Good compliance to enhanced recovery program improves outcome after colorectal surgery.
Colorectal surgery
Compliance
Enhanced recovery after surgery (ERAS)
Fast-track
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
30
03
2020
accepted:
17
08
2020
pubmed:
3
9
2020
medline:
21
10
2021
entrez:
3
9
2020
Statut:
ppublish
Résumé
The fast-track (FT) protocol consists of several measures to optimize physiologic response to the surgical stress and improve postoperative outcome. Our goal was to evaluate the compliance to our protocol and to analyze the effect of compliance to the FT protocol on postoperative outcome and postoperative hospital stay. We also aimed to identify isolated FT measures able to influence outcome. This retrospective study involves a cohort of consecutive patients who underwent colorectal surgery within a FT protocol between 2007 and 2013. Beside basic demographics, adherence to protocol, postoperative complications, and postoperative hospital stay (POHS) were recorded. Both univariate and multivariate analyses were performed to determine the predictive value of the FT protocol compliance and of specific FT items on surgical outcome and POHS. There were 284 patients with a mean age of 58 years. Compliance to the FT protocol reached a median of 18 out of 19 items. The median hospital stay was 3 days (2-49). Overall complications rate was 34.9% and 7,4% when Dindo-Clavien classification > 2 was considered. Higher compliance to the FT protocol reduces the complication rate (p = 0.00004), severity of complication (p = 0.002), and POHS (p = < 0.00001). We have not been able to identify any specific isolated FT measure able to influence post-operative outcome. Greater adherence to the FT protocol decreases postoperative complications and POHS. Our data support a holistic effect of the FT protocol rather than specific isolated measures to improve the patient's postoperative outcome.
Identifiants
pubmed: 32875416
doi: 10.1007/s00464-020-07903-y
pii: 10.1007/s00464-020-07903-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4214-4221Références
Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:172–188
doi: 10.1002/bjs.9394
Lyon A, Payne CJ, Mackay GJ (2012) Enhanced recovery programme in colorectal surgery: does one size fit all? World J Gastroenterol 18:5661–5663
doi: 10.3748/wjg.v18.i40.5661
Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847
doi: 10.1053/j.gastro.2008.10.030
Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS
doi: 10.1007/s00268-018-4844-y
Slim K, Delaunay L, Joris J et al (2016) How to implement an enhanced recovery programme? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE). J Visc Surg 153:45–49
doi: 10.1016/j.jviscsurg.2016.05.008
Liang L, Juying J, Su M, Dan L, Ling L (2017) Compliance with the enhanced recovery after surgery protocol and prognosis after colorectal cancer surgery: a prospective cohort study. Oncotarget 32:53531–53541
Pedziwiatr M, Kisialeuski M, Wierdak M et al (2015) Early implementation of Enhanced Recovery After Surgery (ERAS(R)) protocol—compliance improves outcomes: a prospective cohort study. Int J Surg 21:75–81
doi: 10.1016/j.ijsu.2015.06.087
Gustafsson UO, Oppelstrup H, Thorell A, Nygren J, Ljungqvist O (2016) Adherence to the ERAS protocol is associated with 5-Year survival after colorectal cancer surgery: a retrospective cohort study. World J Surg 40:1741–1747
doi: 10.1007/s00268-016-3460-y
Maggiori L, Rullier E, Lefevre JH et al (2017) Does a combination of laparoscopic approach and full fast track multimodal management decrease postoperative morbidity?: A multicenter randomized controlled trial. Ann Surg 266:729–737
doi: 10.1097/SLA.0000000000002394
Feroci F, Lenzi E, Baraghini M et al (2013) Fast-track colorectal surgery: protocol adherence influences postoperative outcomes. Int J Colorectal Dis 28:103–109
doi: 10.1007/s00384-012-1569-5
Maessen J, Dejong CH, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231
doi: 10.1002/bjs.5468
Thorn CC, White I, Burch J, Malietzis G, Kennedy R, Jenkins JT (2016) Active and passive compliance in an enhanced recovery program. Int J Colorectal Dis 31:1329–1339
doi: 10.1007/s00384-016-2588-4
Ramirez JM, Blasco JA, Roig JV et al (2011) Enhanced recovery in colorectal surgery: a multicenter study. BMC Surg 11:9–16
doi: 10.1186/1471-2482-11-9
Gustafsson UO, Hausel J, Thorell A et al (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577
doi: 10.1001/archsurg.2010.309
Jurt J, Slieker J, Frauche P et al (2017) Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg 41:2464–2470
doi: 10.1007/s00268-017-4054-z
Martin D, Roulin D, Grass F et al (2017) A multicentre qualitative study assessing implementation of an enhanced recovery after surgery program. Clin Nutr 37(6):1–6
Day R, Fielder S, Calhoun J, Kehlet H, Gottumukkala V, Aloia T (2015) Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement. Br J Surg 102:1594–1602
doi: 10.1002/bjs.9918
Slim K, Joris J (2017) The egg-and-chicken situation in postoperative enhanced recovery programmes. Br J Anaesth 118:5–6
doi: 10.1093/bja/aew408
Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L (2013) Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial. Obstet Gynecol 121:533–537
doi: 10.1097/AOG.0b013e318280d50a
Slim K, Vignaud M (2015) Enhanced recovery after surgery: The patient, the team, and the society. Anaesth Crit Care Pain Med 34:249–250
doi: 10.1016/j.accpm.2015.02.005
Harper CM, Lyles YM (1988) Physiology and complications of bed rest. J Am Geriatr Soc 36:1047–1054
doi: 10.1111/j.1532-5415.1988.tb04375.x
Bakker N, Cakir H, Doodeman HJ, Houdijk PJ (2015) Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: Impact of measures to improve adherence. Surgery 157:1130–1136
doi: 10.1016/j.surg.2015.01.016
Feroci F, Lenzi E, Baraghini M et al (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23:259–265
doi: 10.1097/SLE.0b013e31828ba16f
Gotlib Conn L, McKenzie M, Pearsall E, McLeod R (2015) Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions experiences. Implement Sci 10:99–109
doi: 10.1186/s13012-015-0289-y
Dhruva Rao P, Haray P (2014) Enhanced recovery after colorectal surgery: principles and current practice. Surgery 32:185–189
Simpson J, Moonesinghe S, Grocott M et al (2015) Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth 115:560–568
doi: 10.1093/bja/aev105
Ament SM, Gillisen F, Moser A et al (2014) Identification of promising strategies to sustain improvements in hospital practive: a qualitative case study. BMC Health Serv Res 14:641–652
doi: 10.1186/s12913-014-0641-y
Pearsall EA, Meghji Z, Pitzul KB et al (2015) A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 261:92–96
doi: 10.1097/SLA.0000000000000604
Kahokehr A, Robertson P, Sammour T, Soop M, Hill AG (2011) Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Colorectal Dis 13:1308–1313
doi: 10.1111/j.1463-1318.2010.02453.x
King A, Alvis B, Mc EM (2016) Enhanced recovery after surgery, perioperative medicine, and the perioperative surgical home. Curr Opin Anesthesiol 29:727–732
doi: 10.1097/ACO.0000000000000394
Hartman A, Leonard D, Bachmann R, Abbes Orabi N, Remue C, Kartheuser A. (2016) La réhabilitation améliorée ou le « Fast Track » après chirurgie colorectale : 10 ans plus tard. Louvain Médical 305–13.