Late Breaking Original Research
Saturday, November 11, 2023
11:30 AM–01:00 PM
Abstract
Introduction: The purpose of this systematic review is to generate a summary to harmonize published pharmacotherapy recommendations embedded within ERAS
® Society visceral surgery (VS) guidelines. Determining whether a consensus exists for elements would make future guideline preparation for similar surgeries more efficient and consistent.
Research Question or Hypothesis: In which ERAS® pharmacotherapy-related guideline elements has consensus been attained?
Study Design: Systematic Review and Guideline Synthesis
Methods: From the ERAS® Society website up to May 2023, 17 current ERAS® published VS guidelines were included in the analysis to determine consensus and differing statements regarding each ERAS® element. The aims were to (1) determine whether a consensus for each element could be derived, (2) identify gaps in protocol development for pharmacotherapies, and (3) propose potential research directions for addressing the identified gaps in the literature.
Results: Elements with consensus included: preoperative optimization; avoiding mechanical bowel reparation and fasting; multimodal opioid-sparing preanesthetic, perioperative analgesia, and postoperative nausea and vomiting regimens; low molecular weight heparins for in-hospital and at-home venous thromboembolism prophylaxis; antibiotic prophylaxis and skin preparation; goal-directed perioperative fluid management with balanced crystalloids; perioperative nutrition care, ileus prevention with peripherally-acting mu receptor antagonists, and glucose control; and use of antiarrhythmics and magnesium supplementation.
Conclusion: While consensus was found for twelve current ERAS® guideline elements related to pharmacotherapy choice, many of the details related to doses, regimen, timing of administration as well as unique aspects pertaining to specific VS remain to be researched and harmonized to promote guideline consistency and optimized patient outcomes. Specific recommendations for pharmacotherapy should be developed with a focus on providing specific medication regimens instead of general drug classes.
Presenting Author
Bowen Powers B.S.Mercer University School of Medicine
Authors
Richard H.Parrish II BSPharm, MSc, PhD, FCCP, BCPS
Mercer University School of Medicine
Gourang Patel PharmD, MSc, BCCCP, FCCP, FCCM
University of Chicago Hospitals
Harley Ponder B.S.
Mercer University School of Medicine
Rachelle Findley BScPharm, MD
Dalhousie University Faculty of Medicine
Rachel Wolfe PharmD, MHA
Barnes-Jewish Hospital