doi:10.1016/j.jclinane.2022.110752engRipollés-Melchor, J.Abad-Motos, A.Cecconi, M.Pearse, R.Jaber, S.Slim, K.Francis, N.Spinelli, A.Joris, J.Ioannidis, O.Zarzava, E.Sentürk, N.M.Koopman, S.Goettel, N.Stundner, O.Vymazal, T.Kocián, P.El-Hussuna, A.Pedziwiatr, M.Gudaityte, J.Latkauskas, T.Santos, M.D.Machado, H.Zahorec, R.Cvetkovic, A.Miric, M.Georgiou, M.Díez-Remesal, Y.Jammer, I.Mena, G E.Zorrilla-Vaca, A.Marino, M.V.Suárez-de-la-Rica, A.García-Erce, J.A.Logroño-Ejea, M.Ferrando-Ortolá, C.De-Fuenmayor-Valera, M.L.Ugarte-Sierra, B.de Andrés-Ibañez, J.Abad-Gurumeta, A.Pellino, G.Gómez-Ríos, M.A.Poggioli, G.Menzo-Wolthuis, A.Castellano-Paulis, B.Galán-Menéndez, P.Aldecoa, C.Ramírez-Rodríguez, J.M., on behalf of the EuroPOWER Study Investigators GroupEchazarreta-Gallego, E.Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational studyART-2022-128709Study 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. © 2022 Elsevier Inc.2022http://zaguan.unizar.es/record/13277710.1016/j.jclinane.2022.110752http://zaguan.unizar.es/record/132777oai:zaguan.unizar.es:132777JOURNAL OF CLINICAL ANESTHESIA 80 (2022), 110752 [10 pp.]All rights reservedhttp://www.europeana.eu/rights/rr-f/info:eu-repo/semantics/closedAccess