Compliance with the enhanced recovery after surgery protocol and prognosis after colorectal cancer surgery: A prospective cohort study

Abstract

We explored the effects of different levels of compliance with an enhanced recovery after surgery (ERAS) protocol on the short-term prognosis of patients who underwent colorectal cancer surgery. We conducted a single-center prospective cohort study in which 254 patients who received surgical treatment in a teaching tertiary care hospital were enrolled from March 2016 to November 2016. The patients were divided into four groups (I, II, III, and IV) based on individual compliance rates; the corresponding range of compliance rates was 0-60%, 60-70%, 70-80%, and 80-100%, and the number of patients in each group was 66, 63, 53, and 72, respectively. In the four groups from low to high compliance with ERAS (group I, II, III, and IV), the incidence of surgical site infections was 24.2%, 20.6%, 9.4%, and 6.9% (P < 0.05); the overall incidence of postoperative complications was 41.3%, 33.3%, 26.4%, and 16.7% (P < 0.05); the median length of postoperative hospital stay (in days) was 12.5, 10, 9, 8 (P < 0.05); and the median total hospital cost (Chinese Yuan) was 71,733, 73,632, 65,861, and 63,289 (P < 0.05), respectively. These results suggest that higher compliance with the ERAS protocol was associated with a lower incidence of surgical site infections, lower overall postoperative complication rate, shorter postoperative hospital stays, and lower total hospital costs.

Jejum pré-operatório abreviado favorece realimentação pós-operatória com menor custo de internação hospitalar em pacientes oncológicos.

“…Time to achieve full oral intake due to abbreviated fasting.confounding factors, abbreviated fasting revealed itself as the main statistically significant factor to support a return to full diet. A similar result was found by Li et al21 .Despite the fact that other factors leading to a prolonged in-hospital stay, such as complications, fistulae, etc., do not have statistical significance, the indirect indicator of such results (days of in-hospital stay) supports the use of abbreviated fasting in more patients. Possibly, the sample size limitation prevented the occurrence of more significant results, such as those presented by Seretis et al 19 .…”

“…The protocols established so far, based on the perioperative handling of patients who underwent medium and major surgery, regardless of the segment of the gastrointestinal tract used, have been set up in general hospitals, with no selection of the base disease -with only the selection of the surgical procedure applied 10,[19][20][21] .…”

“…The medical literature shows but a few reports of similar protocols applied in leading cancer hospitals specialized in treating patients with more advanced stages of cancer who are, in the great majority, malnourished [9][10][11][20][21][22] .…”

Is It Possible to Maintain High Compliance with the Enhanced Recovery after Surgery (ERAS) Protocol?—A Cohort Study of 400 Consecutive Colorectal Cancer Patients

“…Most importantly high compliance requires full involvement of all members of the team who set their priorities for protocol items which are related to their specialty. A similar multidisciplinary approach has been described by Li et al [ 20 ].…”

Enhanced Recovery After Surgery

“…A compliance level of 80% was needed in colorectal and urological pathways to see statistically significant results, which supported the idea that consistent protocolised pathways provide better patient outcomes. The literature supports the relationship with ERAS and a reduction in complications, mortality and length of stay and therefore more cost savings [9,10].…”