Mi Ran Jung1,2, Seong Yeob Ryu1,2, Young Kyu Park1,2, Oh Jeong3,4. 1. Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea. 2. Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea. 3. Department of Surgery, Chonnam National University College of Medicine, Gwangju, Jeollanam-do, South Korea. surgeonjeong@gmail.com. 4. Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanam-do, South Korea. surgeonjeong@gmail.com.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma. METHODS: This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma. An ERAS program consisting of 18 main elements was implemented, and compliance with each element was evaluated (ClinicalTrials.gov, NCT01653496). RESULTS: Distal gastrectomy was performed for 142 patients (84.5%) and total gastrectomy for 26 patients (10.1%). Laparoscopic surgery was performed for 141 patients (86%). The postoperative morbidity rate was 9.5%, and the mortality rate was 0%. The rates of compliance with the 18 main elements of ERAS ranged from 88.1 to 100%. The lowest compliance rate was observed in the restriction of intravenous fluid element (88.1%). Overall, all ERAS elements were successfully applied for 122 patients (72.6%). In the multivariate analysis, the significant factors that adversely affected compliance with ERAS were surgery during the early study period [odds ratio (OR) 0.39; p = 0.038], open surgery (OR 0.15; p <0.001), and postoperative morbidity (OR 0.16; p = 0.003). CONCLUSIONS: Most elements of ERAS can be successfully applied for patients undergoing gastrectomy for gastric carcinoma. Multimodal collaboration between providers is essential to achieve proper application of ERAS.
BACKGROUND: Enhanced recovery after surgery (ERAS) programs have gained widespread acceptance in different fields of major surgery. However, most elements of perioperative care in ERAS are based on practices that originated from colorectal surgery. This study investigated compliance with the main elements of ERAS for patients undergoing gastrectomy for gastric carcinoma. METHODS: This phase 2 study enrolled 168 patients undergoing elective gastrectomy for gastric carcinoma. An ERAS program consisting of 18 main elements was implemented, and compliance with each element was evaluated (ClinicalTrials.gov, NCT01653496). RESULTS: Distal gastrectomy was performed for 142 patients (84.5%) and total gastrectomy for 26 patients (10.1%). Laparoscopic surgery was performed for 141 patients (86%). The postoperative morbidity rate was 9.5%, and the mortality rate was 0%. The rates of compliance with the 18 main elements of ERAS ranged from 88.1 to 100%. The lowest compliance rate was observed in the restriction of intravenous fluid element (88.1%). Overall, all ERAS elements were successfully applied for 122 patients (72.6%). In the multivariate analysis, the significant factors that adversely affected compliance with ERAS were surgery during the early study period [odds ratio (OR) 0.39; p = 0.038], open surgery (OR 0.15; p <0.001), and postoperative morbidity (OR 0.16; p = 0.003). CONCLUSIONS: Most elements of ERAS can be successfully applied for patients undergoing gastrectomy for gastric carcinoma. Multimodal collaboration between providers is essential to achieve proper application of ERAS.
Authors: Luca Gianotti; Uberto Fumagalli Romario; Stefano De Pascale; Jacopo Weindelmayer; Valentina Mengardo; Marta Sandini; Andrea Cossu; Paolo Parise; Riccardo Rosati; Lapo Bencini; Andrea Coratti; Giovanni Colombo; Federica Galli; Stefano Rausei; Francesco Casella; Andrea Sansonetti; Dario Maggioni; Andrea Costanzi; Davide P Bernasconi; Giovanni De Manzoni Journal: World J Surg Date: 2019-10 Impact factor: 3.352