Luca Gianotti1, Uberto Fumagalli Romario2, Stefano De Pascale3, Jacopo Weindelmayer4, Valentina Mengardo4, Marta Sandini1, Andrea Cossu5, Paolo Parise5, Riccardo Rosati5, Lapo Bencini6, Andrea Coratti6, Giovanni Colombo1, Federica Galli7, Stefano Rausei8, Francesco Casella9, Andrea Sansonetti9, Dario Maggioni10, Andrea Costanzi10, Davide P Bernasconi11, Giovanni De Manzoni4. 1. Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy. 2. Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy. ubertofumagalliromario@gmail.com. 3. Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy. 4. General and Esophagogastric Surgery, University of Verona, Verona, Italy. 5. Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy. 6. Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy. 7. Department of Surgery, ASST Settelaghi, Varese, Italy. 8. Department of Surgery, ASST Valle Olona, Gallarate, Italy. 9. General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy. 10. General Surgery 3, ASST-Monza, Desio Hospital, Desio, Italy. 11. Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
Abstract
BACKGROUND: The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. METHODS: A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). RESULTS: Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235-0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151-0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694-0.950; P 0.009). CONCLUSIONS: These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.
BACKGROUND: The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. METHODS: A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). RESULTS: Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235-0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151-0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694-0.950; P 0.009). CONCLUSIONS: These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.
Authors: K Mortensen; M Nilsson; K Slim; M Schäfer; C Mariette; M Braga; F Carli; N Demartines; S M Griffin; K Lassen Journal: Br J Surg Date: 2014-07-21 Impact factor: 6.939
Authors: Giovanni De Manzoni; Daniele Marrelli; Gian Luca Baiocchi; Paolo Morgagni; Luca Saragoni; Maurizio Degiuli; Annibale Donini; Uberto Fumagalli; Maria Antonietta Mazzei; Fabio Pacelli; Anna Tomezzoli; Mattia Berselli; Filippo Catalano; Alberto Di Leo; Massimo Framarini; Simone Giacopuzzi; Luigina Graziosi; Alberto Marchet; Mario Marini; Carlo Milandri; Gianni Mura; Elena Orsenigo; Vittorio Quagliuolo; Stefano Rausei; Riccardo Ricci; Fausto Rosa; Giandomenico Roviello; Andrea Sansonetti; Giovanni Sgroi; Guido Alberto Massimo Tiberio; Giuseppe Verlato; Carla Vindigni; Riccardo Rosati; Franco Roviello Journal: Gastric Cancer Date: 2016-06-02 Impact factor: 7.370
Authors: Sang Hyeok Park; So Hyun Kang; Sang Jun Lee; Yongjoon Won; Young Suk Park; Sang-Hoon Ahn; Yun-Suhk Suh; Do Joong Park; Hyung-Ho Kim Journal: J Minim Invasive Surg Date: 2021-12-15