Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study |
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| Institution: | 1. Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain;2. Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain;3. Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain;4. Universidad Complutense de Madrid, Madrid, Spain;5. Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy;6. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy;7. Barts and the London School of Medicine & Dentistry, Queen Mary University London, EC1M 6BQ, UK;8. Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire de Montpellier, Montpellier, France;9. The Francophone Group for Enhanced Recovery After Surgery (GRACE), France;10. Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France;11. Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK;12. Anesthesia and Reanimation CHU de Liège, Université de Liège, Liège, Belgium;13. Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.;14. Department of Anesthesia and Surgical Critical Care, General Hospital \"G. Papanikolaou\", Thessaloniki, Greece;15. Department of Anesthesiology, Istanbul University School of Medicine, Istanbul, Turkey;p. Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands.;q. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA;r. Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland;s. Department of Clinical Research, University of Basel, Basel, Switzerland;t. Department of Anesthesia and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria;u. Department of Anesthesiology and Intensive Care, Motol University Hospital, Prague, Czech Republic;v. Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic;w. Department of surgery, Aalborg University Hospital, Aalborg, Denmark;x. Opensource Research Collaboration, Denmark;y. 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland;z. Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania;11. Department of Surgery, Coloproctology Unit, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania;12. Colorectal Surgery, Rectal Cancer Reference Center, Centro Hospitalar do Porto, Porto, Portugal;13. Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal;14. Anesthesiology and Intensive Medicine, Medical School, Comenius University, Bratislava, Slovakia;15. Anesthesiology & Intensive Care Medicine, Institute for Oncology and Radiology of Serbia, Clinic of Surgical Oncology, Belgrade, Serbia;16. Department of Anesthesiology, Reanimatology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia;17. Department of Anesthesiology, Nicosia General Hospital, Nicosia, Cyprus;18. Anesthesia & Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain;19. Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway;110. Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA;111. Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA. USA;112. Department of General and Emergency Surgery, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy;113. Department of Anesthesiology and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain;114. Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain;115. Department of Anesthesiology and Perioperative Medicine, Hospital Universitario de Alava, Alava, Spain;1p. Department of Anesthesiology and Critical Care, Hospital Clínic, Institut d''Investigació August Pi i Sunyer, Barcelona, Spain;1q. CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain;1r. Department of General Surgery, BioCruces Bizkaia Health Research Institute, Hospital Universitario de Galdakao, Galdakao, Vizcaya, Spain;1s. Department of Anesthesiology and Perioperative Medicine, Hospital General Universitario de Valencia, Valencia, Spain;1t. Department of Advanced Medical and Surgical Sciences, Università degli Studi Della Campania \"Luigi Vanvitelli\", Naples, Italy;1u. Colorectal Surgery, Vall d''Hebron University Hospital, Barcelona, Spain;1v. Italian Surgical Research Group (ItSURG), Italy;1w. Anesthesia and Critical Care Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain;1x. Surgery Department, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy;1y. Surgery Department, University Hospital Leuven, Leuven, Belgium;1z. Anesthesia and Critical Care Department, Hospital Universitario Donostia, Donostia-San Sebastián, Spain;21. Anesthesia and Critical Care Department, Vall d''Hebrón University Hospital, Barcelona, Spain;22. Department of Anesthesia and Critical Care, Río Hortega University Hospital, Valladolid, Spain;23. Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain;24. Universidad de Zaragoza, Zaragoza, Spain;1. Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, China;2. Department of Critical Care, Shanghai Jiaotong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, China;1. Department of Anesthesiology and Critical Care Medicine, Children''s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, PA, USA;2. Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada;3. Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy.;4. Department of Anesthesiology and Peri-operative Medicine, Penn State Health, Hershey, PA, USA;5. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children''s Hospital, MA, USA;6. Department of Biomedical and Health Informatics, Children''s Hospital of Philadelphia, USA;7. Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India;8. Indian Association of Paediatric Anaesthesiologists, India |
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| Abstract: | Study objectiveAssess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.DesignProspective cohort study.SettingEuropean centers (185 hospitals) across 21 countries.PatientsA total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.InterventionsRoutine perioperative care.MeasurementsTwenty-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.ResultsA 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).ConclusionsTreatment 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. |
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