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

Abstract

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.

Recuperación mejorada después de cirugía en cáncer colorrectal. Instituto Nacional de Enfermedades Neoplásicas

“…Adicionalmente, permitirá valorar si se reducen los costos en los sistemas de salud como los menciona el estudio de Rawlinson et al [3] . Es importante mencionar que el ERAS requiere de un equipo multidisciplinario permanente, con los especialistas involucrados, para aprender adecuadamente el manejo y mejorar la adherencia a las medidas implementadas [19] .…”

“…Se utilizó la Prueba U de Mann-Whitney, Chi-cuadrado de Pearson, y odds ratios (OR) para el análisis estadístico. Resultados: 90 pacientes ingresaron al programa ERAS con una mediana de estancia hospitalaria postoperatoria de 3 días (rango [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. La cirugía laparoscópica se realizó en el 53 % de los casos, con una estancia hospitalaria significativamente menor que los pacientes con cirugía convencional (p=0,035).…”

High compliance with surgical site infection (SSI) prevention bundle reduces incisional SSI after colorectal surgery

“…Based on the 10 recommended interventions of Thailand’s SSI Prevention Bundle, we achieved a 100% compliance with preoperative smoking cessation, appropriate hair removal, and skin preparation with alcohol-based solution. It is possible that the highest achievement is due to the fact that we included only elective surgery, where smoking cessation at least 2 weeks before surgery is mandatory for every patient and all of these 3 interventions are parts of our well-established ERAS protocol [ 14 , 15 ]. Meanwhile, compliance with other recommended interventions was relatively high except the maintenance of intraoperative normothermia (53.3% compliance), changes of contaminated gloves and surgical instruments before wound closure (31.2% compliance), and the use of antimicrobial-coated sutures for wound closure (19.3% compliance).…”

“…All patients were operated on and treated by a board-certified colorectal surgeon and his team with an established ERAS protocol which was previously described in detail elsewhere [ 14 , 15 ]. Of note, a hospital-based care bundle for the prevention of incisional SSI is a part of full ERAS protocol and practically comparable to Thailand’s SSI Prevention Bundle [ 12 ].…”

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

“…equipos ERAS alcancen una curva adecuada de aprendizaje y adherencia al protocolo. Algunos autores mencionan que se requieren mínimo 76 procedimientos de cirugía colorrectal electiva abierta 40,41 . Hasta el momento, la mayoría de los estudios sobre protocolos ERAS y desenlaces en cirugía colorrectal se han centrado en evaluar y comparar el nivel de adherencia al protocolo con resultados como la duración de la estancia hospitalaria posquirúrgica relacionada con el procedimiento principal y frecuencia de complicaciones.…”