  J., Y.; Brockel,  M.; Raval,  M., V.; Howlett,  A.; Lee,  K., S.; Offringa,  M.; Wong,  K.; de Beer,  D.; Wester,  T.; Skarsgard,  E., D.; Wales,  P., W.; Fecteau,  A.; Haliburton,  B.; Goobie,  S., M.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>World Journal of Surgery</i>, 44(8): 2482-2492. 10 2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://link.springer.com/10.1007/s00268-020-05530-1\"\n     onclick=\"log_download('brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020', 'http://link.springer.com/10.1007/s00268-020-05530-1', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1007/s00268-020-05530-1\"\n     onclick=\"log_download('brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020', 'http://doi.org/10.1007/s00268-020-05530-1', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('brindle-mcdiarmid-short-miller-macrobie-lam-brockel-raval-etal-consensusguidelinesforperioperativecareinneonatalintestinalsurgeryenhancedrecoveryaftersurgeryerassocietyrecommendations-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations},\n type = {article},\n year = {2020},\n pages = {2482-2492},\n volume = {44},\n websites = {http://link.springer.com/10.1007/s00268-020-05530-1},\n month = {10},\n day = {8},\n id = {71a8673b-a631-39b2-8eaf-d6ffe7611e3d},\n created = {2020-10-08T17:27:28.433Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.108Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {Background: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.},\n bibtype = {article},\n author = {Brindle, Mary E. and McDiarmid, Caraline and Short, Kristin and Miller, Kathleen and MacRobie, Ali and Lam, Jennifer Y.K. and Brockel, Megan and Raval, Mehul V. and Howlett, Alexandra and Lee, Kyong Soon and Offringa, Martin and Wong, Kenneth and de Beer, David and Wester, Tomas and Skarsgard, Erik D. and Wales, Paul W. and Fecteau, Annie and Haliburton, Beth and Goobie, Susan M. and Nelson, Gregg},\n doi = {10.1007/s00268-020-05530-1},\n journal = {World Journal of Surgery},\n number = {8}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS® Society guidelines. We created an ERAS® guideline designed to enhance quality of care in neonatal intestinal resection surgery. Methods: A multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process. Results: Final recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline. Discussion: We have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020', 'https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0', event);\">\n    Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gramlich,  L.; Nelson,  G.; Nelson,  A.; Lagendyk,  L.; Gilmour,  L., E.;  and Wasylak,  T.\n</span>\n\n  \n\n</span>\n\n  <i>BMC Health Services Research</i>, 20(1): 361. 10 2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0\"\n     onclick=\"log_download('gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020', 'https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1186/s12913-020-05227-0\"\n     onclick=\"log_download('gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020', 'http://doi.org/10.1186/s12913-020-05227-0', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gramlich-nelson-nelson-lagendyk-gilmour-wasylak-movingenhancedrecoveryaftersurgeryfromimplementationtosustainabilityacrossahealthsystemaqualitativeassessmentofleadershipperspectives-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Moving enhanced recovery after surgery from implementation to sustainability across a health system: A qualitative assessment of leadership perspectives},\n type = {article},\n year = {2020},\n keywords = {Enhanced recovery after surgery,Implementation,Leadership perspectives,Sustainability},\n pages = {361},\n volume = {20},\n websites = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05227-0},\n month = {10},\n day = {8},\n id = {e01cf6f2-4454-3c64-ba53-cbde2973aa33},\n created = {2020-10-08T17:27:28.771Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.123Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {Background: Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system. Methods: Alberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple&#x27;s, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12. Results: Forty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines. Conclusions: Health care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.},\n bibtype = {article},\n author = {Gramlich, Leah and Nelson, Gregg and Nelson, Alison and Lagendyk, Laura and Gilmour, Loreen E. and Wasylak, Tracy},\n doi = {10.1186/s12913-020-05227-0},\n journal = {BMC Health Services Research},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Knowledge Translation evidence from health care practitioners and administrators implementing Enhanced Recovery After Surgery (ERAS) care has allowed for the spread and scale of the health care innovation. There is a need to identify at a health system level, what it takes from a leadership perspective to move from implementation to sustainability over time. The purpose of this research was to systematically synthesize feedback from health care leaders to inform further spread, scale and sustainability of ERAS care across a health system. Methods: Alberta Health Services (AHS) is the largest Canadian health system with approximately 280,000 surgeries annually at more than 50 surgical sites. In 2013 to 2014, AHS used a structured approach to successfully implement ERAS colorectal guidelines at six sites. Between 2016 and 2018, three of the six sites expanded ERAS to other surgical areas (gynecologic oncology, hepatectomy, pancreatectomy/Whipple's, and cystectomy). This research was designed to explore and learn from the experiences of health care leaders involved in the AHS ERAS implementation expansion (eg. surgical care unit, hospital site or provincial program) and build on the model for knowledge mobilization develop during implementation. Following informed consent, leaders were interviewed using a structured interview guide. Data were recorded, coded and analyzed qualitatively through a combination of theory-driven immersion and crystallization, and template coding using NVivo 12. Results: Forty-four individuals (13 physician leaders, 19 leading clinicians and hospital administrators, and 11 provincial leaders) were interviewed. Themes were identified related to Supportive Environments including resources, data, leadership; Champion and Nurse coordinator role; and Capacity Building through change management, education, and teams. The perception and role of leaders changed through initiation and implementation, spread, and sustainability. Barriers and enablers were thematically aligned relative to outcome assessment, consistency of implementation, ERAS care compliance, and the implementation of multiple guidelines. Conclusions: Health care leaders have unique perspectives and approaches to support spread, scale and sustainability of ERAS that are different from site based ERAS teams. These findings inform us what leaders need to do or need to do differently to support implementation and to foster spread, scale and sustainability of ERAS.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/11270540-7746-126d-5e8c-9704cfcf7639/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/11270540-7746-126d-5e8c-9704cfcf7639/full_text.pdf.pdf', event);\">\n    Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Brindle,  M.; Nelson,  G.; Lobo,  D., N.; Ljungqvist,  O.;  and Gustafsson,  U., O.\n</span>\n\n  \n\n</span>\n\n  <i>BJS open</i>, 4(1): 157-163. 2 2020.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/11270540-7746-126d-5e8c-9704cfcf7639/full_text.pdf.pdf\"\n     onclick=\"log_download('brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/11270540-7746-126d-5e8c-9704cfcf7639/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238\"\n     onclick=\"log_download('brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020', 'https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1002/bjs5.50238\"\n     onclick=\"log_download('brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020', 'http://doi.org/10.1002/bjs5.50238', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('brindle-nelson-lobo-ljungqvist-gustafsson-recommendationsfromtheerassocietyforstandardsforthedevelopmentofenhancedrecoveryaftersurgeryguidelines-2020')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines},\n type = {article},\n year = {2020},\n pages = {157-163},\n volume = {4},\n websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs5.50238},\n month = {2},\n publisher = {NLM (Medline)},\n day = {2},\n id = {cee84947-d7b4-3b51-a90d-959c8896f928},\n created = {2020-10-14T16:02:14.429Z},\n accessed = {2020-10-14},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:59.090Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {BACKGROUND: ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS: The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION: There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.},\n bibtype = {article},\n author = {Brindle, M. and Nelson, G. and Lobo, D. N. and Ljungqvist, O. and Gustafsson, U. O.},\n doi = {10.1002/bjs5.50238},\n journal = {BJS open},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  BACKGROUND: ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS: The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION: There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.\n</div>\n\n\n</div>\n\n\n\n\n\n    </div>\n  </div>\n\n  <div class=\"bibbase_group_whole\" id=\"group_2019\">\n    <div class=\"bibbase_group\"\n      onclick=\"toggleGroup('group_2019')\"\n      onkeypress=\"toggleGroup('group_2019')\"\n      tabindex=\"0\">\n      <i class=\"fa fa-angle-down bibbase_group_head_icon\"></i>&nbsp;\n      <span>2019</span>\n      <span class=\"bibbase_group_count\">\n        \n        (18)\n        \n      </span>\n    </div>\n    <div class=\"bibbase_group_body\">\n      \n  \n  <div class=\"bibbase_paper\" id=\"gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://doi.wiley.com/10.1002/ncp.10215\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019', 'http://doi.wiley.com/10.1002/ncp.10215', event);\">\n    Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gillis,  C.; Martin,  L.; Gill,  M.; Gilmour,  L.; Nelson,  G.;  and Gramlich,  L.\n</span>\n\n  \n\n</span>\n\n  <i>Nutrition in Clinical Practice</i>, 34(4): 606-615. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://doi.wiley.com/10.1002/ncp.10215\"\n     onclick=\"log_download('gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019', 'http://doi.wiley.com/10.1002/ncp.10215', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1002/ncp.10215\"\n     onclick=\"log_download('gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019', 'http://doi.org/10.1002/ncp.10215', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gillis-martin-gill-gilmour-nelson-gramlich-foodismedicineaqualitativeanalysisofpatientandinstitutionalbarrierstosuccessfulsurgicalnutritionpracticesinanenhancedrecoveryaftersurgerysetting-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting},\n type = {article},\n year = {2019},\n keywords = {enhanced recovery after surgery,food,nutrition therapy,patient satisfaction,qualitative research},\n pages = {606-615},\n volume = {34},\n websites = {http://doi.wiley.com/10.1002/ncp.10215},\n month = {10},\n day = {8},\n id = {d0b9fc81-d257-318e-844e-687913c6d9b6},\n created = {2020-10-08T17:27:28.632Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.547Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {Background: Close adherence to the Enhanced Recovery After Surgery (ERAS) program is associated with improved outcomes. A nutrition-focused qualitative analysis of patient experience and of ERAS implementation across our province was conducted to better understand the barriers to successful adoption of ERAS nutrition elements. Methods: Enrolled colorectal patients (n = 27) were asked to describe their surgical experience. Narrative interviews (n = 20) and focus groups (n = 7) were transcribed verbatim and analyzed inductively for food and nutrition themes. Qualitative data sources (n = 198 documents) collected throughout our implementation of ERAS were categorized as institutional barriers that impeded the successful adoption of ERAS nutrition practices. Results: We identified patient barriers related to 3 main themes. The first theme, Mistaken nutrition facts &amp; beliefs, describes how information provision was a key barrier to the successful adoption of nutrition elements. Patients held misconceptions and providers tended to provide them with contradictory nutrition messages, ultimately impeding adequate food intake and adherence to ERAS elements. The second theme, White bread is good for the soul?, represents a mismatch between prescribed medical diets and patient priorities. The third theme, Food is medicine, details patient beliefs that food is healing; the perception that nutritious food and dietary support was lacking produced dissatisfaction among patients. Overall, the most important institutional barrier limiting successful adoption of nutrition practices was the lack of education for patients and providers. Conclusion: Applying a patient-centered model of care that focuses on personalizing the ERAS nutrition elements might be a useful strategy to improve patient satisfaction, encourage food intake, correct previously held beliefs, and promote care adherence.},\n bibtype = {article},\n author = {Gillis, Chelsia and Martin, Lisa and Gill, Marlyn and Gilmour, Loreen and Nelson, Gregg and Gramlich, Leah},\n doi = {10.1002/ncp.10215},\n journal = {Nutrition in Clinical Practice},\n number = {4}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Close adherence to the Enhanced Recovery After Surgery (ERAS) program is associated with improved outcomes. A nutrition-focused qualitative analysis of patient experience and of ERAS implementation across our province was conducted to better understand the barriers to successful adoption of ERAS nutrition elements. Methods: Enrolled colorectal patients (n = 27) were asked to describe their surgical experience. Narrative interviews (n = 20) and focus groups (n = 7) were transcribed verbatim and analyzed inductively for food and nutrition themes. Qualitative data sources (n = 198 documents) collected throughout our implementation of ERAS were categorized as institutional barriers that impeded the successful adoption of ERAS nutrition practices. Results: We identified patient barriers related to 3 main themes. The first theme, Mistaken nutrition facts & beliefs, describes how information provision was a key barrier to the successful adoption of nutrition elements. Patients held misconceptions and providers tended to provide them with contradictory nutrition messages, ultimately impeding adequate food intake and adherence to ERAS elements. The second theme, White bread is good for the soul?, represents a mismatch between prescribed medical diets and patient priorities. The third theme, Food is medicine, details patient beliefs that food is healing; the perception that nutritious food and dietary support was lacking produced dissatisfaction among patients. Overall, the most important institutional barrier limiting successful adoption of nutrition practices was the lack of education for patients and providers. Conclusion: Applying a patient-centered model of care that focuses on personalizing the ERAS nutrition elements might be a useful strategy to improve patient satisfaction, encourage food intake, correct previously held beliefs, and promote care adherence.