Magdalena Pisarska1, Michał Pędziwiatr2, Piotr Małczak2, Piotr Major2, Sebastian Ochenduszko3, Anna Zub-Pokrowiecka2, Jan Kulawik2, Andrzej Budzyński2. 1. 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland. Electronic address: magdalena.pisarska@uj.edu.pl. 2. 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland. 3. Department of Oncology, University Hospital Krakow, Śniadeckich 10, 31-501 Kraków, Poland.
Abstract
BACKGROUND: Although the relation between adherence to the ERAS protocol and clinical outcomes was extensively studied, there is still ongoing discussion on the need and feasibility of full compliance in laparoscopic colorectal surgery. In this study, we aimed to verify whether a strict adherence to the protocol (>90%) leads to further improvement in clinical outcomes compared to high (70-90%) and low (<70%) compliance groups. MATERIALS AND METHODS: The analysis included consecutive prospectively registered patients operated laparoscopically for colorectal cancer between January 2012 and December 2015. Patients were divided into three groups depending on the compliance with the ERAS protocol: <70% (Group 1), 70-90% (Group 2), >90% (Group 3). The measured outcomes were: complication rate, readmission rate, recovery parameters (tolerance of early oral diet on 1st postoperative day and mobilization of a patient on the day of surgery), length of stay (LOS). RESULTS: Group 1 consisted of 70, Group 2 of 65 and Group 3 of 116 patients. There were no statistical differences between the groups based on demographic parameters, stage of cancer and operative parameters (operative time, blood loss, conversion rate). The overall compliance with the protocol in the study group was 85.6 ± 11.9%. There was a significant decrease in complication rate with increasing compliance (35.7% vs. 36.4% vs. 16.4%, p = 0.0024) and severity of complications according to the Clavien-Dindo classification (p = 0.0198). Moreover, we observed differences in recovery parameters between the groups: tolerance of oral diet on the 1st postoperative day (52.8% vs. 79.5% vs. 87.9%, p < 0.0001), mobilization of a patient on the day of surgery (68.6% vs. 92.3% vs. 99.1%, p < 0.0001), respectively. We also observed that with compliance increase, the median LOS decreased (6 vs. 4 vs. 3 days, p < 0.0001). CONCLUSION: Full implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.
BACKGROUND: Although the relation between adherence to the ERAS protocol and clinical outcomes was extensively studied, there is still ongoing discussion on the need and feasibility of full compliance in laparoscopic colorectal surgery. In this study, we aimed to verify whether a strict adherence to the protocol (>90%) leads to further improvement in clinical outcomes compared to high (70-90%) and low (<70%) compliance groups. MATERIALS AND METHODS: The analysis included consecutive prospectively registered patients operated laparoscopically for colorectal cancer between January 2012 and December 2015. Patients were divided into three groups depending on the compliance with the ERAS protocol: <70% (Group 1), 70-90% (Group 2), >90% (Group 3). The measured outcomes were: complication rate, readmission rate, recovery parameters (tolerance of early oral diet on 1st postoperative day and mobilization of a patient on the day of surgery), length of stay (LOS). RESULTS: Group 1 consisted of 70, Group 2 of 65 and Group 3 of 116 patients. There were no statistical differences between the groups based on demographic parameters, stage of cancer and operative parameters (operative time, blood loss, conversion rate). The overall compliance with the protocol in the study group was 85.6 ± 11.9%. There was a significant decrease in complication rate with increasing compliance (35.7% vs. 36.4% vs. 16.4%, p = 0.0024) and severity of complications according to the Clavien-Dindo classification (p = 0.0198). Moreover, we observed differences in recovery parameters between the groups: tolerance of oral diet on the 1st postoperative day (52.8% vs. 79.5% vs. 87.9%, p < 0.0001), mobilization of a patient on the day of surgery (68.6% vs. 92.3% vs. 99.1%, p < 0.0001), respectively. We also observed that with compliance increase, the median LOS decreased (6 vs. 4 vs. 3 days, p < 0.0001). CONCLUSION: Full implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.
Authors: Ruben van Zelm; Ellen Coeckelberghs; Walter Sermeus; Anthony De Buck van Overstraeten; Arved Weimann; Deborah Seys; Massimiliano Panella; Kris Vanhaecht Journal: Int J Colorectal Dis Date: 2017-07-17 Impact factor: 2.571
Authors: Piotr Małczak; Michał Wysocki; Hanna Twardowska; Alicja Dudek; Justyna Tabiś; Piotr Major; Magdalena Pisarska; Michał Pędziwiatr Journal: Obes Surg Date: 2020-04 Impact factor: 4.129
Authors: Javier Ripollés-Melchor; José M Ramírez-Rodríguez; Rubén Casans-Francés; César Aldecoa; Ane Abad-Motos; Margarita Logroño-Egea; José Antonio García-Erce; Ángels Camps-Cervantes; Carlos Ferrando-Ortolá; Alejandro Suarez de la Rica; Ana Cuellar-Martínez; Sandra Marmaña-Mezquita; Alfredo Abad-Gurumeta; José M Calvo-Vecino Journal: JAMA Surg Date: 2019-08-01 Impact factor: 14.766