Danish Professor Henrik Kehlet pioneered the fast-track surgery in 1997. The term ERAS was adopted in 2001. The 22 components comprising modern ERAS guidelines are driving improved outcomes in reduced length of stay, reduced post-operative complications, reduced mortality and decreased re-admission rates.
We should encourage institutions that do not have an ERAS program in place to apply goal-directed therapeutic strategies because the current evidence supports patient benefit.4
“Improvements in length of hospital stay from 17 to 7 days, with no increase in mortality, complications or readmissions over a 6-month period, shows that the pathways that took 20 years to evolve in one centre can be implemented in a short period in another high-volume centre, as long as there is an institutional commitment to changing process, perceptions and infrastructure.”
LiDCOrapid was used to monitor real-time continuous assessment of patient’s hemodynamic status and facilitate stroke volume optimization. Goal-directed fluid therapy was administered for 6 h to maximize fluid status utilizing LiDCOrapid.
“The ERP significantly reduced the rate of medical complications (7 versus 27 per cent; P = 0.020)”
LiDCOrapid was used to monitor cardiac output and to guide intravenous fluid therapy administration in patients in the ERP group and GDFT for 6h after hepatic resection. LiDCOrapid was used because the patients were awake during the period of fluid optimization.
“Readmission rates were significantly lower for patients in the ERAS group (11.5 vs. 21.4%; P = 0.029).”
LiDCOrapid was utilized to help guide goal-directed resuscitation.
“We believe that goal-directed therapy has the potential to reduce length of stay in the hospital and decrease post-operative complications in patients undergoing major and high-risk surgery. In fact, recent studies using goal-directed therapy in an ERAS setting have demonstrated a reduction in length of stay and complications.”
“The 30-day mortality rate was 15.5 per cent in the intervention cohort compared with 21.8 per cent in the control cohort (P =0.005; relative risk reduction 29 per cent.”
LiDCOrapid was used for stroke volume (SV)-guided hemodynamic optimization, before, during and after surgery (pulse-contour analysis) carried out in PAU/operating theater.
The authors noted that “The adoption of standardized SV-guided resuscitation might be associated with reduced morbidity, as shown in high-risk surgery.”