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164', event);\">\n    A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Huang,  J.; Cao,  C.; Nelson,  G.;  and Wilson,  R., D.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Obstetrics and Gynaecology Canada</i>, 41(12): 1775-1788. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164\"\n     onclick=\"log_download('huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.jogc.2018.05.043\"\n     onclick=\"log_download('huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019', 'http://doi.org/10.1016/j.jogc.2018.05.043', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('huang-cao-nelson-wilson-areviewofenhancedrecoveryaftersurgeryprinciplesusedforscheduledcaesareandelivery-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {A Review of Enhanced Recovery After Surgery Principles Used for Scheduled Caesarean Delivery},\n type = {article},\n year = {2019},\n keywords = {Caesarean section,Enhanced Recovery After Surgery (ERAS),obstetrical surgery,perioperative care},\n pages = {1775-1788},\n volume = {41},\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S1701216318305164},\n month = {10},\n day = {8},\n id = {1b4f2bc0-880f-3284-aef5-67b85a886171},\n created = {2020-10-08T17:27:28.689Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.130Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {There is an increasing body of evidence to support the success of Enhanced Recovery After Surgery (ERAS) for a wide range of surgical procedures. There has been little formalized application, however, of ERAS principles in obstetrical surgery. The aim of this review was to examine the evidence base of perioperative care for patients undergoing Caesarean delivery (CD) and to determine the feasibility of developing an ERAS Society guideline for this obstetrical care plan. The literature on enhanced recovery programs was reviewed, including fast-track surgery and perioperative care components in the preoperative, intraoperative, and postoperative phases of CD. These studies included randomized controlled trials (RCTs), prospective cohort studies, non-RCT studies, meta-analyses, systematic reviews, reviews, and case studies. This is not a systematic review because each ERAS topic area would require a new question. Certain ERAS elements have the potential to benefit patients undergoing CD. These elements include patient education, preoperative optimization, prophylaxis against thromboembolism, antimicrobial prophylaxis, postoperative nausea and vomiting prevention, hypothermia prevention, perioperative fluid management, postoperative analgesia, ileus prevention, breastfeeding promotion, and early mobilization. ERAS has the potential to be successfully implemented in CD on the basis of the evidence obtained from this review. Knowledge transfer and implementation will require multidisciplinary coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS guideline.},\n bibtype = {article},\n author = {Huang, Jeffrey and Cao, Cathy and Nelson, Gregg and Wilson, R. Douglas},\n doi = {10.1016/j.jogc.2018.05.043},\n journal = {Journal of Obstetrics and Gynaecology Canada},\n number = {12}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  There is an increasing body of evidence to support the success of Enhanced Recovery After Surgery (ERAS) for a wide range of surgical procedures. There has been little formalized application, however, of ERAS principles in obstetrical surgery. The aim of this review was to examine the evidence base of perioperative care for patients undergoing Caesarean delivery (CD) and to determine the feasibility of developing an ERAS Society guideline for this obstetrical care plan. The literature on enhanced recovery programs was reviewed, including fast-track surgery and perioperative care components in the preoperative, intraoperative, and postoperative phases of CD. These studies included randomized controlled trials (RCTs), prospective cohort studies, non-RCT studies, meta-analyses, systematic reviews, reviews, and case studies. This is not a systematic review because each ERAS topic area would require a new question. Certain ERAS elements have the potential to benefit patients undergoing CD. These elements include patient education, preoperative optimization, prophylaxis against thromboembolism, antimicrobial prophylaxis, postoperative nausea and vomiting prevention, hypothermia prevention, perioperative fluid management, postoperative analgesia, ileus prevention, breastfeeding promotion, and early mobilization. ERAS has the potential to be successfully implemented in CD on the basis of the evidence obtained from this review. Knowledge transfer and implementation will require multidisciplinary coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS guideline.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721', event);\">\n    Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3).\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Macones,  G., A.; Caughey,  A., B.; Wood,  S., L.; Wrench,  I., J.; Huang,  J.; Norman,  M.; Pettersson,  K.; Fawcett,  W., J.; Shalabi,  M., M.; Metcalfe,  A.; Gramlich,  L.; Nelson,  G.;  and Wilson,  R., D.\n</span>\n\n  \n\n</span>\n\n  <i>American Journal of Obstetrics and Gynecology</i>, 221(3): 247.e1-247.e9. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721\"\n     onclick=\"log_download('macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3) [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ajog.2019.04.012\"\n     onclick=\"log_download('macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019', 'http://doi.org/10.1016/j.ajog.2019.04.012', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('macones-caughey-wood-wrench-huang-norman-pettersson-fawcett-etal-guidelinesforpostoperativecareincesareandeliveryenhancedrecoveryaftersurgeryerassocietyrecommendationspart3-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)},\n type = {article},\n year = {2019},\n keywords = {cesarean delivery,enhanced recovery},\n pages = {247.e1-247.e9},\n volume = {221},\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819305721},\n month = {10},\n day = {8},\n id = {2751aba3-c6e2-3959-8819-9c45b1bb0677},\n created = {2020-10-08T17:27:28.775Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.555Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {Background: This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. Objective: The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. Study Design: The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Delivery,” “Cesarean Section Delivery,” and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. Results: The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. Conclusion: As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.},\n bibtype = {article},\n author = {Macones, George A. and Caughey, Aaron B. and Wood, Stephen L. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg and Wilson, R. Douglas},\n doi = {10.1016/j.ajog.2019.04.012},\n journal = {American Journal of Obstetrics and Gynecology},\n number = {3}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. Objective: The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. Study Design: The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Delivery,” “Cesarean Section Delivery,” and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. Results: The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. Conclusion: As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750', event);\">\n    Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gregory,  A., J.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Cardiothoracic and Vascular Anesthesia</i>, 33(11): 3020-3021. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750\"\n     onclick=\"log_download('gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1053/j.jvca.2019.06.022\"\n     onclick=\"log_download('gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019', 'http://doi.org/10.1053/j.jvca.2019.06.022', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gregory-movingforwardlessonslearnedfromtheearlyreturnsofenhancedrecoveryprograms-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Moving Forward: Lessons Learned From the Early Returns of Enhanced Recovery Programs},\n type = {article},\n year = {2019},\n pages = {3020-3021},\n volume = {33},\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S1053077019305750},\n month = {10},\n day = {8},\n id = {2500df8a-cb08-3514-869b-9f2b5ed9be0c},\n created = {2020-10-08T17:27:28.775Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.105Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n bibtype = {article},\n author = {Gregory, Alexander J.},\n doi = {10.1053/j.jvca.2019.06.022},\n journal = {Journal of Cardiothoracic and Vascular Anesthesia},\n number = {11}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131', event);\">\n    International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Wijk,  L.; Udumyan,  R.; Pache,  B.; Altman,  A., D.; Williams,  L., L.; Elias,  K., M.; McGee,  J.; Wells,  T.; Gramlich,  L.; Holcomb,  K.; Achtari,  C.; Ljungqvist,  O.; Dowdy,  S., C.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>American Journal of Obstetrics and Gynecology</i>, 221(3): 237.e1-237.e11. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131\"\n     onclick=\"log_download('wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ajog.2019.04.028\"\n     onclick=\"log_download('wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019', 'http://doi.org/10.1016/j.ajog.2019.04.028', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('wijk-udumyan-pache-altman-williams-elias-mcgee-wells-etal-internationalvalidationofenhancedrecoveryaftersurgerysocietyguidelinesonenhancedrecoveryforgynecologicsurgery-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery},\n type = {article},\n year = {2019},\n keywords = {ERAS,compliance,gynecologic oncology,gynecologic surgery,length of stay,perioperative care},\n pages = {237.e1-237.e11},\n volume = {221},\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0002937819306131},\n month = {10},\n day = {8},\n id = {858a502a-ffac-3b05-ac1e-e7d950fb3be3},\n created = {2020-10-08T17:27:28.807Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.821Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n abstract = {Background: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. Objective: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. Study Design: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. Results: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4–11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90–0.95; P&lt;.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82–0.93; P&lt;.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P&lt;.05) among low-complexity patients. Conclusion: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.},\n bibtype = {article},\n author = {Wijk, Lena and Udumyan, Ruzan and Pache, Basile and Altman, Alon D. and Williams, Laura L. and Elias, Kevin M. and McGee, Jake and Wells, Tiffany and Gramlich, Leah and Holcomb, Kevin and Achtari, Chahin and Ljungqvist, Olle and Dowdy, Sean C. and Nelson, Gregg},\n doi = {10.1016/j.ajog.2019.04.028},\n journal = {American Journal of Obstetrics and Gynecology},\n number = {3}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. Objective: To evaluate the association between compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort. Study Design: The study comprised 2101 patients undergoing elective gynecologic/oncology surgery between January 2011 and November 2017 in 10 hospitals across Canada, the United States, and Europe. Patient demographics, surgical/anesthesia details, and Enhanced Recovery After Surgery protocol compliance elements (pre-, intra-, and postoperative phases) were entered into the Enhanced Recovery After Surgery Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low vs medium/high). The following covariates were accounted for in the analysis: age, body mass index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open vs minimally invasive), intraoperative blood loss, hospital, and Enhanced Recovery After Surgery implementation status. The primary end points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates. Results: Patient demographics included a median age 56 years, 35.5% obese, 15% smokers, and 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4–11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in Enhanced Recovery After Surgery guideline score was associated with 8% (IRR, 0.92; 95% confidence interval, 0.90–0.95; P<.001) decrease in days in hospital among low-complexity, and 12% (IRR, 0.88; 95% confidence interval, 0.82–0.93; P<.001) decrease among patients with medium/high-complexity scores. For every unit increase in Enhanced Recovery After Surgery guideline score, the odds of total complications were estimated to be 12% lower (P<.05) among low-complexity patients. Conclusion: Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546', event);\">\n    Efficacy of TAP blocks following ovarian cancer surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Bisch,  S.; Glaze,  S.; Cameron,  A.; Nation,  J.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>Gynecologic Oncology</i>, 154: 151. 10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546\"\n     onclick=\"log_download('bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019', 'https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Efficacy of TAP blocks following ovarian cancer surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ygyno.2019.04.356\"\n     onclick=\"log_download('bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019', 'http://doi.org/10.1016/j.ygyno.2019.04.356', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('bisch-glaze-cameron-nation-nelson-efficacyoftapblocksfollowingovariancancersurgery-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Efficacy of TAP blocks following ovarian cancer surgery},\n type = {article},\n year = {2019},\n pages = {151},\n volume = {154},\n websites = {https://linkinghub.elsevier.com/retrieve/pii/S0090825819308546},\n month = {10},\n day = {8},\n id = {9a1fa7e0-bcef-32ca-9fca-140e96afff7a},\n created = {2020-10-08T17:27:28.852Z},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.126Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n source_type = {JOUR},\n language = {en},\n private_publication = {false},\n bibtype = {article},\n author = {Bisch, S.P. and Glaze, S.J. and Cameron, A. and Nation, J. and Nelson, G.},\n doi = {10.1016/j.ygyno.2019.04.356},\n journal = {Gynecologic Oncology}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/13399be4-1186-8ba5-3252-d382367553e9/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/13399be4-1186-8ba5-3252-d382367553e9/full_text.pdf.pdf', event);\">\n    Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Bisch,  S.; Nelson,  G.;  and Altman,  A.