Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study
Background: Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. Methods: Sin...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-07-01
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| Series: | Brazilian Journal of Anesthesiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001418300095 |
| _version_ | 1797991868424781824 |
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| author | Javier Ripollés-Melchor María Luisa de Fuenmayor Varela Susana Criado Camargo Pablo Jerez Fernández Álvaro Contreras del Barrio Eugenio Martínez-Hurtado Rubén Casans-Francés Alfredo Abad-Gurumeta José Manuel Ramírez-Rodríguez José María Calvo-Vecino |
| author_facet | Javier Ripollés-Melchor María Luisa de Fuenmayor Varela Susana Criado Camargo Pablo Jerez Fernández Álvaro Contreras del Barrio Eugenio Martínez-Hurtado Rubén Casans-Francés Alfredo Abad-Gurumeta José Manuel Ramírez-Rodríguez José María Calvo-Vecino |
| author_sort | Javier Ripollés-Melchor |
| collection | DOAJ |
| description | Background: Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. Methods: Single center observational study. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, 3 years before (Pre-ERAS) and 2 years after (Post-ERAS) the implementation of an ERAS protocol. Baseline characteristics of both groups were compared. The primary outcome was the number of patients with 180 days follow-up with moderate or severe complications; secondary outcomes were postoperative length of stay, and specific complications. Data were extracted from patient records. Results: There were 360 patients in the Pre-ERAS group and 319 patients in the Post-ERAS Group. 214 (59.8%) patients developed at least one complication in the pre ERAS group, versus 163 patients in the Post-ERAS group (51.10%). More patients in the Pre-ERAS group developed moderate or severe complications (31.9% vs. 22.26%, p = 0.009); and severe complications (15.5% vs. 5.3%; p < 0.0001). The median length of stay was 13 (17) days in Pre-ERAS Group and 11 (10) days in the Post-ERAS Group (p = 0.034). No differences were found on mortality rates (4.7% vs. 2.5%; p = 0.154), or readmission (6.39% vs. 4.39%; p = 0.31). Overall ERAS protocol compliance in the Post-ERAS cohort was 88%. Conclusions: The implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay. Resumo: Justificativa: O protocolo ERAS — do Inglês Enhanced Recovery After Surgery — consiste em um conjunto de medidas perioperatórias destinadas a melhorar a recuperação do paciente e diminuir o tempo de internação e as complicações pós-operatórias. Avaliamos a implementação e os resultados de um protocolo ERAS para cirurgia colorretal. Métodos: Estudo observacional em centro único. Os dados foram coletados de pacientes consecutivos submetidos à cirurgia colorretal aberta ou laparoscópica durante dois períodos: três anos antes (pré-ERAS) e dois anos após (pós-ERAS) a implementação de um protocolo ERAS. As características basais de ambos os grupos foram comparadas. O desfecho primário foi o número de pacientes com 180 dias de acompanhamento com complicações moderadas ou graves. Os desfechos secundários foram tempo de internação pós-cirurgia e complicações específicas. Os dados foram extraídos de prontuários dos pacientes. Resultados: O grupo pré-ERAS foi composto por 360 pacientes e o grupo pós-ERAS por 319. No grupo pré ERAS, 214 pacientes (59,8%) desenvolveram pelo menos uma complicação versus 163 pacientes (51,10%) no grupo pós-ERAS. Um número maior de pacientes do grupo pré-ERAS desenvolveu complicações moderadas ou graves (31,9% vs. 22,26%, p = 0,009); e complicações graves (15,5% vs. 5,3%; p < 0,0001). A mediana do tempo de internação foi de 13 (17) dias no grupo Pré-ERAS e de 11 (10) dias no grupo pós-ERAS (p = 0,034). Não houve diferença nas taxas de mortalidade (4,7% vs. 2,5%; p = 0,1554) ou de reinternação (6,39% vs. 4,39%; p = 0,31). A conformidade geral do protocolo ERAS na coorte pós-ERAS foi de 88%. Conclusões: A implantação do protocolo ERAS para cirurgia colorretal foi associada a uma redução significativa das complicações pós-operatórias e do tempo de internação. Keywords: Perioperative, Enhanced recovery after surgery, Postoperative complications, Palavras-chave: Perioperatório, Aceleração da recuperação pós-operatória, Complicações pós-operatórias |
| first_indexed | 2024-04-11T08:59:03Z |
| format | Article |
| id | doaj.art-045627ec6eca4eb6859057adf6331dd6 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-11T08:59:03Z |
