Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery?

Abstract

There is evidence that implementation of enhanced recovery after surgery (ERAS) protocols into colorectal surgery reduces complication rate and improves postoperative recovery. However, most published papers on ERAS outcomes and length of stay in hospital (LOS) include patients undergoing open resections. The aim of this pilot study was to determine the factors affecting recovery and LOS in patients after laparoscopic colorectal surgery for cancer combined with ERAS protocol. One hundred and forty-three consecutive patients undergoing elective laparoscopic resection were prospectively evaluated. They were divided into two subgroups depending on their reaching the targeted length of stay—LOS (75 patients in group 1—≤4 days, 68 patients in group 2—>4 days). A univariate and multivariate logistic regression analysis was performed to assess for factors (demographics, perioperative parameters, complications and compliance with the ERAS protocol) independently associated with LOS of 4 days or longer. The median LOS in the entire group was 4 days. The postoperative complication rate was higher (18.7 vs. 36.7 %), and the compliance with ERAS protocol was lower (91.2 vs. 76.7 %) in group 2. There was an association between the pre- and postoperative compliance and the subsequent complications. In uni- and multivariate analysis, the lack of balanced fluid therapy (OR 3.87), lack of early mobilization (OR 20.74), prolonged urinary catheterization (OR 4.58) and use of drainage (OR 2.86) were significantly associated with prolonged LOS. Neither traditional patient risk factors nor the stage of the cancer was predictive of the duration of hospital stay. Instead, compliance with the ERAS protocol seems to influence recovery and LOS when applied to laparoscopic colorectal cancer surgery.

Enhanced recovery after surgery protocol in oesophageal cancer surgery: Systematic review and meta-analysis

“…Moreover, protocol compliance was only reported by Ford et al, Li et al, Blom et al, Findlay et al and Munitiz et al, [13,17,18,20,21]. This is important since many papers link adherence to the protocol with post-operative outcomes [31]. Due to the lack of data in other studies, it is impossible to determine the compliance rate in this review.…”

Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis

“…Unfortunately, compliance with the protocol was only reported by Campillo-Soto et al, Lemanu et al and Petrick [11, 13, 16]. This is important, since many papers link adherence to the protocol with postoperative outcome [34, 35]. Although there are items that theoretically have greater influence on outcomes (laparoscopic surgery, fluid management, early feeding and ambulation), the success of ERAS programmes resembles improvements described by Sir David Brailsford, performance director of GB cycling team, as aggregation of marginal gains theory [36].…”

Enhanced Recovery After Surgery Pathway: How its Implementation Influenced Digestive Surgery Outcomes?

“…Although this last study demonstrates a striking relationship between adherence to protocol and cancer survival, this may not imply a cause and effect association between them -the study doesn't present evidence of mechanisms behind this effect. Several other studies have demonstrated that an improved adherence to the ERAS protocol, is associated with lower LOSH and improved clinical outcomes following colorectal surgery [27][28][29][30].…”