\n</span>\n\n  \n\n</span>\n\n  5 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/13399be4-1186-8ba5-3252-d382367553e9/full_text.pdf.pdf\"\n     onclick=\"log_download('bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/13399be4-1186-8ba5-3252-d382367553e9/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/\"\n     onclick=\"log_download('bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019', '/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.3390/nu11051088\"\n     onclick=\"log_download('bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019', 'http://doi.org/10.3390/nu11051088', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('bisch-nelson-altman-impactofnutritiononenhancedrecoveryaftersurgeryerasingynecologiconcology-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology},\n type = {misc},\n year = {2019},\n source = {Nutrients},\n keywords = {ERAS,Enhanced recovery after surgery,Gynecologic/oncology,Nutrition},\n volume = {11},\n issue = {5},\n websites = {/pmc/articles/PMC6567220/?report=abstract,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567220/},\n month = {5},\n publisher = {MDPI AG},\n day = {1},\n id = {199ba733-8435-31d1-a2dd-b25546021c22},\n created = {2020-10-08T17:33:58.219Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.800Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Enhanced recovery after surgery (ERAS) pathways aim to improve surgical outcomes by applying evidence-based practices before, during, and after surgery. Patients undergoing surgery for gynecologic malignancies are at high risk of complications due to population, patient, disease, and surgical factors. The nutritional status of the patient provides the foundation for recovery after surgery, and opportunities to optimize outcomes exist from the first patient assessment to the early days after surgery. This review highlights the importance of nutritional assessment and intervention during the pre-operative and post-operative periods in the context of ERAS in gynecologic oncology surgery. The emerging role of immunonutrition, carbohydrate loading, and the importance of individualized care are explored. Evidence from studies in gynecologic oncology is presented, where available, and extrapolated from colorectal and other cancer surgery trials when applicable.},\n bibtype = {misc},\n author = {Bisch, Steven and Nelson, Gregg and Altman, Alon},\n doi = {10.3390/nu11051088}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Enhanced recovery after surgery (ERAS) pathways aim to improve surgical outcomes by applying evidence-based practices before, during, and after surgery. Patients undergoing surgery for gynecologic malignancies are at high risk of complications due to population, patient, disease, and surgical factors. The nutritional status of the patient provides the foundation for recovery after surgery, and opportunities to optimize outcomes exist from the first patient assessment to the early days after surgery. This review highlights the importance of nutritional assessment and intervention during the pre-operative and post-operative periods in the context of ERAS in gynecologic oncology surgery. The emerging role of immunonutrition, carbohydrate loading, and the importance of individualized care are explored. Evidence from studies in gynecologic oncology is presented, where available, and extrapolated from colorectal and other cancer surgery trials when applicable.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/170685e5-d056-a621-53af-dcd3d2557711/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/170685e5-d056-a621-53af-dcd3d2557711/full_text.pdf.pdf', event);\">\n    Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Beesoon,  S.; Robert,  J.;  and White,  J.\n</span>\n\n  \n\n</span>\n\n  12 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/170685e5-d056-a621-53af-dcd3d2557711/full_text.pdf.pdf\"\n     onclick=\"log_download('beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/170685e5-d056-a621-53af-dcd3d2557711/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://tableau.albertahealth\"\n     onclick=\"log_download('beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019', 'https://tableau.albertahealth', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1503/cmaj.190590\"\n     onclick=\"log_download('beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019', 'http://doi.org/10.1503/cmaj.190590', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('beesoon-robert-white-surgerystrategicclinicalnetworkimprovingqualitysafetyandaccesstosurgicalcareinalberta-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Surgery strategic clinical network: Improving quality, safety and access to surgical care in Alberta},\n type = {misc},\n year = {2019},\n source = {Cmaj},\n pages = {S27-S29},\n volume = {191},\n issue = {1},\n websites = {https://tableau.albertahealth},\n month = {12},\n publisher = {Canadian Medical Association},\n day = {4},\n id = {390e1916-451f-3b6b-9593-25d68c0ee5f4},\n created = {2020-10-08T17:34:26.075Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.804Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {CMAJ | VOLUME 191 | SUPPLEMENT 1 S27 P ublicly funded surgical care in Alberta is delivered at 55 hospitals and 42 nonhospital surgical facilities, with more than 293 000 surgeries completed per year at an annual budget of about $2 billion. 1 However, about 1.6% of Alber-ta&#x27;s population is on a surgical wait list (70 000 out of 4.3 million Albertans), and about 50% of these patients are waiting longer than clinically recommended. 2,3 The number of Albertans waiting for an initial consultation with a surgical specialist is unknown. In August 2019, the Blue Ribbon Panel on Alberta&#x27;s Finances reported that per capita health care expenditures in Alberta ($5077) were higher than other provinces (e.g., British Columbia, $4267; Ontario, $4080; and Quebec, $4370), but Alberta lagged behind these provinces on several key performance indicators, such as wait times, lengths of stay and readmission rates. 4 The needs of these patients are diverse, and root causes for untimely access and outcomes are complex and require system-level solutions that address fundamental and recurring challenges such as inefficient referral pathways , increasing disease chronicity, variation in surgical outcomes , antiquated models of care that are provider centric and a mismatch between demand and system capacity. Recognizing the need to address these challenges at a systems level, Alberta Health Services created the Surgery Strategic Clinical Network (SCN; www.ahs.ca/surgeryscn) in 2013 with the goal of bringing together front-line health care professionals, operational leaders, academic partners and the community to identify priorities and develop novel solutions to transform the surgical landscape in Alberta. At the time, common metrics, processes and approaches to explicate surgical care were lacking. Although there were several quality-improvement initiatives at local sites, they were not centrally coordinated, integrated or widely shared. The creation of the Surgery SCN sparked a paradigm shift toward system innovation and learning, with a focus on using objective data to drive change and improve outcomes. From the beginning, it was imperative that the Surgery SCN balance local, facility-based needs and priorities for efficient and effective service delivery (the operational business) while also identifying areas for collective action, improvement and innovation (the strategic business). In its first 3 years (2013-2016), the network focused on specific actions, tools and processes that would improve access, safety and quality of surgical care, and enable ongoing measurement and improvement. Three examples of this work include developing a standardized measurement system, the Alberta Coding Access Targets for Surgery tool to elucidate scheduled wait times, customizing and implementing the Safe Surgery Checklist to reduce surgical errors and implementing care pathways on a provincial scale (e.g., Enhanced Recovery After Surgery guidelines) to standardize care and improve patient outcomes and experience. These initiatives have provided considerable value to the people of Alberta through improved outcomes, patient experience and access to surgical care, system-wide learning and quality improvement on a provincial scale. The network has contributed to the successful implementation of this work and its ongoing evaluation. For example, the Alberta Coding Access Targets for Surgery 5 has improved transparency for surgical wait lists and how they are managed. When a surgery is booked, each patient is assigned 1 of around 2000 diagnostic codes, with a recommended maximum wait time and a &quot;ready-to-treat&quot; date. These data are used to optimize wait lists for surgeons to ensure that urgent cases are prioritized and patients who have been waiting the longest are operated on first. The common measurement system was developed and is adjudicated through consensus by surgeons, bringing together the subspecialties across the province. The implementation was coordin ated through a provincial team working directly with surgeons , their medical office assistants, medical and administrative COMMENTARY KEY POINTS • Timely and equitable access to surgical care continues to feature prominently in public discourse and policy debates across Canada and is currently under scrutiny by Alberta decision-makers. • The first 4 years of the Surgery Strategic Clinical Network (SCN), which was created in 2013 with a mandate to address gaps in care and unwarranted variation, were a &quot;learning-and-doing&quot; period, after which it shifted to a more strategic focus and approach. • Comprising operational leaders, clinicians, academic partners and patient advisors, the Surgery SCN has successfully co-designed, tested, validated and implemented major surgical quality-improvement programs with substantial returns on investment.},\n bibtype = {misc},\n author = {Beesoon, Sanjay and Robert, Jill and White, Jonathan},\n doi = {10.1503/cmaj.190590}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  CMAJ | VOLUME 191 | SUPPLEMENT 1 S27 P ublicly funded surgical care in Alberta is delivered at 55 hospitals and 42 nonhospital surgical facilities, with more than 293 000 surgeries completed per year at an annual budget of about $2 billion. 1 However, about 1.6% of Alber-ta's population is on a surgical wait list (70 000 out of 4.3 million Albertans), and about 50% of these patients are waiting longer than clinically recommended. 2,3 The number of Albertans waiting for an initial consultation with a surgical specialist is unknown. In August 2019, the Blue Ribbon Panel on Alberta's Finances reported that per capita health care expenditures in Alberta ($5077) were higher than other provinces (e.g., British Columbia, $4267; Ontario, $4080; and Quebec, $4370), but Alberta lagged behind these provinces on several key performance indicators, such as wait times, lengths of stay and readmission rates. 4 The needs of these patients are diverse, and root causes for untimely access and outcomes are complex and require system-level solutions that address fundamental and recurring challenges such as inefficient referral pathways , increasing disease chronicity, variation in surgical outcomes , antiquated models of care that are provider centric and a mismatch between demand and system capacity. Recognizing the need to address these challenges at a systems level, Alberta Health Services created the Surgery Strategic Clinical Network (SCN; www.ahs.ca/surgeryscn) in 2013 with the goal of bringing together front-line health care professionals, operational leaders, academic partners and the community to identify priorities and develop novel solutions to transform the surgical landscape in Alberta. At the time, common metrics, processes and approaches to explicate surgical care were lacking. Although there were several quality-improvement initiatives at local sites, they were not centrally coordinated, integrated or widely shared. The creation of the Surgery SCN sparked a paradigm shift toward system innovation and learning, with a focus on using objective data to drive change and improve outcomes. From the beginning, it was imperative that the Surgery SCN balance local, facility-based needs and priorities for efficient and effective service delivery (the operational business) while also identifying areas for collective action, improvement and innovation (the strategic business). In its first 3 years (2013-2016), the network focused on specific actions, tools and processes that would improve access, safety and quality of surgical care, and enable ongoing measurement and improvement. Three examples of this work include developing a standardized measurement system, the Alberta Coding Access Targets for Surgery tool to elucidate scheduled wait times, customizing and implementing the Safe Surgery Checklist to reduce surgical errors and implementing care pathways on a provincial scale (e.g., Enhanced Recovery After Surgery guidelines) to standardize care and improve patient outcomes and experience. These initiatives have provided considerable value to the people of Alberta through improved outcomes, patient experience and access to surgical care, system-wide learning and quality improvement on a provincial scale. The network has contributed to the successful implementation of this work and its ongoing evaluation. For example, the Alberta Coding Access Targets for Surgery 5 has improved transparency for surgical wait lists and how they are managed. When a surgery is booked, each patient is assigned 1 of around 2000 diagnostic codes, with a recommended maximum wait time and a \"ready-to-treat\" date. These data are used to optimize wait lists for surgeons to ensure that urgent cases are prioritized and patients who have been waiting the longest are operated on first. The common measurement system was developed and is adjudicated through consensus by surgeons, bringing together the subspecialties across the province. The implementation was coordin ated through a provincial team working directly with surgeons , their medical office assistants, medical and administrative COMMENTARY KEY POINTS • Timely and equitable access to surgical care continues to feature prominently in public discourse and policy debates across Canada and is currently under scrutiny by Alberta decision-makers. • The first 4 years of the Surgery Strategic Clinical Network (SCN), which was created in 2013 with a mandate to address gaps in care and unwarranted variation, were a \"learning-and-doing\" period, after which it shifted to a more strategic focus and approach. • Comprising operational leaders, clinicians, academic partners and patient advisors, the Surgery SCN has successfully co-designed, tested, validated and implemented major surgical quality-improvement programs with substantial returns on investment.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019', 'http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract', event);\">\n    Embracing change—the time for pediatric enhanced recovery after surgery is now.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Rove,  K., O.; Brockel,  M., A.; Brindle,  M., E.; Scott,  M., J.; Herndon,  C., D.; Ljungqvist,  O.;  and Koyle,  M., A.