[Enhanced Recovery Program in colorectal surgery]. / "Enhanced recovery after surgery" bevezetése a vastagbél sebészetében.

INTRODUCTION: Enhanced recovery after surgery (ERAS) programme has been described and practiced for twenty years in the perioperative management of colorectal patients. ERAS is a complex, evidence based strategy which proved to be extremely effective when linked to laparoscopy in reducing morbidity, length of hospital stay, as well as reducing cost of colorectal service. AIMS: We gradually adapted elements of ERAS protocol along with laparoscopy in the colorectal surgical treatment at a county hospital from 2013. This study reports a retrospective clinical audit of ERAS programme of two years, between 2015-2016. METHODS: In this timeframe we compared clinical results of traditional and ERAS perioperative colorectal management protocols. The two groups were assessed on the basis of demographic, cancer-related parameters and clinical outcomes. RESULTS: Over the two years of audit we treated 130 patients under "traditional" and 84 cases according to ERAS protocol. Mean length of hospital stay was 8 and 6 days median, respectively. Earlier discharge in the ERAS group did not cause any increase in the readmission rates. Morbidity (Clavien-Dindo grade 2 or more) was found to be less in ERAS group: 8,3% vs. 27,4%. ERAS programme success rate, characterized by discharge by 7th postoperative day, was over 70%, keeping well with rates of the experienced centres of ERAS. CONCLUSION: Therefore we can report a successful introduction of ERAS programme for colorectal service in a Middle-Eastern European county hospital. Based on the favourable outcome results of the retrospective audit we have extended ERAS protocol as first choice perioperative scheme for each elective colorectal case from the beginning of 2017.

Prevalence of suspected obesity hypoventilation syndrome in Hungarian Intensive Care Units during the COVID-19 pandemic.

INTRODUCTION: The symptoms of obesity hypoventilation syndrome (OHS) may be present for years with concomitant progressive comorbidities, and the condition is frequently diagnosed late as a result of acute-on-chronic hypercapnic respiratory failure. Although some data exist on intensive care unit (ICU) prevalence, mortality and morbidity of OHS, little is known about the ICU mortality of these chronic respiratory failure patients during the COVID-19 pandemic. METHODS: We performed a cross-sectional observational study in five Hungarian Intensive Care Units for 4 months during the COVID-19 pandemic. All ICU patients were screened for OHS risk factors by treating physicians. Risk factors were defined as obesity (body mass index [BMI] ≥ 30 kg/m2 ) and at least one of the following: Epworth Sleepiness Score ≥ 6; symptoms of right heart failure; daytime or night-time hypoxemia; presence of loud snoring; witnessed apnoea. We calculated prevalence, mortality and factors associated with unfavourable outcome. RESULTS: A total of 904 ICU patients were screened for OHS risk factors. Overall 79 (8.74 ± 5.53%) patients were reported to have met the criteria for suspected OHS with a mortality rate of 40.5%; 69% (54 patients) of the cohort displayed at least 3 symptoms related to OHS before their acute illness. COVID-19 infection was associated with higher mortality in OHS-suspected patients, independently of actual BMI. CONCLUSION: Despite the increased risk of obese patients, suspected OHS did not show higher prevalence than expected during the COVID-19 pandemic in critically ill patients. COVID-19 infection however was a risk for mortality in these patients, independent of actual BMI.