ERAS SGD

Question 1

What is the main objective of Enhanced Recovery After Surgery (ERAS)?

Answer 1

Maintain normal physiology during the perioperative period to optimize outcomes without increasing postoperative complications and readmissions.

Question 2

Since its publication in 2016 and update in 2019, what is the average decrease in hospital stay attributed to ERAS?

Answer 2

1.6 days

Question 3

What percentage reduction in complications has ERAS achieved since its inception?

Answer 3

32%

Question 4

What percentage reduction in re-admissions has been observed with ERAS?

Answer 4

20%

Question 5

Has there been any change in 30-day postoperative mortality rates since the implementation of ERAS?

Answer 5

No change

Question 6

What is a key challenge in the implementation of ERAS recommendations?

Answer 6

Poor adherence due to gaps in understanding core tenets.

Question 7

What are the preoperative counseling goals in ERAS?

Answer 7

• Set expectations and provide information
• Reduce anxiety and increase patient satisfaction
• Improve fatigue and facilitate discharge
• Reduce pain and nausea, improve well-being

Question 8

What should patients receive during preoperative counseling?

Answer 8

Information in written and oral form

Question 9

What is the first-line treatment for anemia identified before surgery?

Answer 9

Iron therapy

Question 10

When should smoking and alcohol consumption be stopped before surgery?

Answer 10

4 weeks before surgery

Question 11

What is the recommended oral intake of clear liquids before surgery?

Answer 11

Up to 2 hours before surgery

Question 12

What is the benefit of carbohydrate loading before surgery?

Answer 12

Reduces perioperative insulin resistance and improves patient satisfaction and comfort

Question 13

What is the recommended approach to preoperative bowel preparation?

Answer 13

Routine pre-operative bowel preparation should not be used before minimally invasive gynecologic surgery and open laparotomy.

Question 14

What are the recommendations for preanesthetic medications?

Answer 14

• NSAIDs for improved pain control
• Acetaminophen for reasonable inclusion
• Limit gabapentinoids in the elderly

Question 15

What is the dual VTE prophylaxis recommended for gynecologic oncology patients undergoing major surgery?

Answer 15

• Low molecular weight heparin
• Unfractionated heparin

Question 16

When should VTE prophylaxis begin?

Answer 16

Before induction of anesthesia

Question 17

What is the recommendation for patients at increased risk of VTE?

Answer 17

They should receive dual mechanical prophylaxis and chemoprophylaxis.

Question 18

What should be done for patients undergoing laparotomy for gynecologic cancer?

Answer 18

They should receive 28 days of extended VTE prophylaxis.

Question 19

What are the elements of the surgical site infection reduction bundles?

Answer 19

• Antimicrobial prophylaxis
• Skin preparation
• Avoiding hypothermia
• Avoiding surgical drains
• Reducing perioperative hyperglycemia

Question 20

What is the first choice for prophylaxis for hysterectomy according to antimicrobial prophylaxis recommendations?

Answer 20

First generation cephalosporins

Question 21

What is the rate of dual penicillin and cephalosporin allergy?

Answer 21

0.7%

Question 22

When should prophylactic antibiotics be terminated?

Answer 22

Within 24 hours of surgery completion

Question 23

What is the recommendation regarding prophylactic antibiotics after surgery?

Answer 23

Prophylactic antibiotics should be terminated within 24 hours of surgery completion.

Question 24

What is the dual allergy rate for penicillin and cephalosporin?

Answer 24

0.7%.

Question 25

What drives the allergic response in penicillin allergies?

Answer 25

Penicillin R1 side chain.

Question 26

When should penicillin-allergic patients avoid cefazolin?

Answer 26

When there is a history of penicillin-induced severe cutaneous adverse reactions or verified cefazolin allergy.

Question 27

What is the recommended skin preparation method to reduce surgical site infections?

Answer 27

Chlorhexidine-alcohol skin preparation.

Question 28

What is the association between skin preparation with chlorhexidine-alcohol and surgical site infections?

Answer 28

40% lower surgical site infection rate compared to povidone iodine.

Question 29

What should patients do before surgery to minimize infection risk?

Answer 29

Shower with chlorhexidine-based antimicrobial soap.

Question 30

What is linked to increased risk of surgical site infections and cardiac events?

Answer 30

Hypothermia.

Question 31

What methods can help prevent hypothermia during surgery?

Answer 31

* Forced air blanket devices * Underbody warming mattresses * Warmed intravenous fluid administration

Question 32

Where is the most convenient site to measure core temperature during gynecological surgery?

Answer 32

Nasopharynx.

Question 33

What should be maintained to ensure patient safety post-surgery?

Answer 33

Normothermia with a temperature >36.0 °C.

Question 34

What is the recommendation regarding the use of drains or tubes after abdominal surgery?

Answer 34

Avoid peritoneal drains, subcutaneous drains, and nasogastric tubes.

Question 35

What blood glucose levels should be maintained perioperatively?

Answer 35

Under 200 mg/dL in diabetics and non-diabetics.

Question 36

What should all surgical patients be screened for?

Answer 36

Diabetes.

Question 37

What is the goal of the standard anesthetic protocol?

Answer 37

To provide hypnosis, analgesia, and optimal surgical conditions.

Question 38

What anesthetic agents are recommended to reduce opioid-related side effects?

Answer 38

Short-acting anesthetic agents.

Question 39

What ventilation strategy is recommended to reduce postoperative pulmonary complications?

Answer 39

Tidal volume of 5-7 kg with PEEP of 4-6 cm H2O.

Question 40

What should be preferred for managing acute pain in abdominal and pelvic surgery?

Answer 40

Fascial plane blocks.

Question 41

What are the recommendations regarding the use of TEA vs TAP?

Answer 41

Techniques such as wound infiltration with local anesthetic and TAP block are preferred over TEA.

Question 42

What is the aim of indwelling bladder catheters (IBC)?

Answer 42

Urinary drainage in immobile patients and monitoring urine output.

Question 43

What is the correlation between the number of days of IBC use and complications?

Answer 43

Higher risk of retention, infections, and pressure injuries.

Question 44

When should IBCs be removed for minimally invasive surgery?

Answer 44

On the day of surgery.

Question 45

What is recommended for patients undergoing planned bowel resection?

Answer 45

Alvimopan is FDA-approved to reduce the time to bowel function return.

Question 46

What dietary recommendation is made for surgical patients?

Answer 46

Regular diet within the first 24 hours.

Question 47

What factors influence the return of bowel function?

Answer 47

* Exposure to opioids * Fluid balance * Extent of peritoneal disease * Complexity of surgery * Receipt of transfusion * Post-operative abdominopelvic complications

Question 48

What interventions are effective in decreasing the time to return of bowel function?

Answer 48

* Drinking coffee * Opioid-sparing analgesia * Early feeding

Question 49

What is the recommendation regarding carbohydrate loading in ERAS?

Answer 49

Carbohydrate loading should be considered to attenuate increased insulin resistance.

Question 50

What is the current status of data on ERAS programs for high complexity procedures?

Answer 50

There is currently a paucity of data.

Question 51

What recommendation is made regarding patient-reported outcomes in ERAS programs?

Answer 51

Consistent collection and documentation allow monitoring of functional recovery.