| publishDate | 2018-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-045627ec6eca4eb6859057adf6331dd62022-12-22T04:32:51ZengElsevierBrazilian Journal of Anesthesiology0104-00142018-07-01684358368Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort studyJavier Ripollés-Melchor0María Luisa de Fuenmayor Varela1Susana Criado Camargo2Pablo Jerez Fernández3Álvaro Contreras del Barrio4Eugenio Martínez-Hurtado5Rubén Casans-Francés6Alfredo Abad-Gurumeta7José Manuel Ramírez-Rodríguez8José María Calvo-Vecino9Universidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Departamento de Anestesia, Madrid, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Corresponding author.Hospital Universitario Infanta Leonor, Departamento de Cirugía General, Madrid, SpainUniversidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Madrid, SpainUniversidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Madrid, SpainUniversidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Madrid, SpainUniversidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Departamento de Anestesia, Madrid, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, SpainGrupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Hospital Clínico Universitario Lozano Blesa, Departamento de Anestesia, Zaragoza, SpainUniversidad Complutense de Madrid, Madrid, Spain; Hospital Universitario Infanta Leonor, Departamento de Anestesia, Madrid, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, SpainGrupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Hospital Clínico Universitario Lozano Blesa, Departamento de Cirugía, Zaragoza, SpainGrupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad de Salamanca, Salamanca, Spain; Complejo Hospitalario de Salamanca, Departamento de Anestesia, Salamanca, SpainBackground: Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. Methods: Single center observational study. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, 3 years before (Pre-ERAS) and 2 years after (Post-ERAS) the implementation of an ERAS protocol. Baseline characteristics of both groups were compared. The primary outcome was the number of patients with 180 days follow-up with moderate or severe complications; secondary outcomes were postoperative length of stay, and specific complications. Data were extracted from patient records. Results: There were 360 patients in the Pre-ERAS group and 319 patients in the Post-ERAS Group. 214 (59.8%) patients developed at least one complication in the pre ERAS group, versus 163 patients in the Post-ERAS group (51.10%). More patients in the Pre-ERAS group developed moderate or severe complications (31.9% vs. 22.26%, p = 0.009); and severe complications (15.5% vs. 5.3%; p < 0.0001). The median length of stay was 13 (17) days in Pre-ERAS Group and 11 (10) days in the Post-ERAS Group (p = 0.034). No differences were found on mortality rates (4.7% vs. 2.5%; p = 0.154), or readmission (6.39% vs. 4.39%; p = 0.31). Overall ERAS protocol compliance in the Post-ERAS cohort was 88%. Conclusions: The implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay. Resumo: Justificativa: O protocolo ERAS — do Inglês Enhanced Recovery After Surgery — consiste em um conjunto de medidas perioperatórias destinadas a melhorar a recuperação do paciente e diminuir o tempo de internação e as complicações pós-operatórias. Avaliamos a implementação e os resultados de um protocolo ERAS para cirurgia colorretal. Métodos: Estudo observacional em centro único. Os dados foram coletados de pacientes consecutivos submetidos à cirurgia colorretal aberta ou laparoscópica durante dois períodos: três anos antes (pré-ERAS) e dois anos após (pós-ERAS) a implementação de um protocolo ERAS. As características basais de ambos os grupos foram comparadas. O desfecho primário foi o número de pacientes com 180 dias de acompanhamento com complicações moderadas ou graves. Os desfechos secundários foram tempo de internação pós-cirurgia e complicações específicas. Os dados foram extraídos de prontuários dos pacientes. Resultados: O grupo pré-ERAS foi composto por 360 pacientes e o grupo pós-ERAS por 319. No grupo pré ERAS, 214 pacientes (59,8%) desenvolveram pelo menos uma complicação versus 163 pacientes (51,10%) no grupo pós-ERAS. Um número maior de pacientes do grupo pré-ERAS desenvolveu complicações moderadas ou graves (31,9% vs. 22,26%, p = 0,009); e complicações graves (15,5% vs. 5,3%; p < 0,0001). A mediana do tempo de internação foi de 13 (17) dias no grupo Pré-ERAS e de 11 (10) dias no grupo pós-ERAS (p = 0,034). Não houve diferença nas taxas de mortalidade (4,7% vs. 2,5%; p = 0,1554) ou de reinternação (6,39% vs. 4,39%; p = 0,31). A conformidade geral do protocolo ERAS na coorte pós-ERAS foi de 88%. Conclusões: A implantação do protocolo ERAS para cirurgia colorretal foi associada a uma redução significativa das complicações pós-operatórias e do tempo de internação. Keywords: Perioperative, Enhanced recovery after surgery, Postoperative complications, Palavras-chave: Perioperatório, Aceleração da recuperação pós-operatória, Complicações pós-operatóriashttp://www.sciencedirect.com/science/article/pii/S0104001418300095 |
| spellingShingle | Javier Ripollés-Melchor María Luisa de Fuenmayor Varela Susana Criado Camargo Pablo Jerez Fernández Álvaro Contreras del Barrio Eugenio Martínez-Hurtado Rubén Casans-Francés Alfredo Abad-Gurumeta José Manuel Ramírez-Rodríguez José María Calvo-Vecino Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study Brazilian Journal of Anesthesiology |
| title | Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study |
| title_full | Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study |
| title_fullStr | Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study |
| title_full_unstemmed | Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study |
| title_short | Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study |
| title_sort | enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery a single center cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S0104001418300095 |
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