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The Impact of Enhan...
The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection Results From an International Registry
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- Currie, Andrew (author)
- Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom
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- Burch, Jennifer (author)
- Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom
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- Jenkins, John T. (author)
- Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom
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- Faiz, Omar (author)
- Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom
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- Kennedy, Robin H. (author)
- Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom,St Marks Hospital, London, England.
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- Ljungqvist, Olle, 1954- (author)
- Karolinska Institutet,Örebro universitet,Institutionen för läkarutbildning,Department of Surgery, Örebro University Hospital, Örebro, Sweden
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- Demartines, Nicolas (author)
- CHUV Lausanne Surg, Lausanne, Switzerland
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- Hjern, Fredrik (author)
- Karolinska Institutet
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- Norderval, Stig (author)
- University Hospital of North Norway, Tromsö, Norway
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- Lassen, Kristoffer (author)
- University Hospital of North Norway, Tromsö, Norway
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- Revhaug, Andarthur (author)
- University Hospital of North Norway, Tromsö, Norway,ERAS Compliance Group
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- Koczkas, Tomas (author)
- Östersunds Sjukhus, Östersund, Sweden
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- Nygren, Jonas (author)
- Karolinska Institutet
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- Gustafsson, Ulf (author)
- Karolinska Institutet
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- Kornfeld, Dan (author)
- Kirurgkliniken St Göran, Stockholm, Sweden
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- Slim, Karem (author)
- University Hospital, Clermont Ferrand, France
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- Hill, Andrew (author)
- Middlemore Hospital, Auckland, New Zealand
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- Soop, Mattias (author)
- North Shore Hospital, Auckland, New Zealand
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- Carlander, Johan (author)
- Uppsala universitet,Centrum för klinisk forskning, Västerås,Västerås Centrallasarett, Västerås, Sweden
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- Lundberg, Owe (author)
- Kirurgkliniken Umeå, Umeå, Sweden
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- Fearon, Ken (author)
- Western General Hospital, Edinburgh, United Kingdom
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- Kennedy, Robin (author)
- St Marks Hospital, London, England.
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Department of Surgery, St Mark's Hospital, Academic Institute, Imperial College London, London, United Kingdom St Marks Hospital, London, England (creator_code:org_t)
- Lippincott Williams & Wilkins, 2015
- 2015
- English.
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In: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 261:6, s. 1153-1159
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- colorectal cancer
- colorectal surgery
- enhanced recovery protocol
- laparoscopy
- quality assurance
- Kirurgi
- Surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Currie, Andrew
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Burch, Jennifer
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Jenkins, John T.
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Faiz, Omar
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Kennedy, Robin H ...
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Ljungqvist, Olle ...
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Demartines, Nico ...
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Hjern, Fredrik
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Norderval, Stig
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Lassen, Kristoff ...
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Revhaug, Andarth ...
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Koczkas, Tomas
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Nygren, Jonas
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Gustafsson, Ulf
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Kornfeld, Dan
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Slim, Karem
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Hill, Andrew
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Soop, Mattias
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Carlander, Johan
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Lundberg, Owe
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Fearon, Ken
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Kennedy, Robin
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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Annals of Surger ...
- By the university
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Örebro University
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Uppsala University
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Karolinska Institutet