Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (power) study

Ripollés-Melchor, Javier ; Ramírez-Rodríguez, José M. (Universidad de Zaragoza) ; Casans-Francés, Rubén (Universidad de Zaragoza) ; Aldecoa, César ; Abad-Motos, Ane ; Logroño-Egea, Margarita ; García-Erce, José Antonio ; Camps-Cervantes, Ángels ; Ferrando-Ortolá, Carlos ; Suarez de la Rica, Alejandro ; Cuellar-Martínez, Ana ; Marmaña-Mezquita, Sandra ; Abad-Gurumeta, Alfredo ; Calvo-Vecino, José M. ; Martínez Ubieto, Javier (Universidad de Zaragoza) ; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM)

Resumen: Importance: enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective: to determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, setting, and participants: the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures: colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main outcomes and measures: the primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results: between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P¿=¿.01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P¿<¿.001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P¿<¿.001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P¿<¿.001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P¿=¿.06) compared with those who had the lowest adherence rates. Conclusions and relevance: an increase in ERAS adherence appears to be associated with a decrease in postoperative complications.

Idioma: Inglés

DOI: 10.1001/jamasurg.2019.0995

Año: 2019

Publicado en: JAMA Surgery 154, 8 (2019), 725-736
ISSN: 2168-6254

Factor impacto JCR: 13.625 (2019)

Categ. JCR: SURGERY rank: 1 / 209 = 0.005 (2019) - Q1 - T1

Factor impacto SCIMAGO: 3.757 - Surgery (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)