5/7/2023 0 Comments Ct fletcher iron wars 2019![]() ![]() 10, 12 ( Box eAppendix in the Supplement). 11 We used the Society of Thoracic Surgeons/American Association for Thoracic Surgery 2017 updated document “Classification of Recommendations and Level of Evidence,” and American College of Cardiology/American Heart Association clinical practice guidelines to grade the consensus class (strength) of recommendation and level (quality) of evidence. The structure of the recommendations was modeled after prior published ERAS guidelines. 10 Consistent with the Institute of Medicine guidelines, panel members with relevant conflicts of interest (COI) were identified and recused from voting on associated recommendations. A minimum of 75% agreement on class and level was required for consensus. Controversies were discussed and resolved via in-person meetings, conference calls, and discussions. When multiple publications had sample overlap, the most recent report was selected. Prospective randomized clinical trials, meta-analyses, and well-designed, nonrandomized studies were given preference. and 1 nonauthor) screened the abstracts considered for topics. 9 Medical Subject Heading terms were used, as were accompanying entry terms for the patient group, interventions, and outcomes. The group agreed on 22 potential interventions, divided into preoperative, intraoperative, and postoperative phases of recovery.Īfter selecting topics and assigning group leaders, literature searches were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Figure), and this included reviews, guideline documents, and studies that were conducted on humans since 2000, published in English, and retrievable from PubMed, Excerpta Medica (Embase), Cochrane, the Agency for Healthcare Research and Quality, and other selected databases relevant to this consensus. A multidisciplinary group of 16 cardiac surgeons, anesthesiologists, and intensivists were identified who demonstrated expertise and experience with ERAS. ![]() 8 We minimized repetition of existing guidelines and consensus statements and focused on specific information in the framework of ERAS protocols.Īs sanctioned by the ERAS Society, we began with a public organizational meeting in 2017 where broad topics of ERAS in CS were discussed, and we solicited public comment regarding appropriate approaches and protocols. We followed the 2011 Institute of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines, using a standardized algorithm that included experts, key questions, subject champions, systematic literature reviews, selection and appraisal of evidence quality, and development of clear consensus recommendations. This article reports the first expert-consensus review of evidence-based CS ERAS practices. ![]() The ERAS Cardiac Society has a formal collaborative agreement with the ERAS Society. To address the need for evidence-based ERAS protocols, we formed a registered nonprofit organization (ERAS Cardiac Society) to use an evidence-driven process to develop recommendations for pathways to optimize patient care in CS contexts through collaborative discovery, analysis, expert consensus, and best practices. 1 In early studies, the ERAS approach showed promise in cardiac surgery (CS) however, evidence-based protocols have yet to emerge. 4 - 6 Evidence-based ERAS protocols have been published across multiple surgical specialties. 2, 3 The ERAS protocols have been associated with a reduction in overall complications and length of stay of up to 50% compared with conventional perioperative patient management in populations having noncardiac surgery. 1 These programs aim to reduce complications and promote an earlier return to normal activities. Shared Decision Making and CommunicationĮnhanced Recovery After Surgery (ERAS) is a multimodal, transdisciplinary care improvement initiative to promote recovery of patients undergoing surgery throughout their entire perioperative journey.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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