TY - JOUR
T1 - Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe
T2 - The EuroPOWER international observational study
AU - Ripollés-Melchor, Javier
AU - Abad-Motos, Ane
AU - Cecconi, Maurizio
AU - Pearse, Rupert
AU - Jaber, Samir
AU - Slim, Karem
AU - Francis, Nader
AU - Spinelli, Antonino
AU - Joris, Jean
AU - Ioannidis, Orestis
AU - Zarzava, Eirini
AU - Şentürk, Nüzhet Mert
AU - Koopman, Seppe
AU - Goettel, Nicolai
AU - Stundner, Ottokar
AU - Vymazal, Tomas
AU - Kocián, Petr
AU - El-Hussuna, Alaa
AU - Pędziwiatr, Michał
AU - Gudaityte, Jurate
AU - Latkauskas, Tadas
AU - Santos, Marisa D.
AU - Machado, Humberto
AU - Zahorec, Roman
AU - Cvetković, Ana
AU - Miric, Mirjana
AU - Georgiou, Maria
AU - Díez-Remesal, Yolanda
AU - Jammer, Ib
AU - Mena, Gabriel E.
AU - Zorrilla-Vaca, Andrés
AU - Marino, Marco V.
AU - Suárez-de-la-Rica, Alejandro
AU - García-Erce, José A.
AU - Logroño-Ejea, Margarita
AU - Ferrando-Ortolá, Carlos
AU - De-Fuenmayor-Valera, María L.
AU - Ugarte-Sierra, Bakarne
AU - de Andrés-Ibañez, José
AU - Abad-Gurumeta, Alfredo
AU - Pellino, Gianluca
AU - Gómez-Ríos, Manuel A.
AU - Poggioli, Gilberto
AU - Menzo-Wolthuis, Albert
AU - Castellano-Paulis, Berta
AU - Galán-Menéndez, Patricia
AU - Aldecoa, César
AU - Ramírez-Rodríguez, José M.
AU - EuroPOWER Study Investigators Group
AU - Francophone Group for Enhanced Recovery After Surgery (GRACE)
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Study objective: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes. Design: Prospective cohort study. Setting: European centers (185 hospitals) across 21 countries. 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. Interventions: Routine perioperative care. 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. 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). 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.
AB - Study objective: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes. Design: Prospective cohort study. Setting: European centers (185 hospitals) across 21 countries. 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. Interventions: Routine perioperative care. 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. 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). 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.
KW - Colorectal surgery
KW - ERAS
KW - Enhanced recovery
KW - Optimization
KW - Perioperative management
KW - Postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=85127807105&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2022.110752
DO - 10.1016/j.jclinane.2022.110752
M3 - Journal article
C2 - 35405517
SN - 0952-8180
VL - 80
JO - Journal of clinical anesthesia
JF - Journal of clinical anesthesia
M1 - 110752
ER -