Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery.
TLDR
Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.Abstract:
Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery. Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded. Setting: Ersta Hospital, Stockholm, Sweden. Patients: Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007. Main Outcome Measures: The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed. Results: Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (<50%). Conclusion: Improved adherence to the standardized multimodal ERAS protocol is significantly associated with improved clinical outcomes following major colorectal cancer surgery, indicating a dose-response relationship.read more
Citations
More filters
Journal ArticleDOI
Enhanced Recovery After Surgery: A Review
TL;DR: Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties, making ERAS an important example of value-based care applied to surgery.
Journal ArticleDOI
Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS®) society recommendations
Ulf Gustafsson,Michael J. Scott,Michael J. Scott,W. Schwenk,Nicolas Demartines,Didier Roulin,Nader K. Francis,Clare McNaught,John MacFie,A. S. Liberman,Mattias Soop,Andrew G. Hill,Robin H. Kennedy,Dileep N. Lobo,Kenneth C. H. Fearon,Olle Ljungqvist,Olle Ljungqvist +16 more
TL;DR: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolicism (ESPEN) present a comprehensive evidence-based consensus review of peri operative care for colonic surgery.
Journal ArticleDOI
Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
Ulf Gustafsson,Michael J. Scott,Michael J. Scott,W. Schwenk,Nicolas Demartines,Didier Roulin,Nader K. Francis,Clare McNaught,John MacFie,A. S. Liberman,Mattias Soop,Andrew G. Hill,Robin H. Kennedy,Dileep N. Lobo,Kenneth C. H. Fearon,Olle Ljungqvist,Olle Ljungqvist +16 more
TL;DR: Based on the evidence available for each item of the multimodal perioperative-care pathway, the Enhanced Recovery After Surgery (ERAS) Society, International Association for Surgical Metabolism and Nutrition (IASMEN) and European Society for Clinical Nutrition and Metabolicism (ESPEN) present a comprehensive evidence-based consensus review of peri operative care for colonic surgery.
Journal ArticleDOI
Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)
Timothy J.P. Batchelor,Neil J. Rasburn,Etienne Abdelnour-Berchtold,Alessandro Brunelli,Robert J. Cerfolio,Michel Gonzalez,Olle Ljungqvist,René Horsleben Petersen,Wanda M. Popescu,Peter Slinger,Babu Naidu +10 more
TL;DR: This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection) using meta-analyses, randomized controlled trials, large non-randomized studies and reviews.
Journal ArticleDOI
Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations.
Yannick Cerantola,Massimo Valerio,Beata Persson,Patrice Jichlinski,Olle Ljungqvist,Martin Hübner,Wassim Kassouf,Stig Müller,Gabriele Baldini,Francesco Carli,Torvind Naesheimh,Lars M. Ytrebø,Arthur Revhaug,Kristoffer Lassen,Tore Knutsen,Erling Aarsether,Peter Wiklund,Hitendra R.H. Patel +17 more
TL;DR: ERAS has not yet been widely implemented in urology and evidence for individual interventions is limited or unavailable and the experience in other surgical disciplines encourages the development of an ERAS protocol for cystectomy.
References
More filters
Journal ArticleDOI
Multimodal strategies to improve surgical outcome.
Henrik Kehlet,Douglas W. Wilmore +1 more
TL;DR: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge.
Journal ArticleDOI
Evidence-based surgical care and the evolution of fast-track surgery.
Henrik Kehlet,Douglas W. Wilmore +1 more
TL;DR: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery and reduces morbidity, and should therefore be more widely adopted.
Journal ArticleDOI
Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial.
TL;DR: The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.
Journal ArticleDOI
Enhanced recovery after surgery
TL;DR: A protocol is presented which is in current use by the ERAS Group and may provide a standard of care against which either current or future novel elements of an enhanced recovery approach can be tested for their effect on outcome.
Journal ArticleDOI
Enhanced recovery after surgery : a consensus review of clinical care for patients undergoing colonic resection
Kenneth C. H. Fearon,Olle Ljungqvist,M.F. von Meyenfeldt,Arthur Revhaug,Cornelis H. C. Dejong,Kristoffer Lassen,Jonas Nygren,Jonatan Hausel,Mattias Soop,Jens Rikardt Andersen,Henrik Kehlet +10 more
TL;DR: In this article, clinical care of patients undergoing colonic surgery differs between hospitals and countries, and there is considerable variation in rates of recovery and length of colon cancer surgery in different countries.