Macarena Barbero1, Javier García2, Isabel Alonso3, Laura Alonso4, Belén San Antonio-San Román4, Viktoria Molnar4, Carmen León3, Matías Cea3. 1. Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España. Electronic address: mak_barbero@hotmail.com. 2. Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España. 3. Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España. 4. Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
Abstract
INTRODUCTION: Compliance to ERAS protocols is a process quality measure that is associated to better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated to functional recovery. METHODS: A prospective observational single-centre study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analysed the relationship between protocol compliance percentage and surgical stress (defined by C reactive protein [CRP] blood levels on postoperative 3rd day), and functional recovery (defined by the proportion of patients who meet the discharge criteria on the 5th PO day or before). Multivariate analysis was performed to asses independent factor associated to functional recovery. RESULTS: 313 were included. For every additional percentage point of compliance to the protocol 3rd day C reactive protein plasmatic level decreases 1,46 mg/dL and increases 7% the probability to meet the discharge criteria (p < 0.001 both). Independent factors associated to functional recovery were ASA III-IV (OR 0.26; 0.14-0.48), surgical CR-POSSUM score (OR 0.68; 0.57-0.83), early mobilization (OR 4.22; 1.43-12.4) and removal of urinary catheter (OR 3.35; 1.79-6.27), p < 0,001 each of them. CONCLUSION: Better compliance to ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.
INTRODUCTION: Compliance to ERAS protocols is a process quality measure that is associated to better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated to functional recovery. METHODS: A prospective observational single-centre study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analysed the relationship between protocol compliance percentage and surgical stress (defined by C reactive protein [CRP] blood levels on postoperative 3rd day), and functional recovery (defined by the proportion of patients who meet the discharge criteria on the 5th PO day or before). Multivariate analysis was performed to asses independent factor associated to functional recovery. RESULTS: 313 were included. For every additional percentage point of compliance to the protocol 3rd day C reactive protein plasmatic level decreases 1,46 mg/dL and increases 7% the probability to meet the discharge criteria (p < 0.001 both). Independent factors associated to functional recovery were ASA III-IV (OR 0.26; 0.14-0.48), surgical CR-POSSUM score (OR 0.68; 0.57-0.83), early mobilization (OR 4.22; 1.43-12.4) and removal of urinary catheter (OR 3.35; 1.79-6.27), p < 0,001 each of them. CONCLUSION: Better compliance to ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.