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BMC Surgery
Published in: BMC Surgery 1/2021

Open Access 01-12-2021 | Colectomy | Research article

Conditions associated with worse acceptance of a simplified accelerated recovery after surgery protocol in laparoscopic colorectal surgery

Authors: Fábio Lopes de Queiroz, Antonio Lacerda-Filho, Adriana Cherem Alves, Fábio Henrique de Oliveira, Paulo Rocha França Neto, Rodrigo de Almeida Paiva

Published in: BMC Surgery | Issue 1/2021

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Abstract

Background

Enhanced Recovery Surgical Programs were initially applied to colorectal procedures and used as multimodal approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the poor tolerance of these patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery.

Methods

161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n = 51) and those who did not (n = 33), in order to analyze factors contributing to protocol nontolerance.

Results

The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). Complications rates and readmissions to emergency room were similar between groups. Multivariate analysis revealed that prolonged operating time, stoma creation and rates of surgical complications were independently associated with poor adherence to SARP (p < 0.0001).

Conclusions

The use of our SARP resulted in improved recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with poor program adhesion.
Trial registration Trial Registry: RBR2b4fyr—Date of registration: 03 October 2017.
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Metadata
Title
Conditions associated with worse acceptance of a simplified accelerated recovery after surgery protocol in laparoscopic colorectal surgery
Authors
Fábio Lopes de Queiroz
Antonio Lacerda-Filho
Adriana Cherem Alves
Fábio Henrique de Oliveira
Paulo Rocha França Neto
Rodrigo de Almeida Paiva
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2021
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-021-01206-2

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