INTRODUCTION: Enhanced recovery after surgery (ERAS) is a well-established and accepted practice following colorectal surgery and has been demonstrated to reduce hospital length of stay (LOS) and 30-day morbidity. Despite evidence to support the individual elements on which the programme is based, there remains uncertainty as to how many and which of these are required to realise its benefits. Furthermore, elements of an ERAS programme might either precipitate or reflect recovery, in which case compliance could have a role in the improvement or prediction of outcome. MATERIALS AND METHODS: A multidimensional prospective database of 799 consecutive patients undergoing colorectal surgery within an established ERAS programme at a single institution was interrogated. After application of exclusion criteria, 614 patients were studied. The novel concept of 'active compliance' is introduced. An ERAS element is classified as 'active' if the participation of the patient is required to achieve its compliance. This contrasts with 'passive' compliance, where an intervention is delivered to the patient without their direct contribution. The short-term surgical outcomes of this cohort are reported with reference to ERAS protocol compliance. RESULTS: Compliance with the passive elements of the programme was higher than with the active elements. Univariate and multivariate analyses demonstrate that poor compliance with active but not passive elements of the programme was significantly associated with major morbidity. Receiver operator characteristic curve analysis demonstrated active compliance to be a stronger predictor of both major morbidity (AUC 0.71 vs. AUC 0.56) and length of stay (AUC 0.83 vs. 0.57) when compared with passive compliance. CONCLUSION: The results suggest that poor active compliance may be a surrogate marker of morbidity which can be recognised in the early post-operative period. This implies the potential for timely diagnosis and intervention. This aspect of ERAS compliance is clinically relevant yet has achieved scant attention. Independent validation of our observations is required.
INTRODUCTION: Enhanced recovery after surgery (ERAS) is a well-established and accepted practice following colorectal surgery and has been demonstrated to reduce hospital length of stay (LOS) and 30-day morbidity. Despite evidence to support the individual elements on which the programme is based, there remains uncertainty as to how many and which of these are required to realise its benefits. Furthermore, elements of an ERAS programme might either precipitate or reflect recovery, in which case compliance could have a role in the improvement or prediction of outcome. MATERIALS AND METHODS: A multidimensional prospective database of 799 consecutive patients undergoing colorectal surgery within an established ERAS programme at a single institution was interrogated. After application of exclusion criteria, 614 patients were studied. The novel concept of 'active compliance' is introduced. An ERAS element is classified as 'active' if the participation of the patient is required to achieve its compliance. This contrasts with 'passive' compliance, where an intervention is delivered to the patient without their direct contribution. The short-term surgical outcomes of this cohort are reported with reference to ERAS protocol compliance. RESULTS: Compliance with the passive elements of the programme was higher than with the active elements. Univariate and multivariate analyses demonstrate that poor compliance with active but not passive elements of the programme was significantly associated with major morbidity. Receiver operator characteristic curve analysis demonstrated active compliance to be a stronger predictor of both major morbidity (AUC 0.71 vs. AUC 0.56) and length of stay (AUC 0.83 vs. 0.57) when compared with passive compliance. CONCLUSION: The results suggest that poor active compliance may be a surrogate marker of morbidity which can be recognised in the early post-operative period. This implies the potential for timely diagnosis and intervention. This aspect of ERAS compliance is clinically relevant yet has achieved scant attention. Independent validation of our observations is required.
Entities:
Keywords:
Enhanced recovery after surgery; Length of stay; Surgical morbidity
Authors: Deborah S Keller; Blake Bankwitz; Donya Woconish; Bradley J Champagne; Harry L Reynolds; Sharon L Stein; Conor P Delaney Journal: Surg Endosc Date: 2013-08-27 Impact factor: 4.584
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J Macfie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: Malaika S Vlug; Jan Wind; Markus W Hollmann; Dirk T Ubbink; Huib A Cense; Alexander F Engel; Michael F Gerhards; Bart A van Wagensveld; Edwin S van der Zaag; Anna A W van Geloven; Mirjam A G Sprangers; Miguel A Cuesta; Willem A Bemelman Journal: Ann Surg Date: 2011-12 Impact factor: 12.969
Authors: Sebastiaan W Polle; Jan Wind; Jan W Fuhring; Jan Hofland; Dirk J Gouma; Willem A Bemelman Journal: Dig Surg Date: 2007-09-13 Impact factor: 2.588
Authors: Juan Mata; Julio F Fiore; Nicolo Pecorelli; Barry L Stein; Sender Liberman; Patrick Charlebois; Liane S Feldman Journal: Surg Endosc Date: 2017-09-15 Impact factor: 4.584
Authors: Nicolò Pecorelli; Julio F Fiore; Pepa Kaneva; Abarna Somasundram; Patrick Charlebois; A Sender Liberman; Barry L Stein; Franco Carli; Liane S Feldman Journal: Surg Endosc Date: 2017-11-02 Impact factor: 4.584
Authors: Trent W Stethen; Yasir A Ghazi; Robert Eric Heidel; Brian J Daley; Linda Barnes; Donna Patterson; James M McLoughlin Journal: J Gastrointest Oncol Date: 2018-10