000089881 001__ 89881 000089881 005__ 20240205160604.0 000089881 0247_ $$2doi$$a10.1001/jamasurg.2019.0995 000089881 0248_ $$2sideral$$a112336 000089881 037__ $$aART-2019-112336 000089881 041__ $$aeng 000089881 100__ $$aRipollés-Melchor, Javier 000089881 245__ $$aAssociation 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 000089881 260__ $$c2019 000089881 5060_ $$aAccess copy available to the general public$$fUnrestricted 000089881 5203_ $$aImportance: 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. 000089881 540__ $$9info:eu-repo/semantics/openAccess$$aAll rights reserved$$uhttp://www.europeana.eu/rights/rr-f/ 000089881 592__ $$a3.757$$b2019 000089881 590__ $$a13.625$$b2019 000089881 593__ $$aSurgery$$c2019$$dQ1 000089881 591__ $$aSURGERY$$b1 / 209 = 0.005$$c2019$$dQ1$$eT1 000089881 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000089881 700__ $$0(orcid)0000-0001-7964-1166$$aRamírez-Rodríguez, José M.$$uUniversidad de Zaragoza 000089881 700__ $$0(orcid)0000-0002-0620-9871$$aCasans-Francés, Rubén$$uUniversidad de Zaragoza 000089881 700__ $$aAldecoa, César 000089881 700__ $$aAbad-Motos, Ane 000089881 700__ $$aLogroño-Egea, Margarita 000089881 700__ $$aGarcía-Erce, José Antonio 000089881 700__ $$aCamps-Cervantes, Ángels 000089881 700__ $$aFerrando-Ortolá, Carlos 000089881 700__ $$aSuarez de la Rica, Alejandro 000089881 700__ $$aCuellar-Martínez, Ana 000089881 700__ $$aMarmaña-Mezquita, Sandra 000089881 700__ $$aAbad-Gurumeta, Alfredo 000089881 700__ $$aCalvo-Vecino, José M. 000089881 700__ $$0(orcid)0000-0003-2462-1904$$aMartínez Ubieto, Javier$$uUniversidad de Zaragoza 000089881 700__ $$aPOWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM) 000089881 7102_ $$11004$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía,Ginecol.Obstetr.$$cÁrea Cirugía 000089881 773__ $$g154, 8 (2019), 725-736$$pJAMA surg.$$tJAMA Surgery$$x2168-6254 000089881 8564_ $$s198124$$uhttps://zaguan.unizar.es/record/89881/files/texto_completo.pdf$$yVersión publicada 000089881 8564_ $$s2174737$$uhttps://zaguan.unizar.es/record/89881/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000089881 909CO $$ooai:zaguan.unizar.es:89881$$particulos$$pdriver 000089881 951__ $$a2024-02-05-16:03:10 000089881 980__ $$aARTICLE