ERAS pathway in colorectal surgery: structured implementation program and high adherence for improved outcomes.
Aged
Aged, 80 and over
Anastomotic Leak
/ epidemiology
Colon
/ surgery
Colonic Diseases
/ surgery
Colorectal Surgery
/ methods
Critical Pathways
Digestive System Surgical Procedures
/ adverse effects
Enhanced Recovery After Surgery
Female
Follow-Up Studies
Humans
Length of Stay
/ statistics & numerical data
Male
Rectal Diseases
/ surgery
Rectum
/ surgery
Time Factors
Treatment Outcome
Anastomotic leakage
Colorectal surgery
Compliance
ERAS
Major morbidity
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
25
08
2020
accepted:
03
09
2020
pubmed:
24
10
2020
medline:
4
8
2021
entrez:
23
10
2020
Statut:
ppublish
Résumé
Although there is clear evidence that an Enhanced Recovery After Surgery (ERAS) program in colorectal surgery leads to significantly reduced morbidity rates and length of hospital stay (LOS), it is still unclear what modalities and levels of implementation of the program are necessary to achieve these results. The purpose of this study is to analyze the methods and results of the first year of structured implementation of a colorectal ERAS program in two surgical units of the Azienda Sanitaria Unica Regionale (ASUR) Marche in Italy. A two-center observational study on a prospectively maintained database was performed on 196 consecutive colorectal resections (excluding emergencies and American Society of Anesthesiologists class > III cases) over a 1-year period. More than 50 variables including adherence to the individual items of the ERAS program were considered. Primary outcomes were overall morbidity, major morbidity, mortality and anastomotic leakage rates; secondary outcomes were LOS, re-admission and re-operation. The results were evaluated by univariate and multivariate analyses through logistic regression. After a median follow-up of 39.5 days, we recorded complications in 72 patients (overall morbidity 36.7%), major complications in 14 patients (major morbidity 7.1%), 6 deaths (mortality 3.1%), anastomotic dehiscence in 9 cases (4.9%), mean overall LOS of 6.6 days, 10 readmissions (5.1%) and 13 reoperations (6.7%). The mean adherence rate to the items of the ERAS program was 85.4%, showing a significant dose-effect curve for overall and major morbidity rates, anastomotic leakage rates and LOS. The implementation methods of a colorectal ERAS program in this study led to a high adherence (> 80%) to the program items. High adherence had significant effects also on major morbidity and anastomotic leakage rates.
Identifiants
pubmed: 33094366
doi: 10.1007/s13304-020-00885-5
pii: 10.1007/s13304-020-00885-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
123-137Références
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