Feasibility of enhanced recovery after surgery program in colorectal surgery during COVID-19 pandemic in Italy: should we change something?

Borghi, Felice; Pellegrino, Luca; Pruiti, Vincenzo; Donati, Danilo; Giraudo, Giorgio

doi:10.1007/s13304-020-00827-1

Cited by 10 publications

(10 citation statements)

References 3 publications

(3 reference statements)

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“…The follow-up of ERAS protocols results in shorter hospital stays and a lower incidence of postoperative complications, which is particularly valuable during the COVID-19 pandemic, where the availability of regular admission hospital beds and intensive care beds has been indispensable for the management of the healthcare crisis [32][33][34]. Optimizing these resources during the pandemic allows us to perform cancer surgeries without excessive delays; said delays would lead to more advanced disease staging, together with a delay in the start of adjuvant chemotherapy, which in turn would result in poorer overall oncological outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic

López-Rodríguez-Arias

Sánchez‐Guillén

Ostáriz

et al. 2021

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Background Surgery remains the first curative treatment for colorectal cancer. Prehabilitation seems to attenuate the loss of lean mass in the early postoperative period. However, its long-term role has not been studied. Lockdown due to the COVID-19 pandemic has forced to carry out the prehabilitation program at home. This study aimed to assess the effect of home prehabilitation on body composition, complications, and hospital stay in patients undergoing oncological colorectal surgery. Methods A prospective and randomized clinical study was conducted in 20 patients operated of colorectal cancer during COVID-19 lockdown (13 March to 21 June 2020) in a single university clinical hospital. Patients were randomized into two study groups (10 per group): prehabilitation vs standard care. Changes in lean mass and fat mass at 45 and 90 days after surgery were measured using multifrequency bioelectrical impedance analysis. Results Prehabilitation managed to reduce hospital stay (4.8 vs 7.2 days, p = 0.052) and postoperative complications (20% vs 50%, p = 0.16). Forty-five days after surgery, the loss of lean mass decreased (1.7% vs 7.1%, p = 0.17). These differences in lean mass were attenuated at 90 days; however, the standard care group increased considerably their fat mass compared to the prehabilitation group (+ 8.72% vs − 8.16%). Conclusions Home prehabilitation has proven its effectiveness, achieving an attenuation of lean mass loss in the early postoperative period and a lower gain in fat mass in the late postoperative period. In addition, it has managed to reduce hospital stays and postoperative complications. Registration number This article is part of an ongoing, randomized, and controlled clinical trial approved by the ethics committee of our hospital and registered in ClinicalTrials.gov in August 2018 with registration number NCT03618329.

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Section: Discussionmentioning

confidence: 99%

Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic

López-Rodríguez-Arias

Sánchez‐Guillén

Ostáriz

et al. 2021

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“…During Covid-19, surgical school has shown promise in terms of increased patient outcomes and healthcare cost savings. 19,20 Although, in our study, given that LOS and peri-operative measures were no different amongst both cohorts, this makes the true impact of surgical school attendance questionable. Further studies are needed, to confirm our preliminary data and to gauge the long-term patient outcomes, including rates of readmission.…”

Section: Surgical School Attendance and Implicationsmentioning

confidence: 61%

A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic

Bennett

Leung

Ahmad

2021

Journal of Clinical Urology

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Objectives: The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes. Patients and methods: Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019–September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery. Results: Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins ( p=0.134), N1 disease ( p=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels ( p<0.007). Conclusion: Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels. Level of evidence: 2b

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“…In the new era, models like this could help maintain essential surgeries, and reducing the consumption of resources for patients hospitalized 23 . We believe that the implementation of an enhanced recovery protocol would be necessary to resume elective cardiac surgeries, as suggested by other surgical specialties 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Safe and effective protocol for discharge 3 days after cardiac surgery

Mejía

Borgomoni

Lasta

et al. 2021

Sci Rep

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The Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the “TotalCor protocol”. After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.

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Feasibility of enhanced recovery after surgery program in colorectal surgery during COVID-19 pandemic in Italy: should we change something?

Cited by 10 publications

References 3 publications

Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic

Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic

A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic

Safe and effective protocol for discharge 3 days after cardiac surgery

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