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Good compliance to enhanced recovery program improves outcome after colorectal surgery

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Abstract

Aim of the study

The fast-track (FT) protocol consists of several measures to optimize physiologic response to the surgical stress and improve postoperative outcome. Our goal was to evaluate the compliance to our protocol and to analyze the effect of compliance to the FT protocol on postoperative outcome and postoperative hospital stay. We also aimed to identify isolated FT measures able to influence outcome.

Methods

This retrospective study involves a cohort of consecutive patients who underwent colorectal surgery within a FT protocol between 2007 and 2013. Beside basic demographics, adherence to protocol, postoperative complications, and postoperative hospital stay (POHS) were recorded. Both univariate and multivariate analyses were performed to determine the predictive value of the FT protocol compliance and of specific FT items on surgical outcome and POHS.

Results

There were 284 patients with a mean age of 58 years. Compliance to the FT protocol reached a median of 18 out of 19 items. The median hospital stay was 3 days (2–49). Overall complications rate was 34.9% and 7,4% when Dindo–Clavien classification > 2 was considered. Higher compliance to the FT protocol reduces the complication rate (p = 0.00004), severity of complication (p = 0.002), and POHS (p =  < 0.00001). We have not been able to identify any specific isolated FT measure able to influence post-operative outcome.

Conclusions

Greater adherence to the FT protocol decreases postoperative complications and POHS. Our data support a holistic effect of the FT protocol rather than specific isolated measures to improve the patient’s postoperative outcome.

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References

  1. Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF (2014) Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 101:172–188

    Article  CAS  Google Scholar 

  2. Lyon A, Payne CJ, Mackay GJ (2012) Enhanced recovery programme in colorectal surgery: does one size fit all? World J Gastroenterol 18:5661–5663

    Article  Google Scholar 

  3. Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847

    Article  Google Scholar 

  4. Gustafsson UO, Scott MJ, Hubner M et al (2019) Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018. World J Surg 43:659–695

    Article  CAS  Google Scholar 

  5. Slim K, Delaunay L, Joris J et al (2016) How to implement an enhanced recovery programme? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE). J Visc Surg 153:45–49

    Article  Google Scholar 

  6. Liang L, Juying J, Su M, Dan L, Ling L (2017) Compliance with the enhanced recovery after surgery protocol and prognosis after colorectal cancer surgery: a prospective cohort study. Oncotarget 32:53531–53541

    Google Scholar 

  7. Pedziwiatr M, Kisialeuski M, Wierdak M et al (2015) Early implementation of Enhanced Recovery After Surgery (ERAS(R)) protocol—compliance improves outcomes: a prospective cohort study. Int J Surg 21:75–81

    Article  Google Scholar 

  8. Gustafsson UO, Oppelstrup H, Thorell A, Nygren J, Ljungqvist O (2016) Adherence to the ERAS protocol is associated with 5-Year survival after colorectal cancer surgery: a retrospective cohort study. World J Surg 40:1741–1747

    Article  Google Scholar 

  9. Maggiori L, Rullier E, Lefevre JH et al (2017) Does a combination of laparoscopic approach and full fast track multimodal management decrease postoperative morbidity?: A multicenter randomized controlled trial. Ann Surg 266:729–737

    Article  Google Scholar 

  10. Feroci F, Lenzi E, Baraghini M et al (2013) Fast-track colorectal surgery: protocol adherence influences postoperative outcomes. Int J Colorectal Dis 28:103–109

    Article  Google Scholar 

  11. Maessen J, Dejong CH, Hausel J et al (2007) A protocol is not enough to implement an enhanced recovery programme for colorectal resection. Br J Surg 94:224–231

    Article  CAS  Google Scholar 

  12. Thorn CC, White I, Burch J, Malietzis G, Kennedy R, Jenkins JT (2016) Active and passive compliance in an enhanced recovery program. Int J Colorectal Dis 31:1329–1339

    Article  Google Scholar 

  13. Ramirez JM, Blasco JA, Roig JV et al (2011) Enhanced recovery in colorectal surgery: a multicenter study. BMC Surg 11:9–16

    Article  Google Scholar 

  14. Gustafsson UO, Hausel J, Thorell A et al (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577

    Article  Google Scholar 

  15. Jurt J, Slieker J, Frauche P et al (2017) Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg 41:2464–2470

    Article  Google Scholar 

  16. Martin D, Roulin D, Grass F et al (2017) A multicentre qualitative study assessing implementation of an enhanced recovery after surgery program. Clin Nutr 37(6):1–6

