Enhanced Recovery After Surgery: Can We Rely on the Key Factors or Do We Need the Bel Ensemble?
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The success of enhanced recovery (ERAS) pathways depends on the actual application of the intended protocol (adherence), but its full implementation remains challenging. In order to potentially streamline the pathway, it is indispensable to know the impact of individual items and the entire protocol on clinical outcomes.
Retrospective analysis including all consecutive colorectal ERAS patients since implementation (May 2011) until February 2014; demographics, adherence and outcomes were retrieved from a prospectively maintained database. Primary outcome was the impact of individual item and of the entire protocol on complications (overall and major) and length of hospital stay. Statistical analysis included logistic multivariate regression and adjustment for confounding factors.
There were 328 patients with complete data sets analyzed. A minimally invasive approach [odd ratio (OR) 0.62; confidence interval (CI) 0.4–0.9] was significantly associated with less overall complications. In contrast, the use of prophylactic nasogastric tubes (OR 3.18; CI 1.4–7.4), prophylactic abdominal and pelvic drains (OR 1.96; 1.2–3.2) and intraoperative thoracic epidural analgesia (OR 1.76; CI 1.3–2.4) were associated with more overall complications. Minimal invasive approach was further associated with reduced hospital stay (OR 0.5; CI 0.4–0.7) and less major complications (OR 0.58; CI 0.4–0.8). Higher adherence to the entire ERAS protocol was associated with significantly less complications (P < 0.001) and shorter hospital stay (P < 0.001).
Minimally invasive surgery was the single most important component of the ERAS pathway while nasogastric tubes, drains and epidurals should be avoided. Overall, increasing adherence with the protocol was associated with better outcomes and should be the goal.
KeywordsSegmental Colectomy Minimal Invasive Approach Abdominal Hernia Repair Perfect Protocol Stoma Procedure
Enhanced recovery after surgery
JJ contributed to conception, analysis, and interpretation, drafting. JS contributed to analysis, interpretation, and critical revision. PF helped in interpretation and critical revision. VA acquired data and critically revised it. JS analyzed, interpreted, and critically revised the data. ND contributed to conception and major critical editing. MH contributed to conception, analysis, interpretation, drafting, and major critical editing. All authors approved the final version.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
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