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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 3/2020

01-03-2020 | Colectomy | Original Article

Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database

Authors: Michele Grieco, Laura Lorenzon, Graziano Pernazza, Massimo Carlini, Antonio Brescia, Roberto Santoro, Antonio Crucitti, Raffaele Macarone Palmieri, Emanuele Santoro, Francesco Stipa, Marco Sacchi, Roberto Persiani

Published in: International Journal of Colorectal Disease | Issue 3/2020

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Abstract

Background

ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions.

Methods

Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions.

Results

A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197–0.9202 and 95%CI 0.7821–0.9603), hospitalization (OR 0.53 95%CI 0.4917–0.5845) and reinterventions (OR 0.84 95%CI 0.7536–0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036–0.5801), left-sided (OR 0.48 95%CI 0.3984–0.5815), and rectal resections (OR 0.46 95%CI 0.3753–0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976–0.9773 and 95%CI 0.7418–0.9634).

Conclusions

Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.
Appendix
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Literature
1.
Lassen K, Soop M, Nygren J et al (2009) Consensus review of optimal perioperative care in colorectal surgery: enhanced recovery after surgery (ERAS) group recommendations. Arch Surg 144:961–969CrossRef
2.
3.
Gustafsson UO, Scott MJ, Schwenk M et al (2013) Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS) society recommendations. World J Surg 37:259–284CrossRef
4.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta- analysis of randomized controlled trials. World J Surg 38:1531–1541CrossRef
5.
Carmichael JC, Keller DS, Baldini G et al (2017) Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 60(8):761–784CrossRef
6.
Lorenzon L, Biondi A, Carus T et al (2018) Achieving high quality standards in laparoscopic colon resection for cancer: a Delphi consensus-based position paper. Eur J Surg Oncol 44(4):469–483CrossRef
7.
8.
Grieco M, Pernazza G, Gasparrini M et al (2019) The “Lazio Network” experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program: a collective database with 1200 patients over two years. Ann Ital Chir 90:157–161
9.
10.
11.
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classifications of surgical complications. Five-years experiences. Ann Surg 250:187–196CrossRef
12.
13.
14.
15.
16.
Giaccaglia V, Salvi PF, Antonelli MS et al (2016) Procalcitonin reveals early dehiscence in colorectal surgery: the PREDICS study. Ann Surg 263(5):967–972CrossRef
17.
Nikolian VC, Kamdar NS, Regenbogen SE et al (2017) Anastomotic leak after colorectal resection: a population-based study of risk factors and hospital variation. Surgery 161(6):1619–1627CrossRef
18.
Braga M, Scatizzi M, Borghi F et al (2018) Identification of core items in the enhanced recovery pathway. Clin Nutr ESPEN 25:139–144CrossRef
19.
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg 43:659–695CrossRef
20.
Ahmed J, Khan S, Lim M et al (2012) Enhanced recovery after surgery protocols - compliance and variations in practice during routine colorectal surgery. Colorectal Dis 14(9):1045–1051CrossRef
21.
Aarts MA, Rotstein OD, Pearsall EA, Victor JC, Okrainec A, McKenzie M, McCluskey S, Conn LG, McLeod R, iERAS group (2018) Postoperative ERAS interventions have the greatest impact on optimal recovery: experience with implementation of ERAS across multiple hospitals. Ann Surg 267:992–997CrossRef
Metadata
Title
Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database
Authors
Michele Grieco
Laura Lorenzon
Graziano Pernazza
Massimo Carlini
Antonio Brescia
Roberto Santoro
Antonio Crucitti
Raffaele Macarone Palmieri
Emanuele Santoro
Francesco Stipa
Marco Sacchi
Roberto Persiani
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 3/2020
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03496-8

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