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Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study

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Abstract

Background

The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge.

Methods

A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twenty-three ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS).

Results

Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235–0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151–0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate >70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694–0.950; P 0.009).

Conclusions

These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.

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Author notes

  1. Luca Gianotti and Uberto Fumagalli Romario have equally contributed to first authorship.

Authors and Affiliations

  1. Department of Surgery, School of Medicine and Surgery, San Gerardo Hospital, Milano - Bicocca University, Monza, Italy

    Luca Gianotti, Marta Sandini & Giovanni Colombo

  2. Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy

    Uberto Fumagalli Romario & Stefano De Pascale

  3. General and Esophagogastric Surgery, University of Verona, Verona, Italy

    Jacopo Weindelmayer, Valentina Mengardo & Giovanni De Manzoni

  4. Digestive Surgery, San Raffaele Hospital, San Raffaele Vita e Salute University, Milan, Italy

    Andrea Cossu, Paolo Parise & Riccardo Rosati

  5. Oncologic and Robotic Surgery, Department of Oncology, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy

    Lapo Bencini & Andrea Coratti

  6. Department of Surgery, ASST Settelaghi, Varese, Italy

    Federica Galli

  7. Department of Surgery, ASST Valle Olona, Gallarate, Italy

    Stefano Rausei

  8. General Surgery, Vannini-Figlie di San Camillo Hospital, Rome, Italy

    Francesco Casella & Andrea Sansonetti

  9. General Surgery 3, ASST-Monza, Desio Hospital, Desio, Italy

    Dario Maggioni & Andrea Costanzi

  10. Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy

    Davide P. Bernasconi

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  1. Luca Gianotti
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Correspondence to Uberto Fumagalli Romario.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the institution ethics committee (authorization number 1383). All authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data. All authors participated in drafting the article or revising it critically for important intellectual content. All authors gave final approval of the version to be submitted and any revised version to be published.

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Informed consent was obtained from all individual participants included in the study.

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Uberto Fumagalli Romario: Previously affiliated in Esophagogastric Surgery, Istituto Clinico Humanitas, Rozzano, Italy.

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Gianotti, L., Fumagalli Romario, U., De Pascale, S. et al. Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population-Based Prospective Multicenter Study. World J Surg 43, 2490–2498 (2019). https://doi.org/10.1007/s00268-019-05068-x

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