\n</span>\n\n  \n\n</span>\n\n  10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract\"\n     onclick=\"log_download('rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019', 'http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Embracing change—the time for pediatric enhanced recovery after surgery is now [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.jpurol.2019.04.005\"\n     onclick=\"log_download('rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019', 'http://doi.org/10.1016/j.jpurol.2019.04.005', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},\n type = {misc},\n year = {2019},\n source = {Journal of Pediatric Urology},\n pages = {491-493},\n volume = {15},\n issue = {5},\n websites = {http://www.jpurol.com/article/S1477513119300804/fulltext,http://www.jpurol.com/article/S1477513119300804/abstract,https://www.jpurol.com/article/S1477-5131(19)30080-4/abstract},\n month = {10},\n publisher = {Elsevier Ltd},\n day = {1},\n id = {6b29f139-a8d8-3ccd-a84c-28e194040667},\n created = {2020-10-08T17:35:24.711Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:27:59.790Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {misc},\n author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},\n doi = {10.1016/j.jpurol.2019.04.005}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30826120/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019', 'https://pubmed.ncbi.nlm.nih.gov/30826120/', event);\">\n    Optimizing postoperative follow-up in pediatric surgery (OFIPS).\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gimon,  T.; Almosallam,  O.; Lopushinsky,  S.; Eccles,  R.; Brindle,  M.;  and Yanchar,  N., L.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Pediatric Surgery</i>, 54(5): 1013-1018. 5 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30826120/\"\n     onclick=\"log_download('gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019', 'https://pubmed.ncbi.nlm.nih.gov/30826120/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Optimizing postoperative follow-up in pediatric surgery (OFIPS) [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.jpedsurg.2019.01.045\"\n     onclick=\"log_download('gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019', 'http://doi.org/10.1016/j.jpedsurg.2019.01.045', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},\n type = {article},\n year = {2019},\n keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},\n pages = {1013-1018},\n volume = {54},\n websites = {https://pubmed.ncbi.nlm.nih.gov/30826120/},\n month = {5},\n publisher = {W.B. Saunders},\n day = {1},\n id = {892d3444-ad4a-380e-834a-59c2bbd4a828},\n created = {2020-10-08T17:36:34.845Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.306Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},\n bibtype = {article},\n author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},\n doi = {10.1016/j.jpedsurg.2019.01.045},\n journal = {Journal of Pediatric Surgery},\n number = {5}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7cf8dfc0-fa77-6b79-3dd7-25f406e62a5d/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7cf8dfc0-fa77-6b79-3dd7-25f406e62a5d/full_text.pdf.pdf', event);\">\n    Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Nelson,  G.; Bakkum-Gamez,  J.; Kalogera,  E.; Glaser,  G.; Altman,  A.; Meyer,  L., A.; Taylor,  J., S.; Iniesta,  M.; Lasala,  J.; Mena,  G.; Scott,  M.; Gillis,  C.; Elias,  K.; Wijk,  L.; Huang,  J.; Nygren,  J.; Ljungqvist,  O.; Ramirez,  P., T.;  and Dowdy,  S., C.\n</span>\n\n  \n\n</span>\n\n  5 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7cf8dfc0-fa77-6b79-3dd7-25f406e62a5d/full_text.pdf.pdf\"\n     onclick=\"log_download('nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7cf8dfc0-fa77-6b79-3dd7-25f406e62a5d/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"http://ijgc.bmj.com/\"\n     onclick=\"log_download('nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019', 'http://ijgc.bmj.com/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1136/ijgc-2019-000356\"\n     onclick=\"log_download('nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019', 'http://doi.org/10.1136/ijgc-2019-000356', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('nelson-bakkumgamez-kalogera-glaser-altman-meyer-taylor-iniesta-etal-guidelinesforperioperativecareingynecologiconcologyenhancedrecoveryaftersurgeryerassocietyrecommendations2019update-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update},\n type = {misc},\n year = {2019},\n source = {International Journal of Gynecological Cancer},\n keywords = {Enhanced Recovery After Surger,intraoperative care,postoperative care,preoperative care,surgery},\n pages = {651-668},\n volume = {29},\n issue = {4},\n websites = {http://ijgc.bmj.com/},\n month = {5},\n publisher = {BMJ Publishing Group},\n day = {1},\n id = {10daa046-8542-38e1-bd4a-a47d5a71b9ae},\n created = {2020-10-08T17:37:30.029Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2021-08-30T16:28:00.339Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.},\n bibtype = {misc},\n author = {Nelson, Gregg and Bakkum-Gamez, Jamie and Kalogera, Eleftheria and Glaser, Gretchen and Altman, Alon and Meyer, Larissa A. and Taylor, Jolyn S. and Iniesta, Maria and Lasala, Javier and Mena, Gabriel and Scott, Michael and Gillis, Chelsia and Elias, Kevin and Wijk, Lena and Huang, Jeffrey and Nygren, Jonas and Ljungqvist, Olle and Ramirez, Pedro T. and Dowdy, Sean C.},\n doi = {10.1136/ijgc-2019-000356}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/4c1dbd91-abb7-91e9-4b2f-9014aba6386d/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/4c1dbd91-abb7-91e9-4b2f-9014aba6386d/full_text.pdf.pdf', event);\">\n    Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Engelman,  D., T.; Ben Ali,  W.; Williams,  J., B.; Perrault,  L., P.; Reddy,  V., S.; Arora,  R., C.; Roselli,  E., E.; Khoynezhad,  A.; Gerdisch,  M.; Levy,  J., H.; Lobdell,  K.; Fletcher,  N.; Kirsch,  M.; Nelson,  G.; Engelman,  R., M.; Gregory,  A., J.;  and Boyle,  E., M.\n</span>\n\n  \n\n</span>\n\n  8 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/4c1dbd91-abb7-91e9-4b2f-9014aba6386d/full_text.pdf.pdf\"\n     onclick=\"log_download('engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/4c1dbd91-abb7-91e9-4b2f-9014aba6386d/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://jamanetwork.com/\"\n     onclick=\"log_download('engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019', 'https://jamanetwork.com/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1001/jamasurg.2019.1153\"\n     onclick=\"log_download('engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019', 'http://doi.org/10.1001/jamasurg.2019.1153', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('engelman-benali-williams-perrault-reddy-arora-roselli-khoynezhad-etal-guidelinesforperioperativecareincardiacsurgeryenhancedrecoveryaftersurgerysocietyrecommendations-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations},\n type = {misc},\n year = {2019},\n source = {JAMA Surgery},\n keywords = {The JAMA Network},\n pages = {755-766},\n volume = {154},\n issue = {8},\n websites = {https://jamanetwork.com/},\n month = {8},\n publisher = {American Medical Association},\n day = {1},\n id = {ae82a777-0785-33cc-8174-8ea7f357182a},\n created = {2020-10-08T17:38:01.095Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.928Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.},\n bibtype = {misc},\n author = {Engelman, Daniel T. and Ben Ali, Walid and Williams, Judson B. and Perrault, Louis P. and Reddy, V. Seenu and Arora, Rakesh C. and Roselli, Eric E. and Khoynezhad, Ali and Gerdisch, Marc and Levy, Jerrold H. and Lobdell, Kevin and Fletcher, Nick and Kirsch, Matthias and Nelson, Gregg and Engelman, Richard M. and Gregory, Alexander J. and Boyle, Edward M.},\n doi = {10.1001/jamasurg.2019.1153}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing cardiac surgery. A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and reviews was conducted for each protocol element. The quality of the evidence was graded and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery After Surgery Society.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/6c73269f-496f-9243-7a4d-08ca37e63d1d/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/6c73269f-496f-9243-7a4d-08ca37e63d1d/full_text.pdf.pdf', event);\">\n    Enhanced recovery after surgery: Implementing a new standard of surgical care.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Altman,  A., D.; Helpman,  L.; McGee,  J.; Samouëlian,  V.; Auclair,  M., H.; Brar,  H.;  and Nelson,  G., S.\n</span>\n\n  \n\n</span>\n\n  4 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/6c73269f-496f-9243-7a4d-08ca37e63d1d/full_text.pdf.pdf\"\n     onclick=\"log_download('altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/6c73269f-496f-9243-7a4d-08ca37e63d1d/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Enhanced recovery after surgery: Implementing a new standard of surgical care [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"www.erassociety.org\"\n     onclick=\"log_download('altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019', 'www.erassociety.org', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Enhanced recovery after surgery: Implementing a new standard of surgical care [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1503/cmaj.180635\"\n     onclick=\"log_download('altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019', 'http://doi.org/10.1503/cmaj.180635', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('altman-helpman-mcgee-samoulian-auclair-brar-nelson-enhancedrecoveryaftersurgeryimplementinganewstandardofsurgicalcare-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Enhanced recovery after surgery: Implementing a new standard of surgical care},\n type = {misc},\n year = {2019},\n source = {Cmaj},\n pages = {E469-E475},\n volume = {191},\n issue = {17},\n websites = {www.erassociety.org},\n month = {4},\n publisher = {Canadian Medical Association},\n day = {29},\n id = {b3a9d3a0-05fc-3483-8721-9fa01c288c16},\n created = {2020-10-08T17:38:10.939Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.970Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {KEY POINTS\nEnhanced recovery after surgery (ERAS) is an evidence-based and multidisciplinary perioperative care pathway and a surgical quality improvement initiative, which has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital length of stay and},\n bibtype = {misc},\n author = {Altman, Alon D. and Helpman, Limor and McGee, Jacob and Samouëlian, Vanessa and Auclair, Marie Hélène and Brar, Harinder and Nelson, Gregg S.},\n doi = {10.1503/cmaj.180635}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  KEY POINTS\nEnhanced recovery after surgery (ERAS) is an evidence-based and multidisciplinary perioperative care pathway and a surgical quality improvement initiative, which has been shown to promote patient mobilization, reduce complication rates after surgery, decrease hospital length of stay and\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30665004/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019', 'https://pubmed.ncbi.nlm.nih.gov/30665004/', event);\">\n    Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Lovely,  J., K.; Hyland,  S., J.; Smith,  A., N.; Nelson,  G.; Ljungqvist,  O.;  and Parrish,  R., H.\n</span>\n\n  \n\n</span>\n\n  3 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30665004/\"\n     onclick=\"log_download('lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019', 'https://pubmed.ncbi.nlm.nih.gov/30665004/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ijsu.2019.01.006\"\n     onclick=\"log_download('lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019', 'http://doi.org/10.1016/j.ijsu.2019.01.006', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('lovely-hyland-smith-nelson-ljungqvist-parrish-clinicalpharmacistperspectivesforoptimizingpharmacotherapywithinenhancedrecoveryaftersurgeryerasprograms-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS®) programs},\n type = {misc},\n year = {2019},\n source = {International Journal of Surgery},\n keywords = {Cost Savings,Humans,Jenna K Lovely,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care*,Pharmacists*,Postoperative Complications / prevention &amp; control,PubMed Abstract,Recovery of Function,Review,Richard H Parrish,Sara Jordan Hyland,doi:10.1016/j.ijsu.2019.01.006,pmid:30665004},\n pages = {58-62},\n volume = {63},\n websites = {https://pubmed.ncbi.nlm.nih.gov/30665004/},\n month = {3},\n publisher = {Elsevier Ltd},\n day = {1},\n id = {164da341-3fdd-3c56-b8f4-2c3e437dfdee},\n created = {2020-10-08T17:38:34.220Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.869Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.},\n bibtype = {misc},\n author = {Lovely, Jenna K. and Hyland, Sara Jordan and Smith, April N. and Nelson, Gregg and Ljungqvist, Olle and Parrish, Richard H.},\n doi = {10.1016/j.ijsu.2019.01.006}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019', 'https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417', event);\">\n    Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Martin,  L.; Gillis,  C.; Atkins,  M.; Gillam,  M.; Sheppard,  C.; Buhler,  S.; Hammond,  C., B.; Nelson,  G.;  and Gramlich,  L.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Parenteral and Enteral Nutrition</i>, 43(2): 206-219. 2 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417\"\n     onclick=\"log_download('martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019', 'https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1002/jpen.1417\"\n     onclick=\"log_download('martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019', 'http://doi.org/10.1002/jpen.1417', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('martin-gillis-atkins-gillam-sheppard-buhler-hammond-nelson-etal-implementationofanenhancedrecoveryaftersurgeryprogramcanchangenutritioncarepracticeamulticenterexperienceinelectivecolorectalsurgery-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery},\n type = {article},\n year = {2019},\n keywords = {compliance,elective colorectal surgery,enhanced recovery after surgery,nutrition risk screening,perioperative nutrition care},\n pages = {206-219},\n volume = {43},\n websites = {https://onlinelibrary.wiley.com/doi/abs/10.1002/jpen.1417},\n month = {2},\n publisher = {John Wiley and Sons Inc.},\n day = {23},\n id = {eba90cba-dacf-32a5-9321-a96b3e8c9d85},\n created = {2020-10-08T17:39:15.041Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.778Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes. Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013–2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications. Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%–61%), early postoperative oral feeding (P &lt;.001), and mobilization (P &lt;.001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (&lt;70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11–3.64; P &lt;.001) and a trend for LOS &gt;5 days (OR 1.40; 95% CI, 1.00–1.96; P =.052). Low compliance to ERAS (&lt;70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23–3.24; P &lt;.001). Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.},\n bibtype = {article},\n author = {Martin, Lisa and Gillis, Chelsia and Atkins, Marlis and Gillam, Melani and Sheppard, Caroline and Buhler, Sue and Hammond, Carlota Basualdo and Nelson, Gregg and Gramlich, Leah},\n doi = {10.1002/jpen.1417},\n journal = {Journal of Parenteral and Enteral Nutrition},\n number = {2}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes. Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013–2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications. Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%–61%), early postoperative oral feeding (P <.001), and mobilization (P <.001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (<70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11–3.64; P <.001) and a trend for LOS >5 days (OR 1.40; 95% CI, 1.00–1.96; P =.052). Low compliance to ERAS (<70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23–3.24; P <.001). Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  Embracing change—the time for pediatric enhanced recovery after surgery is now.\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Rove,  K., O.; Brockel,  M., A.; Brindle,  M., E.; Scott,  M., J.; Herndon,  C., D.; Ljungqvist,  O.;  and Koyle,  M., A.\n</span>\n\n  \n\n</span>\n\n  10 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.jpurol.2019.04.005\"\n     onclick=\"log_download('rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019', 'http://doi.org/10.1016/j.jpurol.2019.04.005', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('rove-brockel-brindle-scott-herndon-ljungqvist-koyle-embracingchangethetimeforpediatricenhancedrecoveryaftersurgeryisnow-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Embracing change—the time for pediatric enhanced recovery after surgery is now},\n type = {misc},\n year = {2019},\n source = {Journal of Pediatric Urology},\n pages = {491-493},\n volume = {15},\n issue = {5},\n month = {10},\n publisher = {Elsevier Ltd},\n day = {1},\n id = {9361d5fc-feba-3636-b243-06661a4b5dcf},\n created = {2020-10-14T16:09:49.511Z},\n accessed = {2020-10-14},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-20T15:18:36.448Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {misc},\n author = {Rove, K. O. and Brockel, M. A. and Brindle, M. E. and Scott, M. J. and Herndon, C. D.A. and Ljungqvist, O. and Koyle, M. A.},\n doi = {10.1016/j.jpurol.2019.04.005}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://doi.org/10.1007/s00383-019-04476-3\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019', 'https://doi.org/10.1007/s00383-019-04476-3', event);\">\n    Embracing change: the era for pediatric ERAS is here.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Brindle,  M., E.; Heiss,  K.; Scott,  M., J.; Herndon,  C., A.; Ljungqvist,  O.;  and Koyle,  M., A.\n</span>\n\n  \n\n</span>\n\n  6 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://doi.org/10.1007/s00383-019-04476-3\"\n     onclick=\"log_download('brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019', 'https://doi.org/10.1007/s00383-019-04476-3', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Embracing change: the era for pediatric ERAS is here [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1007/s00383-019-04476-3\"\n     onclick=\"log_download('brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019', 'http://doi.org/10.1007/s00383-019-04476-3', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('brindle-heiss-scott-herndon-ljungqvist-koyle-embracingchangetheeraforpediatricerasishere-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Embracing change: the era for pediatric ERAS is here},\n type = {misc},\n year = {2019},\n source = {Pediatric Surgery International},\n keywords = {Care pathways,ERAS,Enhanced recovery after surgery,Outcomes,Quality and safety},\n pages = {631-634},\n volume = {35},\n issue = {6},\n websites = {https://doi.org/10.1007/s00383-019-04476-3},\n month = {6},\n publisher = {Springer Verlag},\n day = {7},\n id = {65428606-10d0-317b-8805-4f1ea57513e4},\n created = {2020-10-14T16:10:57.998Z},\n accessed = {2020-10-14},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.906Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.},\n bibtype = {misc},\n author = {Brindle, Mary E. and Heiss, Kurt and Scott, Michael J. and Herndon, C. Anthony and Ljungqvist, Olle and Koyle, Martin A.},\n doi = {10.1007/s00383-019-04476-3}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  The concept of Enhanced Recovery After Surgery (ERAS) has increasingly been embraced by our adult surgical colleagues, but has been slow to crossover to pediatric surgical subspecialties. ERAS ® improves outcomes through multiple, incremental steps that act synergistically throughout the entire surgical journey. In practice, ERAS ® is a strategy of perioperative management that is defined by strong implementation and ongoing adherence to a patient-focused, multidisciplinary, and multimodal approach. There are increasing numbers of surgical teams exploring ERAS ® in children and there is mounting evidence that this approach may improve surgical care for children across the globe. The first World Congress in Pediatric ERAS ® in 2018 has set the stage for a new era in pediatric surgical safety.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  Optimizing postoperative follow-up in pediatric surgery (OFIPS).\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gimon,  T.; Almosallam,  O.; Lopushinsky,  S.; Eccles,  R.; Brindle,  M.;  and Yanchar,  N., L.\n</span>\n\n  \n\n</span>\n\n  <i>Journal of Pediatric Surgery</i>, 54(5): 1013-1018. 5 2019.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.jpedsurg.2019.01.045\"\n     onclick=\"log_download('gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019', 'http://doi.org/10.1016/j.jpedsurg.2019.01.045', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gimon-almosallam-lopushinsky-eccles-brindle-yanchar-optimizingpostoperativefollowupinpediatricsurgeryofips-2019')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Optimizing postoperative follow-up in pediatric surgery (OFIPS)},\n type = {article},\n year = {2019},\n keywords = {Clinic value,Costs,Pediatric surgery,Perceived value,Postoperative follow-up},\n pages = {1013-1018},\n volume = {54},\n month = {5},\n publisher = {W.B. Saunders},\n day = {1},\n id = {69e673a0-4046-37b1-b780-b2262fa3ff5d},\n created = {2020-10-14T16:10:58.002Z},\n accessed = {2020-10-14},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.992Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.},\n bibtype = {article},\n author = {Gimon, Tamara and Almosallam, Osama and Lopushinsky, Steven and Eccles, Robin and Brindle, Mary and Yanchar, Natalie L.},\n doi = {10.1016/j.jpedsurg.2019.01.045},\n journal = {Journal of Pediatric Surgery},\n number = {5}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background/Purpose: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU)in pediatric surgical patients, predictors of clinical value, and visit cost estimates. Methods: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. Results: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered “complex”. Significant costs to the health care system (~$125,000)and families (~$15,000)could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. Conclusion: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. Level of evidence: Level III.\n</div>\n\n\n</div>\n\n\n\n\n\n    </div>\n  </div>\n\n  <div class=\"bibbase_group_whole\" id=\"group_2018\">\n    <div class=\"bibbase_group\"\n      onclick=\"toggleGroup('group_2018')\"\n      onkeypress=\"toggleGroup('group_2018')\"\n      tabindex=\"0\">\n      <i class=\"fa fa-angle-down bibbase_group_head_icon\"></i>&nbsp;\n      <span>2018</span>\n      <span class=\"bibbase_group_count\">\n        \n        (7)\n        \n      </span>\n    </div>\n    <div class=\"bibbase_group_body\">\n      \n  \n  <div class=\"bibbase_paper\" id=\"noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018', 'http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract', event);\">\n    Enhanced Recovery for Cardiac Surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Noss,  C.; Prusinkiewicz,  C.; Nelson,  G.; Patel,  P., A.; Augoustides,  J., G.;  and Gregory,  A., J.\n</span>\n\n  \n\n</span>\n\n  12 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract\"\n     onclick=\"log_download('noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018', 'http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Enhanced Recovery for Cardiac Surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1053/j.jvca.2018.01.045\"\n     onclick=\"log_download('noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018', 'http://doi.org/10.1053/j.jvca.2018.01.045', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('noss-prusinkiewicz-nelson-patel-augoustides-gregory-enhancedrecoveryforcardiacsurgery-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Enhanced Recovery for Cardiac Surgery},\n type = {misc},\n year = {2018},\n source = {Journal of Cardiothoracic and Vascular Anesthesia},\n keywords = {ERAS,ERCS,enhanced recovery},\n pages = {2760-2770},\n volume = {32},\n issue = {6},\n websites = {http://www.jcvaonline.com/article/S1053077018300491/fulltext,http://www.jcvaonline.com/article/S1053077018300491/abstract,https://www.jcvaonline.com/article/S1053-0770(18)30049-1/abstract},\n month = {12},\n publisher = {W.B. Saunders},\n day = {1},\n id = {3ec38b68-38ee-335b-b415-ab9a9c00caaf},\n created = {2020-10-08T17:51:54.574Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.456Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest.},\n bibtype = {misc},\n author = {Noss, Christopher and Prusinkiewicz, Christopher and Nelson, Gregg and Patel, Prakash A. and Augoustides, John G. and Gregory, Alexander J.},\n doi = {10.1053/j.jvca.2018.01.045}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Enhanced Recovery After Surgery (ERAS® Society, Stockholm, Sweden) programs are developing rapidly in multiple specialties, fueled by the promising outcomes in colorectal surgery. There currently are no Enhanced Recovery After Surgery guidelines for cardiac surgery. The elevated burden of mortality, morbidity, and high resource expenditures associated with cardiac surgery present a tremendous opportunity for enhanced recovery. This narrative review sets out to examine the literature involving enhanced recovery in cardiac surgery and explores additional potential areas of interest.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30100053/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018', 'https://pubmed.ncbi.nlm.nih.gov/30100053/', event);\">\n    Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Bisch,  S., P.; Wells,  T.; Gramlich,  L.; Faris,  P.; Wang,  X.; Tran,  D., T.; Thanh,  N., X.; Glaze,  S.; Chu,  P.; Ghatage,  P.; Nation,  J.; Capstick,  V.; Steed,  H.; Sabourin,  J.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>Gynecologic Oncology</i>, 151(1): 117-123. 10 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30100053/\"\n     onclick=\"log_download('bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018', 'https://pubmed.ncbi.nlm.nih.gov/30100053/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ygyno.2018.08.007\"\n     onclick=\"log_download('bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018', 'http://doi.org/10.1016/j.ygyno.2018.08.007', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('bisch-wells-gramlich-faris-wang-tran-thanh-glaze-etal-enhancedrecoveryaftersurgeryerasingynecologiconcologysystemwideimplementationandauditleadstoimprovedvalueandpatientoutcomes-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes},\n type = {article},\n year = {2018},\n keywords = {Clinical outcomes,Cost savings,ERAS,Gynecologic oncology},\n pages = {117-123},\n volume = {151},\n websites = {https://pubmed.ncbi.nlm.nih.gov/30100053/},\n month = {10},\n publisher = {Academic Press Inc.},\n day = {1},\n id = {1ad19dc3-c581-3887-932d-dd5a5787016a},\n created = {2020-10-08T17:52:24.945Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.025Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Objective: Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system. Methods: We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics. Results: We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p &lt; 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p &lt; 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p &lt; 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636). Conclusions: Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.},\n bibtype = {article},\n author = {Bisch, S. P. and Wells, T. and Gramlich, L. and Faris, P. and Wang, X. and Tran, D. T. and Thanh, N. X. and Glaze, S. and Chu, P. and Ghatage, P. and Nation, J. and Capstick, V. and Steed, H. and Sabourin, J. and Nelson, G.},\n doi = {10.1016/j.ygyno.2018.08.007},\n journal = {Gynecologic Oncology},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Objective: Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system. Methods: We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics. Results: We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p < 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p < 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p < 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636). Conclusions: Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30240657/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018', 'https://pubmed.ncbi.nlm.nih.gov/30240657/', event);\">\n    Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1).\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Wilson,  R., D.; Caughey,  A., B.; Wood,  S., L.; Macones,  G., A.; Wrench,  I., J.; Huang,  J.; Norman,  M.; Pettersson,  K.; Fawcett,  W., J.; Shalabi,  M., M.; Metcalfe,  A.; Gramlich,  L.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>American Journal of Obstetrics and Gynecology</i>, 219(6): 523.e1-523.e15. 12 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30240657/\"\n     onclick=\"log_download('wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018', 'https://pubmed.ncbi.nlm.nih.gov/30240657/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1) [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ajog.2018.09.015\"\n     onclick=\"log_download('wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018', 'http://doi.org/10.1016/j.ajog.2018.09.015', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('wilson-caughey-wood-macones-wrench-huang-norman-pettersson-etal-guidelinesforantenatalandpreoperativecareincesareandeliveryenhancedrecoveryaftersurgerysocietyrecommendationspart1-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)},\n type = {article},\n year = {2018},\n keywords = {cesarean delivery,enhanced recovery,intraoperative,postoperative,preoperative,quality,safety},\n pages = {523.e1-523.e15},\n volume = {219},\n websites = {https://pubmed.ncbi.nlm.nih.gov/30240657/},\n month = {12},\n publisher = {Mosby Inc.},\n day = {1},\n id = {940da495-ea9e-3495-8e98-e0b73c312a23},\n created = {2020-10-08T17:52:26.992Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.027Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation,), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.