Applying Effectively What we Already Know Remember this The brick Agenda Traditional Surgery and ERAS Enhanced Recovery Components Improved Outcomes in Adult Surgery Possibilities ID: 1044268
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1. ERASEarly Recovery after SurgeryApplying Effectively What we Already Know.
2. Remember this?? The “brick”…
3. AgendaTraditional Surgery and ERASEnhanced Recovery Components.Improved Outcomes in Adult SurgeryPossibilities in Pediatric Surgery.Summary.
4. http://www.erassociety.org
5. Traditional colorectal surgery.Foley and NGEpidural for 3-4 days.PCAMBP LOS 4-6 daysSlow feeding.Lots of narcotics.Fasting.IV fluids “as needed”
6. ERASNo tubes or MBP or FastingTAP or short EpiduralImmediate feedingMinimal narcotics.“Goal directed” fluids (less swelling) Fewer Complications, Shorter LOS
7. 2 ExamplesCY 4 yr old with UC on TPN, bleedingAlbumin was 2Lap assisted colectomy after 1 week of “optimization” on ERASAte immediately, got “swollen”, ?? AlbuminRecovered after 3-4 days, ate, removed Red Rubber catheter.Home on POD 6
8. 2 ExamplesDS 15 yr old w 2 yr h/o UC, unable wean steroidsLap colectomy w ERAS DC on POD 2Lap assisted proctecomy, J pouch, ileostomy DC on POD 3 on ERASClosure of ileostomy. DC on POD 3 on ERAS
9. ERAS 2016
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11. Fluid/ electrolytes/ nutritional status
12. Pain control
13. Prevention of complications
14. Return of function
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17. Reduced LOS
18. Decrease in nonsurgical complications
19. No increase in readmissions
20. CHOA ERAS Data
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23. What Next?In-patients need to be optimizedOutpatient elective surgery is where the impact seems greatestOpportunities exist to expand to other types besides ColorectalBest to do this with a team that’s dedicatedTeam includes nursing, Anesthesia, Surgery
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25. ConclusionsCulture change.Applying what we already know effectivelyReduce complications >> LOS >> RTSWorks in Peds.Come join us with your IBD patients