Hirofumi Ota1,2, Masakazu Ikenaga3,4, Junichi Hasegawa5, Kohei Murata6, Yasuhiro Miyake7,8, Tsunekazu Mizushima9, Taishi Hata9, Ichiro Takemasa9,10, Hirofumi Yamamoto9, Mitsugu Sekimoto4, Riichiro Nezu7, Yuichiro Doki9, Masaki Mori9. 1. Department of Digestive Surgery, Ikeda City Hospital, 3-1-18 Jyonan, Ikeda, Osaka, 563-8510, Japan. hirootajp@yahoo.co.jp. 2. Department of Surgery, Osaka Saiseikai Senri Hospital, Suita, Japan. hirootajp@yahoo.co.jp. 3. Department of Surgery, Higashiosaka City General Hospital, Higashiosaka, Japan. 4. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 5. Department of Surgery, Osaka Rosai Hospital, Sakai, Japan. 6. Department of Surgery, Suita Municipal Hospital, Suita, Japan. 7. Department of Surgery, Nishinomiya Municipal Hospital, Nishinomiya, Japan. 8. Department of Surgery, Mino City Hospital, Mino, Japan. 9. Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan. 10. Department of Surgery, Oncology and Science, Sapporo Medical University, Sapporo, Japan.
Abstract
PURPOSE: The aim of this multi-institutional study was to prospectively evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for colonic surgery. METHODS: The subjects of this study were 320 patients with an American Society of Anesthesiologists (ASA) grade I or II physical status. Patients underwent elective open or laparoscopic colonic resectionor high anterior resection between April 2011 and January 2014 at one of six institutions. Three hospitals implemented an ERAS protocol (n = 159), and three administered conventional care (n = 161). The primary outcome measure was the surgical complication rate. RESULTS: Most operations, irrespective of group, were performed laparoscopically. The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group (P = 0.842), in which several non-surgical complications also arose. Oral food intake was implemented earlier for the ERAS group vs. the conventional group, after a median (range) of 1 (1-31) vs. 3 (1-9) days for the ERAS vs. conventional care groups, respectively (P < 0.001). The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group, being 8.5 (5-41) vs. 14 (7-56) days for the ERAS vs. conventional care groups, respectively (P < 0.001). CONCLUSION: This multi-institutional controlled study clearly demonstrated that an ERAS protocol was efficient, without increasing the complication risk.
RCT Entities:
PURPOSE: The aim of this multi-institutional study was to prospectively evaluate the safety and efficacy of an enhanced recovery after surgery (ERAS) protocol for colonic surgery. METHODS: The subjects of this study were 320 patients with an American Society of Anesthesiologists (ASA) grade I or II physical status. Patients underwent elective open or laparoscopic colonic resection or high anterior resection between April 2011 and January 2014 at one of six institutions. Three hospitals implemented an ERAS protocol (n = 159), and three administered conventional care (n = 161). The primary outcome measure was the surgical complication rate. RESULTS: Most operations, irrespective of group, were performed laparoscopically. The incidence of a surgical complication was 17.0 % in the ERAS group vs. 16.1 % in the conventional group (P = 0.842), in which several non-surgical complications also arose. Oral food intake was implemented earlier for the ERAS group vs. the conventional group, after a median (range) of 1 (1-31) vs. 3 (1-9) days for the ERAS vs. conventional care groups, respectively (P < 0.001). The median length of postoperative hospital stay was reduced by 5.5 days for the ERAS group, being 8.5 (5-41) vs. 14 (7-56) days for the ERAS vs. conventional care groups, respectively (P < 0.001). CONCLUSION: This multi-institutional controlled study clearly demonstrated that an ERAS protocol was efficient, without increasing the complication risk.
Entities:
Keywords:
Colon surgery; Enhanced recovery after surgery; Multi-institutional trial
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