},\n bibtype = {article},\n author = {Wilson, R. Douglas and Caughey, Aaron B. and Wood, Stephen L. and Macones, George A. and Wrench, Ian J. and Huang, Jeffrey and Norman, Mikael and Pettersson, Karin and Fawcett, William J. and Shalabi, Medhat M. and Metcalfe, Amy and Gramlich, Leah and Nelson, Gregg},\n doi = {10.1016/j.ajog.2018.09.015},\n journal = {American Journal of Obstetrics and Gynecology},\n number = {6}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation,), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a8bd581-b033-0dd3-5c4b-c6e2768d50d5/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a8bd581-b033-0dd3-5c4b-c6e2768d50d5/full_text.pdf.pdf', event);\">\n    Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Kalogera,  E.; Nelson,  G.; Liu,  J.; Hu,  Q., L.; Ko,  C., Y.; Wick,  E.;  and Dowdy,  S., C.\n</span>\n\n  \n\n</span>\n\n  12 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a8bd581-b033-0dd3-5c4b-c6e2768d50d5/full_text.pdf.pdf\"\n     onclick=\"log_download('kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a8bd581-b033-0dd3-5c4b-c6e2768d50d5/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/30031749/\"\n     onclick=\"log_download('kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018', 'https://pubmed.ncbi.nlm.nih.gov/30031749/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ajog.2018.07.014\"\n     onclick=\"log_download('kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018', 'http://doi.org/10.1016/j.ajog.2018.07.014', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n  &nbsp;\n  <span class=\"bibbase_stats_paper\" style=\"color: #777;\">\n    <span>1 download</span>\n  </span>\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('kalogera-nelson-liu-hu-ko-wick-dowdy-surgicaltechnicalevidencereviewforgynecologicsurgeryconductedfortheagencyforhealthcareresearchandqualitysafetyprogramforimprovingsurgicalcareandrecovery-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery},\n type = {misc},\n year = {2018},\n source = {American Journal of Obstetrics and Gynecology},\n keywords = {Agency for Healthcare Research and Quality,Improving Surgical Care and Recovery,enhanced recovery after surgery,enhanced recovery pathway,gynecologic surgery,patient safety,review},\n pages = {563.e1-563.e19},\n volume = {219},\n issue = {6},\n websites = {https://pubmed.ncbi.nlm.nih.gov/30031749/},\n month = {12},\n publisher = {Mosby Inc.},\n day = {1},\n id = {6f9ea4b6-6266-3fe2-b6d8-c1170f55878f},\n created = {2020-10-08T17:52:29.281Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.443Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective: The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design: We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results: Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion: Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.},\n bibtype = {misc},\n author = {Kalogera, Eleftheria and Nelson, Gregg and Liu, Jessica and Hu, Q. Lina and Ko, Clifford Y. and Wick, Elizabeth and Dowdy, Sean C.},\n doi = {10.1016/j.ajog.2018.07.014}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective: The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design: We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results: Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion: Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/29532139/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018', 'https://pubmed.ncbi.nlm.nih.gov/29532139/', event);\">\n    The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  AlBalawi,  Z.; Gramlich,  L.; Nelson,  G.; Senior,  P.; Youngson,  E.;  and McAlister,  F., A.\n</span>\n\n  \n\n</span>\n\n  <i>World Journal of Surgery</i>, 42(9): 2691-2700. 9 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/29532139/\"\n     onclick=\"log_download('albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018', 'https://pubmed.ncbi.nlm.nih.gov/29532139/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1007/s00268-018-4559-0\"\n     onclick=\"log_download('albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018', 'http://doi.org/10.1007/s00268-018-4559-0', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('albalawi-gramlich-nelson-senior-youngson-mcalister-theimpactoftheimplementationoftheenhancedrecoveryaftersurgeryerasprograminanentirehealthsystemanaturalexperimentinalbertacanada-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada},\n type = {article},\n year = {2018},\n keywords = {Adult,Aged,Alberta,Colorectal Surgery / statistics &amp; numerical data*,Digestive System Surgical Procedures / statistics,Female,Finlay A McAlister,Humans,Leah Gramlich,Length of Stay / statistics &amp; numerical data*,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Non-U.S. Gov&#x27;t,Patient Readmission,Perioperative Care / methods,Perioperative Care / standards*,Postoperative Care / methods,Postoperative Care / standards*,Postoperative Complications / prevention &amp; control,Program Evaluation,PubMed Abstract,Research Support,Retrospective Studies,Zaina AlBalawi,doi:10.1007/s00268-018-4559-0,pmid:29532139},\n pages = {2691-2700},\n volume = {42},\n websites = {https://pubmed.ncbi.nlm.nih.gov/29532139/},\n month = {9},\n publisher = {Springer New York LLC},\n day = {1},\n id = {b6ad9164-222a-3ae3-a7bf-166d9eff307b},\n created = {2020-10-08T17:52:43.181Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.314Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. Methods: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery. Results: Of 2714 patients (mean age 60.4 years, 55% men) with similar demographics and comorbidity profiles in the pre/post-ERAS time periods, LOS was significantly shorter post-ERAS (8.5 vs. 9.5 days, p = 0.01; − 0.84 days [95% CI − 0.04 to − 1.64 days] after adjustment for age, sex, Charlson comorbidity score, procedure type, surgical approach, and hospital). However, interrupted time series demonstrated no significant level change (p = 0.30) or change in slope (p = 0.63) with ERAS implementation, consistent with continuation of an underlying secular trend of reductions in LOS over time. There were no significant differences (in multivariate analysis or ITS) in risk of 30-day death/readmission (14.3% post vs. 13.5% pre-ERAS, aOR 1.12, 95% CI 0.89–1.40), 30-day death/ED visit (27.2% post vs. 30.0% pre, aOR 0.93, 95% CI 0.78–1.10), or 30-day death/readmission/ED visit (27.8% post vs. 30.6% pre, aOR 0.93, 95% CI 0.78–1.10). The 428 patients with diabetes had longer LOS but exhibited no significant difference post- versus pre-ERAS (10.7 vs. 11.6 days, p = 0.53; p = 0.56 for level change and p = 0.66 for slope change on ITS). Conclusion: Although there was a secular trend toward decreasing LOS over time in Alberta, ERAS implementation was not associated with statistically significant changes in LOS or postoperative outcomes for all colorectal surgery patients or for those with diabetes. Our study highlights the importance of evaluating system changes (for both uptake and outcomes) rather than assuming trial benefits will translate directly into practice. Interventions to improve LOS and postoperative outcomes for patients with diabetes undergoing colorectal surgery are still needed even in the ERAS era.},\n bibtype = {article},\n author = {AlBalawi, Zaina and Gramlich, Leah and Nelson, Gregg and Senior, Peter and Youngson, Erik and McAlister, Finlay A.},\n doi = {10.1007/s00268-018-4559-0},\n journal = {World Journal of Surgery},\n number = {9}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: The Enhanced Recovery After Surgery (ERAS) program has been shown to reduce length of stay (LOS) in colorectal surgical patients in randomized trials. The impact outside of trial settings, or in subgroups of patients excluded from trials such as individuals with diabetes, is uncertain. We conducted this study to evaluate the impact of ERAS implementation in Alberta, Canada. Methods: This is a retrospective cohort study and interrupted time series analysis using linked administrative data to examine LOS and postoperative outcomes in the 12 months pre- and post-implementation of ERAS in 2013 for all adults undergoing elective colorectal surgery. Results: Of 2714 patients (mean age 60.4 years, 55% men) with similar demographics and comorbidity profiles in the pre/post-ERAS time periods, LOS was significantly shorter post-ERAS (8.5 vs. 9.5 days, p = 0.01; − 0.84 days [95% CI − 0.04 to − 1.64 days] after adjustment for age, sex, Charlson comorbidity score, procedure type, surgical approach, and hospital). However, interrupted time series demonstrated no significant level change (p = 0.30) or change in slope (p = 0.63) with ERAS implementation, consistent with continuation of an underlying secular trend of reductions in LOS over time. There were no significant differences (in multivariate analysis or ITS) in risk of 30-day death/readmission (14.3% post vs. 13.5% pre-ERAS, aOR 1.12, 95% CI 0.89–1.40), 30-day death/ED visit (27.2% post vs. 30.0% pre, aOR 0.93, 95% CI 0.78–1.10), or 30-day death/readmission/ED visit (27.8% post vs. 30.6% pre, aOR 0.93, 95% CI 0.78–1.10). The 428 patients with diabetes had longer LOS but exhibited no significant difference post- versus pre-ERAS (10.7 vs. 11.6 days, p = 0.53; p = 0.56 for level change and p = 0.66 for slope change on ITS). Conclusion: Although there was a secular trend toward decreasing LOS over time in Alberta, ERAS implementation was not associated with statistically significant changes in LOS or postoperative outcomes for all colorectal surgery patients or for those with diabetes. Our study highlights the importance of evaluating system changes (for both uptake and outcomes) rather than assuming trial benefits will translate directly into practice. Interventions to improve LOS and postoperative outcomes for patients with diabetes undergoing colorectal surgery are still needed even in the ERAS era.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/29432221/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018', 'https://pubmed.ncbi.nlm.nih.gov/29432221/', event);\">\n    Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Huber,  G., F.;  and Dort,  J., C.\n</span>\n\n  \n\n</span>\n\n  4 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/29432221/\"\n     onclick=\"log_download('huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018', 'https://pubmed.ncbi.nlm.nih.gov/29432221/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1097/MOO.0000000000000442\"\n     onclick=\"log_download('huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018', 'http://doi.org/10.1097/MOO.0000000000000442', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('huber-dort-reducingmorbidityandcomplicationsaftermajorheadandneckcancersurgerythefutureroleofenhancedrecoveryaftersurgeryprotocols-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Reducing morbidity and complications after major head and neck cancer surgery: The (future) role of enhanced recovery after surgery protocols},\n type = {misc},\n year = {2018},\n source = {Current Opinion in Otolaryngology and Head and Neck Surgery},\n keywords = {enhanced recovery after surgery,implementation,outcomes improvement},\n pages = {71-77},\n volume = {26},\n issue = {2},\n websites = {https://pubmed.ncbi.nlm.nih.gov/29432221/},\n month = {4},\n publisher = {Lippincott Williams and Wilkins},\n day = {1},\n id = {050e96ba-0a69-3e2b-9ab7-beb65c6fbbad},\n created = {2020-10-08T17:52:59.150Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.224Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.},\n bibtype = {misc},\n author = {Huber, Gerhard F. and Dort, Joseph C.},\n doi = {10.1097/MOO.0000000000000442}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Purpose of review To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries. Recent findings Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness. Summary There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7d497b40-a90b-e645-460b-0abf5f7e30a9/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7d497b40-a90b-e645-460b-0abf5f7e30a9/full_text.pdf.pdf', event);\">\n    Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gibb,  A., C.; Crosby,  M., A.; McDiarmid,  C.; Urban,  D.; Lam,  J., Y.; Wales,  P., W.; Brockel,  M.; Raval,  M.; Offringa,  M.; Skarsgard,  E., D.; Wester,  T.; Wong,  K.; De Beer,  D.; Nelson,  G.;  and Brindle,  M., E.\n</span>\n\n  \n\n</span>\n\n  <i>BMJ Open</i>, 8(12): 23651. 12 2018.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7d497b40-a90b-e645-460b-0abf5f7e30a9/full_text.pdf.pdf\"\n     onclick=\"log_download('gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/7d497b40-a90b-e645-460b-0abf5f7e30a9/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"http://bmjopen.bmj.com/\"\n     onclick=\"log_download('gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018', 'http://bmjopen.bmj.com/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1136/bmjopen-2018-023651\"\n     onclick=\"log_download('gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018', 'http://doi.org/10.1136/bmjopen-2018-023651', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gibb-crosby-mcdiarmid-urban-lam-wales-brockel-raval-etal-creationofanenhancedrecoveryaftersurgeryerasguidelineforneonatalintestinalsurgerypatientsaknowledgesynthesisandconsensusgenerationapproachandprotocolstudy-2018')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Creation of an Enhanced Recovery after Surgery (ERAS) Guideline for neonatal intestinal surgery patients: A knowledge synthesis and consensus generation approach and protocol study},\n type = {article},\n year = {2018},\n pages = {23651},\n volume = {8},\n websites = {http://bmjopen.bmj.com/},\n month = {12},\n publisher = {BMJ Publishing Group},\n day = {1},\n id = {d705b8c7-657f-3100-8825-18cfb9abc496},\n created = {2020-10-08T17:55:50.898Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:59.130Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. Methods: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. Ethics and dissemination: This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.},\n bibtype = {article},\n author = {Gibb, Ashleigh C.N. and Crosby, Megan A. and McDiarmid, Caraline and Urban, Denisa and Lam, Jennifer Y.K. and Wales, Paul W. and Brockel, Megan and Raval, Mehul and Offringa, Martin and Skarsgard, Erik D. and Wester, Tomas and Wong, Kenneth and De Beer, David and Nelson, Gregg and Brindle, Mary E.},\n doi = {10.1136/bmjopen-2018-023651},\n journal = {BMJ Open},\n number = {12}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Introduction: Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. Methods: A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. Ethics and dissemination: This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.\n</div>\n\n\n</div>\n\n\n\n\n\n    </div>\n  </div>\n\n  <div class=\"bibbase_group_whole\" id=\"group_2017\">\n    <div class=\"bibbase_group\"\n      onclick=\"toggleGroup('group_2017')\"\n      onkeypress=\"toggleGroup('group_2017')\"\n      tabindex=\"0\">\n      <i class=\"fa fa-angle-down bibbase_group_head_icon\"></i>&nbsp;\n      <span>2017</span>\n      <span class=\"bibbase_group_count\">\n        \n        (8)\n        \n      </span>\n    </div>\n    <div class=\"bibbase_group_body\">\n      \n  \n  <div class=\"bibbase_paper\" id=\"dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"http://www.erassociety.org\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017', 'http://www.erassociety.org', event);\">\n    Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Dort,  J., C.; Farwell,  D., G.; Findlay,  M.; Huber,  G., F.; Kerr,  P.; Shea-Budgell,  M., A.; Simon,  C.; Uppington,  J.; Zygun,  D.; Ljungqvist,  O.;  and Harris,  J.