Identification of core items in the enhanced recovery pathway
| Autor: | Hedayat Bouzari, Umberto Casiraghi, Felice Borghi, Marco Azzola, Ferdinando Ficari, Andrea Pisani Ceretti, Riccardo Iuliani, Luigi Beretta, Marianna Maspero, Marco Scatizzi, Stefano Bona, Roberta Monzani, Luca Pellegrino, Danilo Radrizzani, Andrea Muratore, Giancarlo Missana, Michele Crespi, Nicolò Pecorelli, Marco Braga, Carlo Bima, Marco Gemma |
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| Přispěvatelé: | Braga, M, Scatizzi, M, Borghi, F, Missana, G, Radrizzani, D, Gemma, M, Beretta, L, Bona, S, Monzani, R, Azzola, M, Muratore, A, Crespi, M, Iuliani, R, Bima, C, Bouzari, H, Ceretti, A, Pellegrino, L, Maspero, M, Pecorelli, N, Casiraghi, U, Ficari, F, Braga, Marco, Scatizzi, Marco, Borghi, Felice, Missana, Giancarlo, Radrizzani, Danilo, Gemma, Marco, Beretta, Luigi, Bona, Stefano, Monzani, Roberta, Azzola, Marco, Muratore, Andrea, Crespi, Michele, Iuliani, Riccardo, Bima, Carlo, Bouzari, Hedayat, Ceretti, Andrea Pisani, Pellegrino, Luca, Maspero, Marianna, Pecorelli, Nicolò, Casiraghi, Umberto, Ficari, Ferdinando |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Multivariate analysis Colon Health Status Endocrinology Diabetes and Metabolism Postoperative morbidity Perioperative Care 03 medical and health sciences Postoperative Complications 0302 clinical medicine Endocrinology Enhanced recovery Core ERAS item Risk Factors Colorectal surgery Secondary analysis Clinical endpoint medicine Humans In patient Hospital Mortality Registries Urinary catheter Digestive System Surgical Procedures Aged Retrospective Studies Core (anatomy) Hospital stay Nutrition and Dietetics business.industry Rectum Recovery of Function Length of Stay Middle Aged Patient Discharge Surgery Diabetes and Metabolism Outcome and Process Assessment Health Care Treatment Outcome Italy 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology business |
| Popis: | Background & aims: The Enhanced Recovery After Surgery (ERAS) pathway represents an optimal approach in patients undergoing colorectal surgery but complexity in implementing its items could limit its application. The aim of this study is to identify possible core items within an ERAS pathway following elective colorectal resection. Methods: This is a retrospective review of data prospectively collected between January 2014 and September 2015 by 14 Italian Hospitals in an electronic registry dedicated to an ERAS protocol. 722 patients undergoing elective colorectal surgery within an ERAS protocol have been included in the study. Adherence to ERAS items was assessed in all patients. A secondary analysis was restricted to pre- and intraoperative ERAS items. Time to readiness for discharge (TRD) was the primary endpoint of the study. Postoperative overall morbidity was the secondary endpoint. Results: Multivariate analyses showed that active intraoperative warming (p = 0.008), early stop of intravenous fluids (p = 0.0001), and early removal of urinary catheter (p = 0.0001) were associated to a shorter TRD, while early stop of intravenous fluids (p < 0.001) also reduced morbidity. When the analysis was restricted to pre- and intraoperative items, removal of NGT at the end of surgery had an independent role to shorten TRD (p < 0.001) and to reduce overall morbidity (p = 0.019), while the absence of oral bowel preparation reduced postoperative overall morbidity (p = 0.021). Conclusions: In implementing an ERAS pathway, hospitals could initially focus on active intraoperative warming, early stop of intravenous fluids, early removal of urinary catheter, removal of NGT at the end of surgery, and absence of oral bowel preparation, keeping on continuous effort to apply the complete ERAS protocol. |
| Databáze: | OpenAIRE |
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