title: Enhanced recovery after giant ventral hernia repair.
abstract: OBJECTIVE
  Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current study prospectively examined the results of implementation of an ERAS pathway including high-dose preoperative glucocorticoid, and compared the outcome with patients previously treated according to standard care (SC).
  
  
  METHODS
  Consecutive patients who underwent giant ventral hernia repair were included. Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated with SC.
  
  
  RESULTS
  A total of 32 patients were included. Postoperative LOS was decreased after the introduction of the ERAS pathway compared with SC (median 3.0 vs. 5.5 days, P = 0.003). Scores of pain, nausea and fatigue were low, while mean oxygen saturation during the first three postoperative days was 0.92. There were no differences when comparing readmission (5 vs. 2, P = 0.394), postoperative complications (7 vs. 4, P = 0. 458), or reoperation (5 vs. 1, P = 0.172) in ERAS versus controls.
  
  
  CONCLUSIONS
  The current study suggests that an ERAS pathway including preoperative high-dose glucocorticoid may lead to low scores of pain, fatigue and nausea after giant ventral hernia repair with reduced LOS compared with patients treated according to SC.
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. mail@kristiankiim.dk.
authors.forename: K K
authors.initials: KK
authors.lastname: Jensen
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
authors.forename: T L
authors.initials: TL
authors.lastname: Brondum
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Harling
authors.affiliation: Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
authors.forename: L N
authors.initials: LN
authors.lastname: Jorgensen
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012086:Reoperation
chemical_list: D005938:Glucocorticoids
keywords: Enhanced recovery; Glucocorticoid; Hernia; Recovery