Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study.

Ripollés-Melchor, Javier; Abad-Motos, Ane; Cecconi, Maurizio; Pearse, Rupert; Jaber, Samir; Slim, Karem; Francis, Nader; Spinelli, Antonino; Joris, Jean; Ioannidis, Orestis; Zarzava, Eirini; Şentürk, Nüzhet Mert; Koopman, Seppe; Goettel, Nicolai; Stundner, Ottokar; Vymazal, Tomas; Kocián, Petr; El-Hussuna, Alaa; Pędziwiatr, Michał; Gudaityte, Jurate; Latkauskas, Tadas; Santos, Marisa D; Machado, Humberto; Zahorec, Roman; Cvetković, Ana; Miric, Mirjana; Georgiou, Maria; Díez-Remesal, Yolanda; Jammer, Ib; Mena, Gabriel E; Zorrilla-Vaca, Andrés; Marino, Marco V; Suárez-de-la-Rica, Alejandro; García-Erce, José A; Logroño-Ejea, Margarita; Ferrando-Ortolá, Carlos; De-Fuenmayor-Valera, María L; Ugarte-Sierra, Bakarne; de Andrés-Ibañez, José; Abad-Gurumeta, Alfredo; Pellino, Gianluca; Gómez-Ríos, Manuel A; Poggioli, Gilberto; Menzo-Wolthuis, Albert; Castellano-Paulis, Berta; Galán-Menéndez, Patricia; Aldecoa, César; Ramírez-Rodríguez, José M; EuroPOWER Study Investigators Group; Spanish Perioperative Audit and Research Network (RedGERM-SPARN); Francophone Group for Enhanced Recovery After Surgery (GRACE)

doi:10.1016/j.jclinane.2022.110752

Article (Scientific journals)

Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study.

Ripollés-Melchor, Javier; Abad-Motos, Ane; Cecconi, Maurizio et al.

2022 • In Journal of Clinical Anesthesia, 80, p. 110752

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/296079

DOI
10.1016/j.jclinane.2022.110752

PubMed
35405517

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Keywords :

Colorectal surgery; ERAS; Enhanced recovery; Optimization; Perioperative management; Postoperative complications; Adult; Elective Surgical Procedures/adverse effects; Humans; Length of Stay; Observational Studies as Topic; Perioperative Care/methods; Postoperative Complications/epidemiology; Postoperative Complications/etiology; Prospective Studies; Colorectal Surgery/adverse effects; Enhanced Recovery After Surgery; Elective Surgical Procedures; Perioperative Care; Anesthesiology and Pain Medicine

Abstract :

[en] STUDY OBJECTIVE: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes. DESIGN: Prospective cohort study. SETTING: European centers (185 hospitals) across 21 countries. PATIENTS: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020. INTERVENTIONS: Routine perioperative care. MEASUREMENTS: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences. RESULTS: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001). CONCLUSIONS: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.

Disciplines :

Anesthesia & intensive care
Surgery

Author, co-author :

Ripollés-Melchor, Javier; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain, Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain, Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: javier.ripolles@salud.madrid.org

Abad-Motos, Ane; Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain, Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain, Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain

Cecconi, Maurizio; Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

Pearse, Rupert; Barts and the London School of Medicine & Dentistry, Queen Mary University London, EC1M 6BQ, UK

Jaber, Samir; Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire de Montpellier, Montpellier, France, The Francophone Group for Enhanced Recovery After Surgery (GRACE), France

Slim, Karem; The Francophone Group for Enhanced Recovery After Surgery (GRACE), France, Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France

Francis, Nader; Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK

Spinelli, Antonino; Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

Joris, Jean ; Université de Liège - ULiège

Ioannidis, Orestis; Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

More authors (41 more)

Language :

English

Title :

Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study.

Publication date :

2022

Journal title :

Journal of Clinical Anesthesia

ISSN :

0952-8180

Publisher :

Elsevier Inc., United States

Volume :

Pages :

110752

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S095281802200109X?httpAccept=text/xml

Funding text :

This research did not receive a specific grant from funding agencies in the public, commercial or not-for-profit sectors. Support was provided solely from institutional and/or departmental sources. The Postoperative Outcomes within Enhanced Recovery After Surgery Protocol in Europe (EuroPOWER) study was supported by the Spanish Perioperative Audit and Research Network (RedGERM), The Francophone Group for Enhanced Recovery After Surgery (GRACE), the Grupo Español de Rehabilitación Multimodal (GERM), the Spanish Society of Anesthesia and Critical Care (SEDAR), and the Swiss Society of Anesthesiology and Reanimation (SGAR/SSAR).Javier Garc?a-Fern?ndez, PhD (Hospital Universitario Puerta de Hierro, Majadahonda, Spain), as President Elect of the Spanish Society of Anesthesiology and Critical Care (SEDAR), the Enhanced Recovery After Surgery Society United Kingdom (ERAS UK), the European Society of Anesthesia and Intensive Care (ESAIC) and the Italian Surgical Research Group (ItSURG), provided a no compensated pre-recruitment announcement of the study on their respective Internet websites. The European Society of Coloproctology (ESCP) disinterestedly inserted EuroPOWER in the ESCP Trial Map. Alejandro Bona Enguita, MD (Zaragoza, Spain) serves as the webmaster for the EuroPOWER Internet website. Alberto Cebollada-Solanas, MD (Zaragoza, Spain) assisted with statistical analyses. This research did not receive a specific grant from funding agencies in the public, commercial or not-for-profit sectors. Support was provided solely from institutional and/or departmental sources. The Postoperative Outcomes within Enhanced Recovery After Surgery Protocol in Europe (EuroPOWER) study was supported by the Spanish Perioperative Audit and Research Network (RedGERM), The Francophone Group for Enhanced Recovery After Surgery (GRACE), the Grupo Espa?ol de Rehabilitaci?n Multimodal (GERM), the Spanish Society of Anesthesia and Critical Care (SEDAR), and the Swiss Society of Anesthesiology and Reanimation (SGAR/SSAR). Role of the Funder/Sponsor: RedGERM had a role in the design and study protocol of the study; collection, management, but had no role in the analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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