Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database

Grieco, Michele; Lorenzon, Laura; Pernazza, Graziano; Carlini, Massimo; Brescia, Antonio; Santoro, Roberto; Crucitti, Antonio; Palmieri, Raffaele; Santoro, Emanuele; Stipa, F; Sacchi, Marco; Persiani, Roberto

doi:10.1007/s00384-019-03496-8

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…Germany-wide in-hospital mortality is comparable to other western countries such as France or the USA [7,16]. Nevertheless the length of stay is significant longer than in other countries or than suggested by ERAS regimes [17]. In previous analyzes from 2012 to 2015, we were able to show that there is a significant association between the number of cases treated per year and inhospital mortality after surgery for colon or rectal cancer [3,11,18].…”

Section: Discussionmentioning

confidence: 66%

Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume

Diers

Baum

Matthes

et al. 2021

European Journal of Surgical Oncology

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Background: The German Cancer Society ("Deutsche Krebsgesellschaft"; DKG) certifies on a volunteer base colorectal cancer centers based on, among other things, minimum operative amounts (at least 30 oncological colon cancer resections and 20 oncological rectal cancer resections per year). In this work, nationwide hospital mortality and death after documented complications ('Failure to Rescue' ¼ FtR) were evaluated depending on the fulfillment of the minimum amounts. Methods: This is a retrospective analysis of the nationwide hospital billing data (DRG data, 2012e2017). Categorization is based on the DKG minimum quantities (fully, partially or not fulfilled). Results: Of 287,227 patients analyzed, 56.5% were operated in centers that met the DKG minimum amounts. The overall hospital mortality rate was 5.0%. In centers which met the minimum quantities, it was significantly lower (4.3%) than in hospitals which partially (5.7%) or not (6.2%) met the minimum quantities. The risk-adjusted hospital mortality rate for patients in hospitals who meet the minimum amount was 20% lower (OR 0.80; 95% CI [0.74e0.87], p < 0.001). For complications, both surgical and non-surgical, there was an unadjusted and adjusted lower FtR in hospitals that met the minimum amounts (e.g. anastomotic leak: 11.2% vs. 15.6%, p < 0.001; pulmonary artery embolism 21.3% vs. 28.2%, p ¼ 0.001). Conclusion:There is a 1/3 lower mortality and FtR rate after surgery for a colon or rectal cancer in centers fulfilling the DKG minimum amounts. The presented data implicate that there is an urgent need for a nationwide centralization program.

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Section: Discussionmentioning

confidence: 66%

Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume

Diers

Baum

Matthes

et al. 2021

European Journal of Surgical Oncology

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“…En la cohorte analizada, la me-Odds ratio (IC95%) diana de la estancia hospitalaria fue de 4 días y disminuye a 3 días con adherencias superiores al 80 %. Se encontró una correlación negativa entre los niveles de adherencia al protocolo ERAS y la duración de la estancia hospitalaria 25 . Hubo mayor incidencia de complicaciones con adherencias menores al 60 %.…”

Section: Discussionunclassified

Asociación entre desenlaces clínicos y cumplimiento del protocolo de recuperación mejorada después de la cirugía (ERAS) en procedimientos colorrectales: estudio multicéntrico

Duarte¹,

Barrios

Zárate-López

et al. 2020

Rev Colomb Cir

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Introducción. Los protocolos de recuperación mejorada después de cirugía se han diseñado como una innovación en salud tras demostrarse que la mejora en los dispositivos médicos y la depuración de técnicas alcanzaron la meseta en disminución de complicaciones. Con estas estrategias de la medicina perioperatoria, en cirugía colorrectal se reducen la morbilidad y estancia hospitalaria. El objetivo del estudio fue evaluar si la tasa de adherencia al programa de recuperación mejorada después de la cirugía (ERAS) está asociada con los resultados quirúrgicos. Métodos. Estudio multicéntrico, observacional, retrospectivo de cohorte (2015-2019), en cinco hospitales latinoamericanos certificados por la sociedad ERAS. Se calculó la incidencia de complicaciones quirúrgicas durante el posquirúrgico inmediato (30 días) y la duración de la estancia hospitalaria. Se utilizaron análisis bivariado y regresión logística multivariada para evaluar los factores asociados con la tasa de complicaciones. Resultados. Fueron incluidos en el estudio 648 pacientes en cinco hospitales ERAS, con edad promedio de 61 años y mayor porcentaje de hombres (51 %). El cumplimiento global al protocolo ERAS fue de 75 % y la estancia promedio de 6,2 días (mediana: 4 días). Se tuvo un cumplimiento óptimo del protocolo ERAS (igual o mayor al 80 %) en 23,6 % de los pacientes. Se documentó fuga de la anastomosis en 4 %, complicaciones infecciosas en 8,4 %, íleo en 5,7 %, reingreso en 10,2 % y mortalidad de 1,1 %. El análisis multivariado mostró que los niveles de adherencia óptima al protocolo ERAS reducen significativamente la aparición de complicaciones como fuga de la anastomosis (OR 0,08; IC95% 0,01-0,48; p=0,005) y complicaciones infecciosas (OR 0,17; IC95% 0,03-0,76; p=0,046). Discusión. Los resultados sugieren que un cumplimiento del programa ERAS mayor al 80 % se asocia a menor frecuencia de complicaciones en pacientes con cirugía electiva colorrectal.

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“…The “Lazio Network” project is a multi-institutional, nonprofit study group including 15 institutions based in Italy’s Lazio region and dedicated to the improvement and promotion of ERAS protocol application to colorectal cancer [ 9 , 10 ]. The study group protocol was approved by the “A.…”

Section: Methodsmentioning

confidence: 99%

Impact of the COVID‐19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the “Lazio Network” Database

Grieco

Galiffa²,

Marcellinaro³

et al. 2022

World j. surg.

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Background The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the “Lazio Network” project. Methods A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy. Results The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups. Conclusions The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the “Lazio Network” study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06694-8.

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Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database

Cited by 18 publications

References 14 publications

Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume

Mortality and complication management after surgery for colorectal cancer depending on the DKG minimum amounts for hospital volume

Asociación entre desenlaces clínicos y cumplimiento del protocolo de recuperación mejorada después de la cirugía (ERAS) en procedimientos colorrectales: estudio multicéntrico

Impact of the COVID‐19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the “Lazio Network” Database

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