Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study

Ripollés‐Melchor, Javier; Varela, María Luisa de Fuenmayor; Camargo, Susana Criado; Fernández, Pablo Jerez; Barrio, Álvaro Contreras del; Martínez‐Hurtado, Eugenio; Francés, R. Casans; Abad‐Gurumeta, Alfredo; Ramírez-Rodríguez, José Manuel; Calvo-Vecino, J.M.

doi:10.1016/j.bjane.2018.01.007

Cited by 17 publications

(24 citation statements)

References 36 publications

(40 reference statements)

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“…The length of hospital stay also depends on whether the patient underwent emergency or elective surgery. Our series demonstrated the median hospital stay of 5.7 days (1-20 days) for elective surgeries and 8.5 days (2-30 days) for emergency surgeries which is comparable to published literature [14]. Strict enforcement of ERAS protocols especially during the postoperative period helped us achieve equivalent results.…”

Section: Discussionsupporting

confidence: 82%

Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour

Sukumar

Pandey

Kumar

et al. 2020

Indian J Surg Oncol

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The health services across the world have been deeply impacted by the ongoing COVID-19 pandemic which has resulted in diversion of resources to testing, isolating and treating COVID-19 patients. This meant cutting down resources and manpower away of various healthcare facilities and severely hampering the functioning of various cancer services across the world. It is however, important to understand, cancer itself is a life-threatening condition, and there is a need to continue running cancer care services, at least for those who needed the most. Various clinical societies have put forward guidelines and protocols to help continue surgical services during the pandemic. The role of minimally invasive surgery (MIS) was initially questioned at the start of the pandemic, however gradually increasing evidence favored MIS as it reduced hospital stay and complication. Enhanced recovery programs which have been introduced to various fields of surgery to improve outcomes and reduce hospital stay. It plays an essential role in times like this, where the optimal usage of minimal resources is essential. We embraced these methods to ensure safety of our patients and staff and at the same time provide the highest standards of care. Here we are presenting our experience of running a colorectal surgical unit during these difficult times with emphasis on promotion of minimally invasive surgery, at the epicenter of the pandemic in India.

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Section: Discussionsupporting

confidence: 82%

Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour

Sukumar

Pandey

Kumar

et al. 2020

Indian J Surg Oncol

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“…As with performing ERP, affirming that goal-directed hemodynamic therapy is conducted is not enough; after all, avoiding volume overload has been shown to reduce complications in multiple studies. 8,19…”

Section: Discussionmentioning

confidence: 99%

“…10 Furthermore, postoperative complications were analyzed, including centers with ERP and those without ERP, but in which the individual components of the ERP were assessed in all the patients included in the study. Despite a few randomized clinical trials, to date, auditing of ERAS has been largely performed in a manner similar to intention-to-treat analysis, such that only the treatment assignment (pre-ERAS vs ERAS) was relevant, 8 or in large databases including only patients in ERAS centers. [10][11][12] These types of studies obtained the same conclusions: the application of ERAS, and especially a high adherence to the protocols improve the postoperative outcomes.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…These programs combine use of a multidisciplinary team, protocolization of perioperative management, and patient education. 7 Single-center studies, 8,9 multicenter observational studies, [10][11][12] and meta-analyses 13 have reported that the application of a perioperative ERP is associated with improvements in postoperative outcomes. Many of the components of the ERP could be considered as standard care 14 ; nevertheless, there are still barriers for its full implementation, 15 despite health systems recommendations.…”

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confidence: 99%

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Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

et al. 2019

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IMPORTANCE Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. OBJECTIVE To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. EXPOSURES Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. MAIN OUTCOMES AND MEASURES The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. RESULTS Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates.

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“…Interestingly, the introduction of early nutrition has been shown to increase collagen deposit at the anastomosis, improve wound strength and reduce anastomotic breakdown . Previous prospective randomized controlled trials have shown that early feeding reduces post‐operative ileus duration and hospital stay without increasing morbidity and mortality …”

Section: Discussionmentioning

confidence: 99%

Prophylactic Foley catheter insertion into defunctioning ileostomy to reduce obstruction after colorectal surgery: pilot randomized controlled trial*

Kulasegaran

Nisbet

et al. 2020

ANZ Journal of Surgery

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Background Defunctioning ileostomies provide faecal diversion in major colorectal surgery. This reduces the consequences of an anastomotic leak. However, the formation of an ileostomy carries risks including obstruction at the level of the fascia. Post‐operative oedema at the level of the fascia may contribute to obstruction. We hypothesize that the prophylactic insertion of a Foley catheter into the afferent limb of a defunctioning loop ileostomy may help decompress and improve time to low‐residue diet (LRD). The objective of the study was to assess the feasibility of a Foley catheter, prophylactically inserted into the afferent limb of a defunctioning loop ileostomy, after major colorectal surgery. Methods The study was a prospective pilot‐randomized controlled trial. Ethical approval was obtained from Northern B Health and Disability Ethics Committee 15/NTB/91 ANZCTR Trial ID: ACTRN12615000691549. Results Forty‐nine patients undergoing major elective colorectal surgery with a defunctioning ileostomy, between the years of 2015 and 2018 at North Shore Hospital, Auckland, New Zealand were included in this study. Patients were randomly allocated to either the Foley catheter (n = 26) or non‐Foley catheter (n = 23) group. The median time taken to tolerate LRD the primary outcome, was 2 days in the Foley group versus 2 days in the non‐Foley group (P = 0.05). There were no differences in the secondary outcome measures such as time to stoma output, length of stay or complications. Conclusion This trial failed to show a statistical difference in time taken to tolerate a LRD residue in the Foley catheter group. There was no difference in length of stay, time to flatus or stoma output.

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Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study

Cited by 17 publications

References 36 publications

Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour

Colorectal Services in Covid-19 Times: Minimally Invasive Surgery and Enhanced Recovery, the Need of the Hour

Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery

Prophylactic Foley catheter insertion into defunctioning ileostomy to reduce obstruction after colorectal surgery: pilot randomized controlled trial*

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