Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study.

Autor: Ripollés-Melchor J; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: javier.ripolles@salud.madrid.org., Abad-Motos A; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain., Cecconi M; Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Pearse R; Barts and the London School of Medicine & Dentistry, Queen Mary University London, EC1M 6BQ, UK., Jaber S; Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; The Francophone Group for Enhanced Recovery After Surgery (GRACE), France., Slim K; The Francophone Group for Enhanced Recovery After Surgery (GRACE), France; Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France., Francis N; Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK., Spinelli A; Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy., Joris J; The Francophone Group for Enhanced Recovery After Surgery (GRACE), France; Anesthesia and Reanimation CHU de Liège, Université de Liège, Liège, Belgium., Ioannidis O; Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece., Zarzava E; Department of Anesthesia and Surgical Critical Care, General Hospital 'G. Papanikolaou', Thessaloniki, Greece., Şentürk NM; Department of Anesthesiology, Istanbul University School of Medicine, Istanbul, Turkey., Koopman S; Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands., Goettel N; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA; Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland., Stundner O; Department of Anesthesia and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria., Vymazal T; Department of Anesthesiology and Intensive Care, Motol University Hospital, Prague, Czech Republic., Kocián P; Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic., El-Hussuna A; Department of surgery, Aalborg University Hospital, Aalborg, Denmark; Opensource Research Collaboration, Denmark., Pędziwiatr M; 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland., Gudaityte J; Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania., Latkauskas T; Department of Surgery, Coloproctology Unit, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania., Santos MD; Colorectal Surgery, Rectal Cancer Reference Center, Centro Hospitalar do Porto, Porto, Portugal., Machado H; Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal., Zahorec R; Anesthesiology and Intensive Medicine, Medical School, Comenius University, Bratislava, Slovakia., Cvetković A; Anesthesiology & Intensive Care Medicine, Institute for Oncology and Radiology of Serbia, Clinic of Surgical Oncology, Belgrade, Serbia., Miric M; Department of Anesthesiology, Reanimatology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia., Georgiou M; Department of Anesthesiology, Nicosia General Hospital, Nicosia, Cyprus., Díez-Remesal Y; Anesthesia & Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain., Jammer I; Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway., Mena GE; Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Zorrilla-Vaca A; Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. USA., Marino MV; Department of General and Emergency Surgery, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy., Suárez-de-la-Rica A; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain., García-Erce JA; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain., Logroño-Ejea M; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Hospital Universitario de Alava, Alava, Spain., Ferrando-Ortolá C; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Critical Care, Hospital Clínic, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain., De-Fuenmayor-Valera ML; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain., Ugarte-Sierra B; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, BioCruces Bizkaia Health Research Institute, Hospital Universitario de Galdakao, Galdakao, Vizcaya, Spain., de Andrés-Ibañez J; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Hospital General Universitario de Valencia, Valencia, Spain., Abad-Gurumeta A; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain., Pellino G; Department of Advanced Medical and Surgical Sciences, Università degli Studi Della Campania 'Luigi Vanvitelli', Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain; Italian Surgical Research Group (ItSURG), Italy., Gómez-Ríos MA; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Anesthesia and Critical Care Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain., Poggioli G; Surgery Department, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy., Menzo-Wolthuis A; Surgery Department, University Hospital Leuven, Leuven, Belgium., Castellano-Paulis B; Anesthesia and Critical Care Department, Hospital Universitario Donostia, Donostia-San Sebastián, Spain., Galán-Menéndez P; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Anesthesia and Critical Care Department, Vall d'Hebrón University Hospital, Barcelona, Spain., Aldecoa C; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesia and Critical Care, Río Hortega University Hospital, Valladolid, Spain., Ramírez-Rodríguez JM; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2022 Sep; Vol. 80, pp. 110752. Date of Electronic Publication: 2022 Apr 08.
DOI: 10.1016/j.jclinane.2022.110752
Abstrakt: 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.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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