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Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study.
Ripollés-Melchor, Javier; Abad-Motos, Ane; Cecconi, Maurizio; Pearse, Rupert; Jaber, Samir; Slim, Karem; Francis, Nader; Spinelli, Antonino; Joris, Jean; Ioannidis, Orestis; Zarzava, Eirini; Sentürk, Nüzhet Mert; Koopman, Seppe; Goettel, Nicolai; Stundner, Ottokar; Vymazal, Tomas; Kocián, Petr; El-Hussuna, Alaa; Pedziwiatr, Michal; Gudaityte, Jurate; Latkauskas, Tadas; Santos, Marisa D; Machado, Humberto; Zahorec, Roman; Cvetkovic, Ana; Miric, Mirjana; Georgiou, Maria; Díez-Remesal, Yolanda; Jammer, Ib; Mena, Gabriel E; Zorrilla-Vaca, Andrés; Marino, Marco V; Suárez-de-la-Rica, Alejandro; García-Erce, José A; Logroño-Ejea, Margarita; Ferrando-Ortolá, Carlos; De-Fuenmayor-Valera, María L; Ugarte-Sierra, Bakarne; de Andrés-Ibañez, José; Abad-Gurumeta, Alfredo; Pellino, Gianluca; Gómez-Ríos, Manuel A; Poggioli, Gilberto; Menzo-Wolthuis, Albert; Castellano-Paulis, Berta; Galán-Menéndez, Patricia; Aldecoa, César; Ramírez-Rodríguez, José M.
  • 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. E
  • 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.
  • Sentürk 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.
  • Pedziwiatr 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.
  • Cvetkovic 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 Respir
  • 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.
J Clin Anesth ; 80: 110752, 2022 09.
Article en En | MEDLINE | ID: mdl-35405517
ABSTRACT
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.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Cirugía Colorrectal / Recuperación Mejorada Después de la Cirugía Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Año: 2022 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Search on Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Cirugía Colorrectal / Recuperación Mejorada Después de la Cirugía Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Humans Idioma: En Año: 2022 Tipo del documento: Article