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

Ripollés-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 Group (Universidad de Zaragoza) ; Echazarreta-Gallego, E.

Resumen: 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. © 2022 Elsevier Inc.

Idioma: Inglés

DOI: 10.1016/j.jclinane.2022.110752

Año: 2022

Publicado en: JOURNAL OF CLINICAL ANESTHESIA 80 (2022), 110752 [10 pp.]
ISSN: 0952-8180

Factor impacto JCR: 6.7 (2022)

Categ. JCR: ANESTHESIOLOGY rank: 5 / 35 = 0.143 (2022) - Q1 - T1

Factor impacto CITESCORE: 6.7 - Medicine (Q1)

Factor impacto SCIMAGO: 1.019 - Anesthesiology and Pain Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Cirugía (Dpto. Cirugía)