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Effect of implementation of enhanced recovery after surgery (ERAS) protocol and risk factors on 3-year survival after colorectal surgery for cancer–a retrospective cohort of 1001 patients

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Abstract

Purpose

Several recent studies have shown that the enhanced recovery after surgery (ERAS) protocol reduces morbidity and mortality and shortens the length of stay compared to conventional recovery strategy (pre-ERAS). The aim of this study was to evaluate the effect of the implementation of this protocol on 3-year overall survival and postoperative outcome in patients undergoing colorectal resection for cancer.

Methods

This was a retrospective, single-center, comparative, and non-randomized study. Between January, 2005, and December, 2017, 1001 patients were included (ERAS, n = 497; pre-ERAS, n = 504).

Results

The 3-year overall survival rate was significantly better for ERAS than for pre-ERAS patients (76.1 vs 69.2%; p = 0.017). The length of hospital stay (median 10 days vs 15; p =  ≤ 0.001) and the 90-day readmission rate (15 vs 20%; p = 0.037) were significantly lower in the ERAS group. Three-year recurrence-free survival (p = 0.398) and 90-day complications (p = 0.560) were similar in the two groups. Analysis of 3-year survival by a multivariate Cox model identified ERAS as a protective factor with a 30% reduction in the risk of death: (HR = 0.70 [0.55–0.90]).

Conclusion

The implementation of the ERAS protocol was associated with an improvement in 3-year survival, a reduction of the length of hospital stay and the rate of readmission. ERAS is associated with better 3-year survival, independent of other commonly considered parameters. An ASA score > 2, smoking, a history of cancer, and atrial fibrillation are deleterious risk factors linked to earlier mortality.

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Change history

  • 08 May 2022

    In the affiliation 2 postal code has been updated and the data under the section "Duration of hospitalization" and "Discussion" that were mistakenly presented as reference citations has been corrected.

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Author information

Authors and Affiliations

  1. Colorectal Unit, Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble, France

    Fatah Tidadini, Aline Bonne, Bertrand Trilling, Pierre-Yves Sage, Alison Foote, Catherine Arvieux & Jean-Luc Faucheron

  2. Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France

    Fatah Tidadini & Catherine Arvieux

  3. Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, 38043, Grenoble, France

    Jean-Louis Quesada

Authors
  1. Fatah Tidadini
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  2. Aline Bonne
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  3. Bertrand Trilling
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  4. Jean-Louis Quesada
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  5. Pierre-Yves Sage
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  6. Alison Foote
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  7. Catherine Arvieux
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  8. Jean-Luc Faucheron
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Corresponding author

Correspondence to Jean-Luc Faucheron.

Ethics declarations

Ethics approval

Study ethics approval was obtained on 25 August 2021 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891) and was registered in the internal register of the Grenoble Alpes University Hospital of studies respecting the reference methodology MR004 of the French National Commission for Informatics and Freedoms (CNIL).

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Patients were informed that their anonymized data might in the future be the subject of clinical research and could oppose this by informing the doctor.

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Not required.

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The authors declare no competing interests.

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Tidadini, F., Bonne, A., Trilling, B. et al. Effect of implementation of enhanced recovery after surgery (ERAS) protocol and risk factors on 3-year survival after colorectal surgery for cancer–a retrospective cohort of 1001 patients. Int J Colorectal Dis 37, 1151–1159 (2022). https://doi.org/10.1007/s00384-022-04155-1

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  • DOI: https://doi.org/10.1007/s00384-022-04155-1

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