\n</span>\n\n  \n\n</span>\n\n  3 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"http://www.erassociety.org\"\n     onclick=\"log_download('dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017', 'http://www.erassociety.org', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1001/jamaoto.2016.2981\"\n     onclick=\"log_download('dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017', 'http://doi.org/10.1001/jamaoto.2016.2981', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('dort-farwell-findlay-huber-kerr-sheabudgell-simon-uppington-etal-optimalperioperativecareinmajorheadandneckcancersurgerywithfreeflapreconstructionaconsensusreviewandrecommendationsfromtheenhancedrecoveryaftersurgerysociety-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: A consensus review and recommendations from the enhanced recovery after surgery society},\n type = {misc},\n year = {2017},\n source = {JAMA Otolaryngology - Head and Neck Surgery},\n keywords = {The JAMA Network},\n pages = {292-303},\n volume = {143},\n issue = {3},\n websites = {http://www.erassociety.org},\n month = {3},\n publisher = {American Medical Association},\n day = {1},\n id = {a36721d5-88c7-36e5-8ad6-e4699bada3cf},\n created = {2020-10-08T17:42:34.613Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.616Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included &quot;head and neck surgery,&quot; &quot;pharyngectomy,&quot; &quot;laryngectomy,&quot; &quot;laryngopharyngectomy,&quot; &quot;neck dissection,&quot;&quot;parotid lymphadenectomy,&quot;&quot;thyroidectomy,&quot;&quot;oral cavity resection,&quot;&quot;glossectomy,&quot; and &quot;head and neck.&quot; The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.},\n bibtype = {misc},\n author = {Dort, Joseph C. and Farwell, D. Gregory and Findlay, Merran and Huber, Gerhard F. and Kerr, Paul and Shea-Budgell, Melissa A. and Simon, Christian and Uppington, Jeffrey and Zygun, David and Ljungqvist, Olle and Harris, Jeffrey},\n doi = {10.1001/jamaoto.2016.2981}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  IMPORTANCE: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. OBJECTIVE: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. EVIDENCE REVIEW: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included \"head and neck surgery,\" \"pharyngectomy,\" \"laryngectomy,\" \"laryngopharyngectomy,\" \"neck dissection,\"\"parotid lymphadenectomy,\"\"thyroidectomy,\"\"oral cavity resection,\"\"glossectomy,\" and \"head and neck.\" The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. FINDINGS: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. CONCLUSIONS AND RELEVANCE: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/5e1a4272-28b8-85a9-7d51-0e7ce1a7d4ed/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/5e1a4272-28b8-85a9-7d51-0e7ce1a7d4ed/full_text.pdf.pdf', event);\">\n    Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gramlich,  L., M.; Sheppard,  C., E.; Wasylak,  T.; Gilmour,  L., E.; Ljungqvist,  O.; Basualdo-Hammond,  C.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  <i>Implementation Science</i>, 12(1): 67. 5 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/5e1a4272-28b8-85a9-7d51-0e7ce1a7d4ed/full_text.pdf.pdf\"\n     onclick=\"log_download('gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/5e1a4272-28b8-85a9-7d51-0e7ce1a7d4ed/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5\"\n     onclick=\"log_download('gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017', 'http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1186/s13012-017-0597-5\"\n     onclick=\"log_download('gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017', 'http://doi.org/10.1186/s13012-017-0597-5', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gramlich-sheppard-wasylak-gilmour-ljungqvist-basualdohammond-nelson-implementationofenhancedrecoveryaftersurgeryastrategytotransformsurgicalcareacrossahealthsystem-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Implementation of Enhanced Recovery After Surgery: A strategy to transform surgical care across a health system},\n type = {article},\n year = {2017},\n keywords = {Enhanced Recovery After Surgery,Implementation,QUERI,Theoretical Domains Framework},\n pages = {67},\n volume = {12},\n websites = {http://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0597-5},\n month = {5},\n publisher = {BioMed Central Ltd.},\n day = {19},\n id = {a1961964-3924-3b25-b4c0-57aa038478e5},\n created = {2020-10-08T17:42:36.845Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.382Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). Methods: ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Results: Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Conclusions: Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.},\n bibtype = {article},\n author = {Gramlich, Leah M. and Sheppard, Caroline E. and Wasylak, Tracy and Gilmour, Loreen E. and Ljungqvist, Olle and Basualdo-Hammond, Carlota and Nelson, Gregg},\n doi = {10.1186/s13012-017-0597-5},\n journal = {Implementation Science},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). Methods: ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Results: Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Conclusions: Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28445352/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017', 'https://pubmed.ncbi.nlm.nih.gov/28445352/', event);\">\n    Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Temple-Oberle,  C.; Shea-Budgell,  M., A.; Tan,  M.; Semple,  J., L.; Schrag,  C.; Barreto,  M.; Blondeel,  P.; Hamming,  J.; Dayan,  J.;  and Ljungqvist,  O.\n</span>\n\n  \n\n</span>\n\n  In <i>Plastic and Reconstructive Surgery</i>, volume 139, pages 1056e-1071e, 5 2017. Lippincott Williams and Wilkins\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28445352/\"\n     onclick=\"log_download('templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017', 'https://pubmed.ncbi.nlm.nih.gov/28445352/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1097/PRS.0000000000003242\"\n     onclick=\"log_download('templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017', 'http://doi.org/10.1097/PRS.0000000000003242', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('templeoberle-sheabudgell-tan-semple-schrag-barreto-blondeel-hamming-etal-consensusreviewofoptimalperioperativecareinbreastreconstructionenhancedrecoveryaftersurgeryerassocietyrecommendations-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@inproceedings{\n title = {Consensus review of optimal perioperative care in breast reconstruction: Enhanced recovery after surgery (ERAS) society recommendations},\n type = {inproceedings},\n year = {2017},\n keywords = {Claire Temple-Oberle,Consensus Development Conference,ERAS Society,Female,Humans,MEDLINE,Mammaplasty*,Melissa A Shea-Budgell,Meta-Analysis as Topic,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / standards*,Practice Guideline,Prospective Studies,PubMed Abstract,Randomized Controlled Trials as Topic,Review,Systematic Review,doi:10.1097/PRS.0000000000003242,pmid:28445352},\n pages = {1056e-1071e},\n volume = {139},\n issue = {5},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28445352/},\n month = {5},\n publisher = {Lippincott Williams and Wilkins},\n day = {1},\n id = {4ffc228a-b7ca-33b7-92a0-18076980d130},\n created = {2020-10-08T17:43:00.105Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.659Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.},\n bibtype = {inproceedings},\n author = {Temple-Oberle, Claire and Shea-Budgell, Melissa A. and Tan, Mark and Semple, John L. and Schrag, Christiaan and Barreto, Marcio and Blondeel, Phillip and Hamming, Jeremy and Dayan, Joseph and Ljungqvist, Olle},\n doi = {10.1097/PRS.0000000000003242},\n booktitle = {Plastic and Reconstructive Surgery}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1f7eb0de-e998-ca91-1b05-e870d4e988dd/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1f7eb0de-e998-ca91-1b05-e870d4e988dd/full_text.pdf.pdf', event);\">\n    Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Yeung,  S., E.; Hilkewich,  L.; Gillis,  C.; Heine,  J., A.;  and Fenton,  T., R.\n</span>\n\n  \n\n</span>\n\n  <i>American Journal of Clinical Nutrition</i>, 106(1): 44-51. 7 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1f7eb0de-e998-ca91-1b05-e870d4e988dd/full_text.pdf.pdf\"\n     onclick=\"log_download('yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/1f7eb0de-e998-ca91-1b05-e870d4e988dd/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28468890/\"\n     onclick=\"log_download('yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017', 'https://pubmed.ncbi.nlm.nih.gov/28468890/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.3945/ajcn.116.148619\"\n     onclick=\"log_download('yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017', 'http://doi.org/10.3945/ajcn.116.148619', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('yeung-hilkewich-gillis-heine-fenton-proteinintakesareassociatedwithreducedlengthofstayacomparisonbetweenenhancedrecoveryaftersurgeryerasandconventionalcareafterelectivecolorectalsurgery-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Protein intakes are associated with reduced length of stay: A comparison between Enhanced Recovery after Surgery (ERAS) and conventional care after elective colorectal surgery},\n type = {article},\n year = {2017},\n keywords = {Bowel surgery,Colorectal surgery,Diet,Dietary protein,Energy,Enhanced Recovery After Surgery,Length of stay,Malnutrition screening tool,Nutrition,Oral nutrition supplement},\n pages = {44-51},\n volume = {106},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28468890/},\n month = {7},\n publisher = {American Society for Nutrition},\n day = {1},\n id = {8c303c6e-f852-3849-934c-d0952ea1804c},\n created = {2020-10-08T17:43:28.938Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.547Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P &lt; 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P &lt; 0.001), and the consumption of $60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: 26.8, 22.0 d; P &lt; 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS.},\n bibtype = {article},\n author = {Yeung, Sophia E. and Hilkewich, Leslee and Gillis, Chelsia and Heine, John A. and Fenton, Tanis R.},\n doi = {10.3945/ajcn.116.148619},\n journal = {American Journal of Clinical Nutrition},\n number = {1}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of $60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: 26.8, 22.0 d; P < 0.001). Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3bb92bf8-4fc8-d1d5-3c96-f464169995c1/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3bb92bf8-4fc8-d1d5-3c96-f464169995c1/full_text.pdf.pdf', event);\">\n    Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Gillis,  C.; Gill,  M.; Marlett,  N.; Mackean,  G.; Germann,  K.; Gilmour,  L.; Nelson,  G.; Wasylak,  T.; Nguyen,  S.; Araujo,  E.; Zelinsky,  S.;  and Gramlich,  L.\n</span>\n\n  \n\n</span>\n\n  <i>BMJ Open</i>, 7(6). 6 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3bb92bf8-4fc8-d1d5-3c96-f464169995c1/full_text.pdf.pdf\"\n     onclick=\"log_download('gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3bb92bf8-4fc8-d1d5-3c96-f464169995c1/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28647727/\"\n     onclick=\"log_download('gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017', 'https://pubmed.ncbi.nlm.nih.gov/28647727/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1136/bmjopen-2017-017002\"\n     onclick=\"log_download('gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017', 'http://doi.org/10.1136/bmjopen-2017-017002', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('gillis-gill-marlett-mackean-germann-gilmour-nelson-wasylak-etal-patientsaspartnersinenhancedrecoveryaftersurgeryaqualitativepatientledstudy-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Patients as partners in Enhanced Recovery after Surgery: A qualitative patient-led study},\n type = {article},\n year = {2017},\n keywords = {Colorectal surgery,Quality in healthcare},\n volume = {7},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28647727/},\n month = {6},\n publisher = {BMJ Publishing Group},\n day = {1},\n id = {43fb09fc-36cf-3715-bbea-f27413387b6f},\n created = {2020-10-08T17:43:40.924Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.680Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.},\n bibtype = {article},\n author = {Gillis, Chelsia and Gill, Marlyn and Marlett, Nancy and Mackean, Gail and Germann, Kathy and Gilmour, Loreen and Nelson, Gregg and Wasylak, Tracy and Nguyen, Susan and Araujo, Edamil and Zelinsky, Sandra and Gramlich, Leah},\n doi = {10.1136/bmjopen-2017-017002},\n journal = {BMJ Open},\n number = {6}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Objectives Explore the experience of patients undergoing colorectal surgery within an Enhanced Recovery After Surgery (ERAS) programme. Use these experiential data to inform the development of a framework to support ongoing, meaningful patient engagement in ERAS. Design Qualitative patient-led study using focus groups and narrative interviews. Data were analysed iteratively using a Participatory Grounded Theory approach. Setting Five tertiary care centres in Alberta, Canada, following the ERAS programme. Participants Twenty-seven patients who had undergone colorectal surgery in the last 12 months were recruited through purposive sampling. Seven patients participated in a codesign focus group to set and prioritise the research direction. Narrative interviews were conducted with 20 patients. Results Patients perceived that an ERAS programme should not be limited to the perioperative period, but should encompass the journey from diagnosis to recovery. Practical recommendations to improve the patient experience across the surgical continuum, and enhance patient engagement within ERAS included: (1) fully explain every protocol, and the purpose of the protocol, both before surgery and while in-hospital, so that patients can become knowledgeable partners in their recovery; (2) extend ERAS guidelines to the presurgery phase, so that patients can be ready emotionally, psychologically and physically for surgery; (3) extend ERAS guidelines to the recovery period at home to avoid stressful situations for patients and families; (4) consider activating a programme where experienced patients can provide peer support; (5) one size does not fit all; personalised adaptations within the standardised pathway are required. Drawing upon these data, and through consultation with ERAS Alberta stakeholders, the ERAS team developed a matrix to guide sustained patient involvement and action throughout the surgical care continuum at three levels: individual, unit and ERAS system. Conclusion This patient-led study generated new insights into the needs of ERAS patients and informed the development of a framework to improve patient experiences and outcomes.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28645426/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017', 'https://pubmed.ncbi.nlm.nih.gov/28645426/', event);\">\n    Enhanced recovery in gynecologic oncology – A sea change in perioperative management.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Dowdy,  S., C.