Study objective: Assess the relationship between the Enhanced Recovery After Surgery (ERAS (R)) pathway and routine care and 30-day postoperative outcomes.& nbsp;Design: Prospective cohort study.& nbsp;Setting: European centers (185 hospitals) across 21 countries.& nbsp;Patients: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.& nbsp;Interventions: Routine perioperative care.& nbsp;Measurements: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences.& nbsp;Results: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (>= 65% vs. < 48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001).& nbsp;Conclusions: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.
Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study / Javier Ripoll??s-Melchor; Ane Abad-Motos; Maurizio Cecconi; Rupert Pearse; Samir Jaber; Karem Slim; Nader Francis; Antonino Spinelli; Jean Joris; Orestis Ioannidis; Eirini Zarzava; N??zhet Mert ??ent??rk; Seppe Koopman; Nicolai Goettel; Ottokar Stundner; Tomas Vymazal; Petr Koci??n; Alaa El-Hussuna; Micha?? P??dziwiatr; Jurate Gudaityte; Tadas Latkauskas; Marisa D. Santos; Humberto Machado; Roman Zahorec; Ana Cvetkovi??; Mirjana Miric; Maria Georgiou; Yolanda D??ez-Remesal; Ib Jammer; Gabriel E. Mena; Andr??s Zorrilla-Vaca; Marco V. Marino; Alejandro Su??rez-de-la-Rica; Jos?? A. Garc??a-Erce; Margarita Logro??o-Ejea; Carlos Ferrando-Ortol??; Mar??a L. De-Fuenmayor-Valera; Bakarne Ugarte-Sierra; Jos?? de Andr??s-Iba??ez; Alfredo Abad-Gurumeta; Gianluca Pellino; Manuel A. G??mez-R??os; Gilberto Poggioli; Albert Menzo-Wolthuis; Berta Castellano-Paulis; Patricia Gal??n-Men??ndez; C??sar Aldecoa; Jos?? M. Ram??rez-Rodr??guez. - In: JOURNAL OF CLINICAL ANESTHESIA. - ISSN 0952-8180. - ELETTRONICO. - 80:(2022), pp. 1-10. [10.1016/j.jclinane.2022.110752]
Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study
Gilberto Poggioli;
2022
Abstract
Study objective: Assess the relationship between the Enhanced Recovery After Surgery (ERAS (R)) pathway and routine care and 30-day postoperative outcomes.& nbsp;Design: Prospective cohort study.& nbsp;Setting: European centers (185 hospitals) across 21 countries.& nbsp;Patients: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.& nbsp;Interventions: Routine perioperative care.& nbsp;Measurements: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences.& nbsp;Results: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (>= 65% vs. < 48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001).& nbsp;Conclusions: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
