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The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry
Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom.
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2015 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 261, no 6, p. 1153-1159Article in journal (Refereed) Published
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Text
Abstract [en]

Background: The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.

Objective: This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.

Methods: The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.

Findings: A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR= 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).

Conclusions: This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015. Vol. 261, no 6, p. 1153-1159
Keywords [en]
colorectal cancer, colorectal surgery, enhanced recovery protocol, laparoscopy, quality assurance
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-48766DOI: 10.1097/SLA.0000000000001029ISI: 000369611600046PubMedID: 25671587Scopus ID: 2-s2.0-84946195333OAI: oai:DiVA.org:oru-48766DiVA, id: diva2:907557
Note

Funding Agencies:

Nutricia Clinical Care

FreseniusKabi

Nutricia

Fresenius-Kabi

Barcapel Foundation

Savvas Regas Foundation

Wates Foundation

Ethicon Endosurgery and Olympus

Lothian Hospitals Oncology Endowment Fund

Available from: 2016-02-29 Created: 2016-02-29 Last updated: 2018-07-03Bibliographically approved

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Ljungqvist, Olle

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School of Medicine, Örebro University, Sweden
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