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Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions.

Methods

Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions.

Results

A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197–0.9202 and 95%CI 0.7821–0.9603), hospitalization (OR 0.53 95%CI 0.4917–0.5845) and reinterventions (OR 0.84 95%CI 0.7536–0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036–0.5801), left-sided (OR 0.48 95%CI 0.3984–0.5815), and rectal resections (OR 0.46 95%CI 0.3753–0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976–0.9773 and 95%CI 0.7418–0.9634).

Conclusions

Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.

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Lazio Network collaborators

Domenico D’Ugo1, Liliana Sollazzi1, Maria Cristina Mele1, Antonio Gasbarrini1, Flavio Tirelli1, Maria Carmen Lirosi1, Emanuele Rinninnella1, Marco Cintoni1, Enrica Adducci1, Paola Marino2, Chiara Benucci2, Laura De Luca2, Domenico Spoletini3, Filippo Palla3, Giulia Tarantino3, Giuseppe Lamacchia3, Gian Marco Giorgetti3, Marcello Gasparrini4, Fabrizio Apponi4, Massimiliano Pezzatini4, Fabiana Troisi4, Gherardo Romeo4, Giovanni Battista Levi Sandri5, Andrea Mazzari6, Paolo Diamanti6, Lucilla Muccichini6, Damiano Menghetti6, Pietro Maria Amodio7, Pietro Vecchiarelli7, Paola Paiolo7, Giuseppe Pedullà8, Raffaele Donadio8, Giulia Russo9, Lorenzo Firmi9, Matteo De Stefano10, Marcello Palladino10, Francesca Pietrosanti10.

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Authors and Affiliations

  1. General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli–IRCCS, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy

    Michele Grieco, Laura Lorenzon & Roberto Persiani

  2. San Giovanni Addolorata Hospital, Rome, Italy

    Graziano Pernazza

  3. Sant’Eugenio Hospital, Rome, Italy

    Massimo Carlini

  4. Sant’Andrea University Hospital, “Sapienza” University, Rome, Italy

    Antonio Brescia

  5. Santa Scolastica Hospital, Cassino, Frosinone, Italy

    Roberto Santoro

  6. Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

  7. Belcolle Hospital, Viterbo, Italy

    Raffaele Macarone Palmieri

  8. San Paolo Hospital, Civitavecchia, Rome, Italy

    Emanuele Santoro

  9. San Camillo De Lellis Hospital, Rieti, Italy

    Francesco Stipa

  10. Santa Maria Goretti Hospital, Latina, Italy

    Marco Sacchi

Authors
  1. Michele Grieco
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  2. Laura Lorenzon
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  3. Graziano Pernazza
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  4. Massimo Carlini
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  5. Antonio Brescia
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  6. Roberto Santoro
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  7. Antonio Crucitti
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  8. Raffaele Macarone Palmieri
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  9. Emanuele Santoro
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  10. Francesco Stipa
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  11. Marco Sacchi
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  12. Roberto Persiani
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Corresponding author

Correspondence to Michele Grieco.

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Conflict of interest

Michele Grieco, Laura Lorenzon, Graziano Pernazza, Massimo Carlini, Antonio Brescia, Roberto Santoro, Antonio Crucitti, Raffaele Macarone Palmieri, Emanuele Santoro, Francesco Stipa, Marco Sacchi, Roberto Persiani and the “Lazio Network” collaborators have no conflicts of interest or financial ties that are relevant to this article to disclose

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Supplementary Fig. 1

Study flowchart according to the STROBE criteria (JPG 232 kb)

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Grieco, M., Lorenzon, L., Pernazza, G. et al. Impact of implementation of the ERAS program in colorectal surgery: a multi-center study based on the “Lazio Network” collective database. Int J Colorectal Dis 35, 445–453 (2020). https://doi.org/10.1007/s00384-019-03496-8

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  • DOI: https://doi.org/10.1007/s00384-019-03496-8

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