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  8 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28645426/\"\n     onclick=\"log_download('dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017', 'https://pubmed.ncbi.nlm.nih.gov/28645426/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Enhanced recovery in gynecologic oncology – A sea change in perioperative management [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ygyno.2017.06.015\"\n     onclick=\"log_download('dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017', 'http://doi.org/10.1016/j.ygyno.2017.06.015', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('dowdy-nelson-enhancedrecoveryingynecologiconcologyaseachangeinperioperativemanagement-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {Enhanced recovery in gynecologic oncology – A sea change in perioperative management},\n type = {misc},\n year = {2017},\n source = {Gynecologic Oncology},\n keywords = {Editorial,Female,Female / surgery*,Genital Neoplasms,Gregg Nelson,Gynecologic Surgical Procedures / methods*,Humans,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Perioperative Care / methods*,PubMed Abstract,Randomized Controlled Trials as Topic,Sean C Dowdy,doi:10.1016/j.ygyno.2017.06.015,pmid:28645426},\n pages = {225-227},\n volume = {146},\n issue = {2},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28645426/},\n month = {8},\n publisher = {Academic Press Inc.},\n day = {1},\n id = {d9f6d109-93f5-3d15-a27b-5b978231e0fb},\n created = {2020-10-08T17:44:02.463Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.651Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {misc},\n author = {Dowdy, Sean C. and Nelson, Gregg},\n doi = {10.1016/j.ygyno.2017.06.015}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28873501/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017', 'https://pubmed.ncbi.nlm.nih.gov/28873501/', event);\">\n    ERAS—Value based surgery.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Ljungqvist,  O.; Thanh,  N., X.;  and Nelson,  G.\n</span>\n\n  \n\n</span>\n\n  10 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28873501/\"\n     onclick=\"log_download('ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017', 'https://pubmed.ncbi.nlm.nih.gov/28873501/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"ERAS—Value based surgery [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1002/jso.24820\"\n     onclick=\"log_download('ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017', 'http://doi.org/10.1002/jso.24820', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('ljungqvist-thanh-nelson-erasvaluebasedsurgery-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@misc{\n title = {ERAS—Value based surgery},\n type = {misc},\n year = {2017},\n source = {Journal of Surgical Oncology},\n keywords = {ERAS,clinical outcomes,cost of care,implementation},\n pages = {608-612},\n volume = {116},\n issue = {5},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28873501/},\n month = {10},\n publisher = {John Wiley and Sons Inc.},\n day = {1},\n id = {5d77dee8-99d2-3783-beba-eca6bffb5797},\n created = {2020-10-08T17:44:10.582Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.536Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.},\n bibtype = {misc},\n author = {Ljungqvist, Olle and Thanh, Nguyen X. and Nelson, Gregg},\n doi = {10.1002/jso.24820}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. Reports from many different surgery types shows that implementation of ERAS reduces complications and shortens hospital stay. These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2927c56a-6389-4525-4fcb-890e767a03e9/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2927c56a-6389-4525-4fcb-890e767a03e9/full_text.pdf.pdf', event);\">\n    Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Nelson,  G.; Dowdy,  S., C.; Lasala,  J.; Mena,  G.; Bakkum-Gamez,  J.; Meyer,  L., A.; Iniesta,  M., D.;  and Ramirez,  P., T.\n</span>\n\n  \n\n</span>\n\n  <i>Gynecologic Oncology</i>, 147(3): 617-620. 12 2017.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2927c56a-6389-4525-4fcb-890e767a03e9/full_text.pdf.pdf\"\n     onclick=\"log_download('nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/2927c56a-6389-4525-4fcb-890e767a03e9/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28947172/\"\n     onclick=\"log_download('nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017', 'https://pubmed.ncbi.nlm.nih.gov/28947172/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1016/j.ygyno.2017.09.023\"\n     onclick=\"log_download('nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017', 'http://doi.org/10.1016/j.ygyno.2017.09.023', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('nelson-dowdy-lasala-mena-bakkumgamez-meyer-iniesta-ramirez-enhancedrecoveryaftersurgeryerasingynecologiconcologypracticalconsiderationsforprogramdevelopment-2017')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Enhanced recovery after surgery (ERAS®) in gynecologic oncology – Practical considerations for program development},\n type = {article},\n year = {2017},\n keywords = {ERAS®,Enhanced recovery after surgery,Guidelines,Surgery},\n pages = {617-620},\n volume = {147},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28947172/},\n month = {12},\n publisher = {Academic Press Inc.},\n day = {1},\n id = {c78d5930-6ee1-3269-8d4f-34cd457ba7ff},\n created = {2020-10-08T17:45:16.839Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.767Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n bibtype = {article},\n author = {Nelson, G. and Dowdy, S. C. and Lasala, J. and Mena, G. and Bakkum-Gamez, J. and Meyer, L. A. and Iniesta, M. D. and Ramirez, P. T.},\n doi = {10.1016/j.ygyno.2017.09.023},\n journal = {Gynecologic Oncology},\n number = {3}\n}</pre>\n</div>\n\n\n\n</div>\n\n\n\n\n\n    </div>\n  </div>\n\n  <div class=\"bibbase_group_whole\" id=\"group_2016\">\n    <div class=\"bibbase_group\"\n      onclick=\"toggleGroup('group_2016')\"\n      onkeypress=\"toggleGroup('group_2016')\"\n      tabindex=\"0\">\n      <i class=\"fa fa-angle-down bibbase_group_head_icon\"></i>&nbsp;\n      <span>2016</span>\n      <span class=\"bibbase_group_count\">\n        \n        (2)\n        \n      </span>\n    </div>\n    <div class=\"bibbase_group_body\">\n      \n  \n  <div class=\"bibbase_paper\" id=\"nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/26928854/\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016', 'https://pubmed.ncbi.nlm.nih.gov/26928854/', event);\">\n    Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Nelson,  G.; Kiyang,  L., N.; Crumley,  E., T.; Chuck,  A.; Nguyen,  T.; Faris,  P.; Wasylak,  T.; Basualdo-Hammond,  C.; McKay,  S.; Ljungqvist,  O.;  and Gramlich,  L., M.\n</span>\n\n  \n\n</span>\n\n  <i>World Journal of Surgery</i>, 40(5): 1092-1103. 5 2016.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/26928854/\"\n     onclick=\"log_download('nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016', 'https://pubmed.ncbi.nlm.nih.gov/26928854/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1007/s00268-016-3472-7\"\n     onclick=\"log_download('nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016', 'http://doi.org/10.1007/s00268-016-3472-7', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('nelson-kiyang-crumley-chuck-nguyen-faris-wasylak-basualdohammond-etal-implementationofenhancedrecoveryaftersurgeryerasacrossaprovincialhealthcaresystemtheerasalbertacolorectalsurgeryexperience-2016')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {Implementation of Enhanced Recovery after Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience},\n type = {article},\n year = {2016},\n keywords = {Aged,Alberta,Clinical Protocols,Colon / surgery*,Female,Gregg Nelson,Guideline Adherence / economics,Guideline Adherence / statistics &amp; numerical data,Humans,Lawrence N Kiyang,Leah M Gramlich,Length of Stay / statistics &amp; numerical data,MEDLINE,Male,Middle Aged,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Patient Readmission / statistics &amp; numerical data,Perioperative Care / standards*,Postoperative Complications,PubMed Abstract,Rectum / surgery*,doi:10.1007/s00268-016-3472-7,pmid:26928854},\n pages = {1092-1103},\n volume = {40},\n websites = {https://pubmed.ncbi.nlm.nih.gov/26928854/},\n month = {5},\n publisher = {Springer New York LLC},\n day = {1},\n id = {c988171f-cbb2-3cb4-ad58-be400e3abff0},\n created = {2020-10-08T17:41:13.178Z},\n accessed = {2020-10-08},\n file_attached = {false},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.325Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system. Methods: We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts. Results: A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value &lt;0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient. Conclusion: The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.},\n bibtype = {article},\n author = {Nelson, Gregg and Kiyang, Lawrence N. and Crumley, Ellen T. and Chuck, Anderson and Nguyen, Thanh and Faris, Peter and Wasylak, Tracy and Basualdo-Hammond, Carlota and McKay, Susan and Ljungqvist, Olle and Gramlich, Leah M.},\n doi = {10.1007/s00268-016-3472-7},\n journal = {World Journal of Surgery},\n number = {5}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system. Methods: We compared pre- and post-guideline implementation in consecutive elective colorectal patients, ≥18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts. Results: A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value <0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient. Conclusion: The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.\n</div>\n\n\n</div>\n\n\n  <div class=\"bibbase_paper\" id=\"thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016\">\n  <span class=\"bibbase_paper_titleauthoryear\">\n\n  \n  <span class=\"bibbase_paper_title\">\n  \n  \n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a11f0b3-9f18-5fb1-0bad-85c5c37773a9/full_text.pdf.pdf\"\n     onclick=\"return trackOutboundLink('publications', 'click', 'thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a11f0b3-9f18-5fb1-0bad-85c5c37773a9/full_text.pdf.pdf', event);\">\n    An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta.\n  </a>\n  \n  \n  \n</span>\n\n  <span class=\"bibbase_paper_author\">\n  Thanh,  N., X.; Chuck,  A., W.; Wasylak,  T.; Lawrence,  J.; Faris,  P.; Ljungqvist,  O.; Nelson,  G.;  and Gramlich,  L., M.\n</span>\n\n  \n\n</span>\n\n  <i>Canadian Journal of Surgery</i>, 59(6): 415-421. 12 2016.\n  <span class=\"note\"></span>\n\n<span class=\"bibbase_note\"></span>\n\n<br class=\"bibbase_paper_content\"/>\n\n<span class=\"bibbase_paper_content dontprint\">\n\n  \n  <a href=\"https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a11f0b3-9f18-5fb1-0bad-85c5c37773a9/full_text.pdf.pdf\"\n     onclick=\"log_download('thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016', 'https://bibbase.org/service/mendeley/86547d07-1cc0-383b-9ce2-f92f7669d97d/file/3a11f0b3-9f18-5fb1-0bad-85c5c37773a9/full_text.pdf.pdf', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/pdf.svg\"\n\t     alt=\"An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta [pdf]\"\n       title=\"Paper\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Paper</span></a>\n  &nbsp;\n  \n  <a href=\"https://pubmed.ncbi.nlm.nih.gov/28445024/\"\n     onclick=\"log_download('thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016', 'https://pubmed.ncbi.nlm.nih.gov/28445024/', event.ctrlKey, event)\">\n    <img src=\"//bibbase.org/img/filetypes/link.svg\"\n\t     alt=\"An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta [link]\"\n       title=\"Website\"\n\t     class=\"bibbase_icon\"\n         ><span class=\"bibbase_icon_text\">Website</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"http://doi.org/10.1503/cjs.006716\"\n     onclick=\"log_download('thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016', 'http://doi.org/10.1503/cjs.006716', event.ctrlKey)\"\n     class=\"bibbase doi link\">\n    <span>doi</span></a>\n  &nbsp;\n  \n\n  \n  <a href=\"//bibbase.org/network/publication/thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016\"\n     class=\"bibbase bibbase_page link\">link</a>\n  &nbsp;\n  \n\n  <a href=\"#\"\n     onclick=\"showBib(event); return false;\"\n     class=\"bibbase bibtex link\">bibtex\n    <i class=\"fa fa-caret-down\"></i></a>\n\n  \n  &nbsp;\n  <a class=\"bibbase_abstract_link bibbase link\"\n     href=\"#\"\n     onclick=\"showAbstract(event); return false;\">\n    abstract <i class=\"fa fa-caret-down\"></i></a>\n  \n\n  \n  &nbsp;\n  <span class=\"bibbase_stats_paper\" style=\"color: #777;\">\n    <span>1 download</span>\n  </span>\n  \n\n  <!-- <a class=\"bibbase read link hidden\" -->\n  <!--    href=\"javascript:toggleRead('thanh-chuck-wasylak-lawrence-faris-ljungqvist-nelson-gramlich-aneconomicevaluationoftheenhancedrecoveryaftersurgeryerasmultisiteimplementationprogramforcolorectalsurgeryinalberta-2016')\" -->\n  <!--    title=\"Marking this paper as read adds it to your library on BibBase.\" -->\n  <!--    > -->\n  <!--   <i class=\"fa fa-check\"></i>&nbsp; -->\n  <!--   <span>mark as read</span> -->\n  <!-- </a> -->\n\n  &nbsp;\n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n  \n\n</span>\n\n<div class=\"well well-small bibbase\" data-type=\"bibtex\"\n     style=\"display:none\">\n  <pre style=\"white-space: pre-wrap;\">@article{\n title = {An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta},\n type = {article},\n year = {2016},\n keywords = {Anderson W. Chuck,Leah M. Gramlich,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Nguyen X. Thanh,PMC5125924,PubMed Abstract,doi:10.1503/cjs.006716,pmid:28445024},\n pages = {415-421},\n volume = {59},\n websites = {https://pubmed.ncbi.nlm.nih.gov/28445024/},\n month = {12},\n publisher = {Canadian Medical Association},\n day = {1},\n id = {04defe8f-0779-324a-af01-ee10c7a5be70},\n created = {2020-10-08T17:41:55.193Z},\n accessed = {2020-10-08},\n file_attached = {true},\n profile_id = {86547d07-1cc0-383b-9ce2-f92f7669d97d},\n group_id = {b341668a-8f3d-35d8-a220-ea63383761b6},\n last_modified = {2020-10-14T16:12:58.443Z},\n read = {false},\n starred = {false},\n authored = {false},\n confirmed = {true},\n hidden = {false},\n private_publication = {false},\n abstract = {Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods: We assessed the impact of ERAS on patients&#x27; health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return. Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.},\n bibtype = {article},\n author = {Thanh, Nguyen X. and Chuck, Anderson W. and Wasylak, Tracy and Lawrence, Jeannette and Faris, Peter and Ljungqvist, Olle and Nelson, Gregg and Gramlich, Leah M.},\n doi = {10.1503/cjs.006716},\n journal = {Canadian Journal of Surgery},\n number = {6}\n}</pre>\n</div>\n\n\n<div class=\"well well-small bibbase\" data-type=\"abstract\"\n     style=\"display:none\">\n  Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return. Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.\n</div>\n\n\n</div>\n\n\n\n\n\n    </div>\n  </div>\n\n\n\n\n  </div>\n\n\n  <!-- Modal -->\n\n  <!-- <iframe id=\"bibbase_network_frame\" -->\n  <!--         src=\"//bibbase.org/network/control\" -->\n  <!--         style=\"display: none;\"> -->\n  <!-- </iframe> -->\n\n</div>\n"}; document.write(bibbase_data.data);