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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

2022; Elsevier BV; Volume: 80; Linguagem: Inglês

10.1016/j.jclinane.2022.110752

1873-4529

Javier Ripollés‐Melchor, Ane Abad‐Motos, Maurizio Cecconi, Rupert M. Pearse, Samir Jaber, K. Slim, Nader Francis, Antonino Spinelli, Jean Joris, Orestis Ioannidis, Eirini Zarzava, Nüzhet Şentürk, Seppe Koopman, Nicolai Goettel, Ottokar Stundner, Tomáš Vymazal, Petr Kocián, Alaa El‐Hussuna, Michał Pędziwiatr, Jūratė Gudaitytė, Tadas Latkauskas, Marisa D. Santos, Humberto S Machado, Roman Záhorec, Ana Cvetković, Mirjana Mirić, Μαρία Γεωργίου, Yolanda Díez-Remesal, Ib Jammer, Gabriel E. Mena, Andrés Zorrilla‐Vaca, Marco V. Marino, Alejandro Suárez-de-la-Rica, José Antonio García‐Erce, Margarita Logroño-Ejea, Carlos Ferrando-Ortolá, María L. De-Fuenmayor-Valera, Bakarne Ugarte-Sierra, J. De Andrés-Ibáñez, A. Abad‐Gurumeta, Gianluca Pellino, Manuel Ángel Gómez‐Ríos, Gilberto Poggioli, Albert Menzo-Wolthuis, Berta Castellano-Paulis, P. Galán-Menéndez, César Aldecoa, José Manuel ́Ramírez Rodríguez,

Colorectal Cancer Surgical Treatments

Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.Prospective cohort study.European centers (185 hospitals) across 21 countries.A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.Routine perioperative care.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.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).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.