Marco Catarci1,2, Giacomo Ruffo3, Massimo Giuseppe Viola4, Felice Pirozzi5, Paolo Delrio6, Felice Borghi7, Gianluca Garulli8, Gianandrea Baldazzi9, Pierluigi Marini10, Giuseppe Sica11. 1. General Surgery Unit, "C. E G. Mazzoni" Hospital, Ascoli Piceno, Italy. marco.catarci@aslroma2.it. 2. General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy. marco.catarci@aslroma2.it. 3. General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy. 4. General Surgery Unit, Cardinale G. Panico Hospital, Tricase, LE, Italy. 5. General Surgery Unit, ASL Napoli 2 Nord, Pozzuoli, NA, Italy. 6. Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione Giovanni Pascale IRCCS-Italia", Naples, Italy. 7. General & Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy. 8. General Surgery Unit, Infermi Hospital, Rimini, Italy. 9. General Surgery Unit, ASST Nord Milano, Sesto San Giovanni, MI, Italy. 10. General Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy. 11. Minimally Invasive Surgery Unit, Policlinico tor Vergata University Hospital, Rome, Italy.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) programs influence morbidity rates and length of stay after colorectal surgery (CRS), and may also impact major complications and anastomotic leakage rates. A prospective multicenter observational study to investigate the interactions between ERAS program adherence and early outcomes after elective CRS was carried out. METHODS: Prospective enrolment of patients submitted to elective CRS with anastomosis in 18 months. Adherence to 21 items of ERAS program was measured upon explicit criteria in every case. After univariate analysis, independent predictors of primary endpoints [major morbidity (MM) and anastomotic leakage (AL) rates] were identified through logistic regression analyses including all significant variables, presenting odds ratios (OR). RESULTS: Institutional ERAS protocol was declared by 27 out of 38 (71.0%) participating centers. Median overall adherence to ERAS program items was 71.4%. Among 3830 patients included in the study, MM and AL rates were 4.7% and 4.2%, respectively. MM rates were independently influenced by intra- and/or postoperative blood transfusions (OR 7.79, 95% CI 5.46-11.10; p < 0.0001) and standard anesthesia protocol (OR 0.68, 95% CI 0.48-0.96; p = 0.028). AL rates were independently influenced by male gender (OR 1.48, 95% CI 1.06-2.07; p = 0.021), intra- and/or postoperative blood transfusions (OR 4.29, 95% CI 2.93-6.50; p < 0.0001) and non-standard resections (OR 1.49, 95% CI 1.01-2.22; p = 0.049). CONCLUSIONS: This study disclosed wide room for improvement in compliance to several ERAS program items. It failed to detect any significant association between institutionalization and/or adherence rates to ERAS program with primary endpoints. These outcomes were independently influenced by gender, intra- and postoperative blood transfusions, non-standard resections, and standard anesthesia protocol.
BACKGROUND: Enhanced recovery after surgery (ERAS) programs influence morbidity rates and length of stay after colorectal surgery (CRS), and may also impact major complications and anastomotic leakage rates. A prospective multicenter observational study to investigate the interactions between ERAS program adherence and early outcomes after elective CRS was carried out. METHODS: Prospective enrolment of patients submitted to elective CRS with anastomosis in 18 months. Adherence to 21 items of ERAS program was measured upon explicit criteria in every case. After univariate analysis, independent predictors of primary endpoints [major morbidity (MM) and anastomotic leakage (AL) rates] were identified through logistic regression analyses including all significant variables, presenting odds ratios (OR). RESULTS: Institutional ERAS protocol was declared by 27 out of 38 (71.0%) participating centers. Median overall adherence to ERAS program items was 71.4%. Among 3830 patients included in the study, MM and AL rates were 4.7% and 4.2%, respectively. MM rates were independently influenced by intra- and/or postoperative blood transfusions (OR 7.79, 95% CI 5.46-11.10; p < 0.0001) and standard anesthesia protocol (OR 0.68, 95% CI 0.48-0.96; p = 0.028). AL rates were independently influenced by male gender (OR 1.48, 95% CI 1.06-2.07; p = 0.021), intra- and/or postoperative blood transfusions (OR 4.29, 95% CI 2.93-6.50; p < 0.0001) and non-standard resections (OR 1.49, 95% CI 1.01-2.22; p = 0.049). CONCLUSIONS: This study disclosed wide room for improvement in compliance to several ERAS program items. It failed to detect any significant association between institutionalization and/or adherence rates to ERAS program with primary endpoints. These outcomes were independently influenced by gender, intra- and postoperative blood transfusions, non-standard resections, and standard anesthesia protocol.
Authors: Kristoffer Lassen; Pascal Hannemann; Olle Ljungqvist; Ken Fearon; Cornelis H C Dejong; Maarten F von Meyenfeldt; Jonatan Hausel; Jonas Nygren; Jens Andersen; Arthur Revhaug Journal: BMJ Date: 2005-05-23
Authors: J Maessen; C H C Dejong; J Hausel; J Nygren; K Lassen; J Andersen; A G H Kessels; A Revhaug; H Kehlet; O Ljungqvist; K C H Fearon; M F von Meyenfeldt Journal: Br J Surg Date: 2007-02 Impact factor: 6.939
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Authors: Freek Gillissen; Christiaan Hoff; José M C Maessen; Bjorn Winkens; Jitske H F A Teeuwen; Maarten F von Meyenfeldt; Cornelis H C Dejong Journal: World J Surg Date: 2013-05 Impact factor: 3.352