    Google Scholar 

  17. Day R, Fielder S, Calhoun J, Kehlet H, Gottumukkala V, Aloia T (2015) Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement. Br J Surg 102:1594–1602

    Article  Google Scholar 

  18. Slim K, Joris J (2017) The egg-and-chicken situation in postoperative enhanced recovery programmes. Br J Anaesth 118:5–6

    Article  CAS  Google Scholar 

  19. Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L (2013) Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial. Obstet Gynecol 121:533–537

    Article  Google Scholar 

  20. Slim K, Vignaud M (2015) Enhanced recovery after surgery: The patient, the team, and the society. Anaesth Crit Care Pain Med 34:249–250

    Article  Google Scholar 

  21. Harper CM, Lyles YM (1988) Physiology and complications of bed rest. J Am Geriatr Soc 36:1047–1054

    Article  CAS  Google Scholar 

  22. Bakker N, Cakir H, Doodeman HJ, Houdijk PJ (2015) Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: Impact of measures to improve adherence. Surgery 157:1130–1136

    Article  Google Scholar 

  23. Feroci F, Lenzi E, Baraghini M et al (2013) Fast-track surgery in real life: how patient factors influence outcomes and compliance with an enhanced recovery clinical pathway after colorectal surgery. Surg Laparosc Endosc Percutan Tech 23:259–265

    Article  Google Scholar 

  24. Gotlib Conn L, McKenzie M, Pearsall E, McLeod R (2015) Successful implementation of an enhanced recovery after surgery programme for elective colorectal surgery: a process evaluation of champions experiences. Implement Sci 10:99–109

    Article  Google Scholar 

  25. Dhruva Rao P, Haray P (2014) Enhanced recovery after colorectal surgery: principles and current practice. Surgery 32:185–189

    Google Scholar 

  26. Simpson J, Moonesinghe S, Grocott M et al (2015) Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth 115:560–568

    Article  CAS  Google Scholar 

  27. Ament SM, Gillisen F, Moser A et al (2014) Identification of promising strategies to sustain improvements in hospital practive: a qualitative case study. BMC Health Serv Res 14:641–652

    Article  Google Scholar 

  28. Pearsall EA, Meghji Z, Pitzul KB et al (2015) A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 261:92–96

    Article  Google Scholar 

  29. Kahokehr A, Robertson P, Sammour T, Soop M, Hill AG (2011) Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Colorectal Dis 13:1308–1313

    Article  CAS  Google Scholar 

  30. King A, Alvis B, Mc EM (2016) Enhanced recovery after surgery, perioperative medicine, and the perioperative surgical home. Curr Opin Anesthesiol 29:727–732

    Article  Google Scholar 

  31. Hartman A, Leonard D, Bachmann R, Abbes Orabi N, Remue C, Kartheuser A. (2016) La réhabilitation améliorée ou le « Fast Track » après chirurgie colorectale : 10 ans plus tard. Louvain Médical 305–13.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate, 10, 1200, Bruxelles, Belgium

    A. Hartman, D. Leonard, C. Trefois, C. Remue, R. Bachmann, N. Abbes Orabi & A. Kartheuser

  2. Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruxelles, Belgium

    I. Lupu, B. Robu & A. Steyaert

Authors
  1. A. Hartman
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  2. D. Leonard
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  3. C. Trefois
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  4. C. Remue
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  5. R. Bachmann
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  6. N. Abbes Orabi
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  7. I. Lupu
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  8. B. Robu
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  9. A. Steyaert
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  10. A. Kartheuser
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Corresponding author

Correspondence to A. Kartheuser.

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Disclosures

Drs Hartman, Leonard, Trefois, Remue, Bachmann, Abbes Orabi, Lupu, Robu, Steyaert, and Kartheuser have no conflicts of interest or financial ties to disclose.

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Hartman, A., Leonard, D., Trefois, C. et al. Good compliance to enhanced recovery program improves outcome after colorectal surgery. Surg Endosc 35, 4214–4221 (2021). https://doi.org/10.1007/s00464-020-07903-y

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  • DOI: https://doi.org/10.1007/s00464-020-07903-y

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