Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry

Braga, Marco; Borghi, Felice; Scatizzi, Marco; Missana, Giancarlo; Guicciardi, Marco; Bona, Stefano; Ficari, Ferdinando; Maspero, Marianna; Pecorelli, Nicolò

doi:10.1007/s00464-017-5486-0

Cited by 16 publications

(12 citation statements)

References 24 publications

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“…Despite some item variations, patients undergoing surgery for rectal cancer showed similar results in terms of both protocol adherence and outcomes when compared to other colonic resections. Unlike those described in other studies, [20] our results show that median LOS was 6 days for both laparoscopic rectal and colonic resections.…”

Section: Discussioncontrasting

confidence: 91%

“…[23] We included in this study only patients treated with a minimally invasive approach, since its effect on recovery after major surgery is well reported and it increases adherence to postoperative ERAS protocol items as recently reported by the PeriOperative Italian Society. [20] Since the best postoperative outcomes are achieved combining ERAS protocol and laparoscopy, we considered the laparoscopic approach as a standard item of the ERAS protocol when indicated.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program

et al. 2018

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There is increasing evidence that minimally invasive techniques associated with Enhanced Recovery After Surgery (ERAS) protocols reduce surgery-related stress and promote faster recovery after major colorectal surgery. As a single tertiary referral center for colorectal surgery, our aim was to analyze the effects of our ERAS protocol on a heterogeneous population undergoing laparoscopic colorectal surgery.Prospectively collected data from 283 patients undergoing laparoscopic colorectal resection at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between March 2014 and March 2018 were retrospectively analyzed. Patients' adherence to pre-, intra-, and postoperative ERAS protocol items together with surgical short-term outcomes such as morbidity, mortality, length of hospital stay, and readmission rate was considered.The study protocol was approved by the Ethics Committee of Azienda Ospedaliera Universitaria Integrata di Verona (CRINF-1034 CESC).During the study period, 200 patients met the inclusion criteria and were enrolled in the ERAS protocol. In this series, 34% of patients were aged 70 years or older. Rectal resections represented 26% of all cases, with stoma formation performed in 14.5% of patients. Despite such procedural heterogeneity, good short-term results were obtained: by postoperative day (POD) 2, 58.5% of patients had full return of bowel function, while 63.5% and 88% achieved regular soft diet intake and autonomous walking, respectively. Median (range) length of hospital stay was 5.5 days (2-40) with 71% of patients being discharged by POD 6. No postoperative mortality was recorded, and the rate of major complications was 3.5%. During the study period, 6 patients required redo surgery (3%) and 5 patients required rehospitalization within 30 days (2.5%).This study analyzing the results of the fast-track program in our first 200 cases confirms the feasibility and safety of ERAS protocol application within a heterogeneous population undergoing laparoscopic colonic and rectal resection for benign and malignant diseases.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program

et al. 2018

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“…Patients undergoing laparoscopic colorectal surgery were excluded because this study focused on the analysis of learning curve for ERAS program - not the that for laparoscopic surgery which may be influenced by surgeon’s experience and operative complexity. Moreover, laparoscopy might be a key factor offering independent advantages beyond an ERAS program[9,10]. Patients undergoing non-resection surgery ( e.g ., loop colostomy and colonic bypass procedures) and those with clinical peritonitis or acute colonic obstruction were also excluded.…”

Section: Methodsmentioning

confidence: 99%

“…When comparing laparoscopy and open surgery within an ERAS program for colorectal surgery, the latter had a higher rate of complication and was more difficulty to implement an ERAS program[9]. There are several studies on the impact of ERAS compliance on surgical outcomes[4,5,10,11], but little attention is drawn to the analysis of the early stage of ERAS implementation into colorectal operation especially in an open surgery - as a learning curve of a multidisciplinary ERAS team.…”

Section: Introductionmentioning

confidence: 99%

Learning curve of enhanced recovery after surgery program in open colorectal surgery

Lohsiriwat

2019

WJGS

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BACKGROUND Enhanced recovery after surgery (ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients’ outcomes is unknown. AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery. METHODS This was a review of prospectively collected database of 380 “unselected” patients undergoing elective “open” colectomy and/or proctectomy under ERAS protocol from 2011 (commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups (76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery: defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission. RESULTS Hospitalization more than 5 d occurred in 22.6% ( n = 86), major complication was present in 2.9% ( n = 11) and 30-d readmission rate was 2.4% ( n = 9) accounting for unsuccessful recovery of 25% ( n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles ( P < 0.001). Average compliance with ERAS protocol gradually increased over the time - from 68.6% in 1 st quintile to 75.5% in 5 th quintile ( P < 0.001). The application of preoperative counseling, nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period. CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.

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“…In recent years enhanced recovery after surgery program (ERAS), mostly in colorectal surgery, has shown interesting results in terms of reduction in post-operative complications, hospital stays and costs. At our centre, ERAS pathway was implemented in 2010 and, so far, over 1300 patients have been included in the protocol [2,3]. During the lockdown period (March-April 2020), adopting specific guideline recommendations for preserving COVID-19 transmission, we continued to apply the same program, treating 24 patients (16 males and 8 women) with mean age of 68.2 years.…”

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confidence: 99%

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

et al. 2020

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Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry

Abstract: The present study showed that a successful laparoscopic procedure had an independent role to increase the adherence to postoperative ERP and to improve short-term postoperative outcome.

Cited by 16 publications

References 24 publications

Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program

Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program

Learning curve of enhanced recovery after surgery program in open colorectal surgery

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

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