Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry

Marco Braga, N. Pecorelli, Marco Scatizzi, Felice Borghi, Giancarlo Missana, Danilo Radrizzani, Marco Azzola, Luigi Beretta, Carlo Bima, Stefano Bona, Hedayat Bouzari, Umberto Casiraghi, Andrea Pisani Ceretti, Michele Crespi, Ferdinando Ficari, Riccardo Iuliani, Marianna Maspero, Roberta Monzani, Andrea Muratore, Luca Pellegrino

Research output: Contribution to journalArticle

Abstract

Background: Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection. Methods: Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I–II vs. III–IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes. Results: Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2 %) patients without significant differences among groups (p = 0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3–6) days, length of hospital stay (LOS) was 6 (4–7) days, and both were significantly shorter by only 1 day in the groups of younger patients (p < 0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS. Conclusion: ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalWorld Journal of Surgery
DOIs
Publication statusAccepted/In press - Oct 20 2016

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Colorectal Surgery
Registries
Length of Stay
Laparoscopy
Morbidity
Postoperative Nausea and Vomiting
Urinary Catheters
Epidural Analgesia
Multivariate Analysis
Regression Analysis

ASJC Scopus subject areas

  • Surgery

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Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery : Results from the PeriOperative Italian Society Registry. / Braga, Marco; Pecorelli, N.; Scatizzi, Marco; Borghi, Felice; Missana, Giancarlo; Radrizzani, Danilo; Azzola, Marco; Beretta, Luigi; Bima, Carlo; Bona, Stefano; Bouzari, Hedayat; Casiraghi, Umberto; Ceretti, Andrea Pisani; Crespi, Michele; Ficari, Ferdinando; Iuliani, Riccardo; Maspero, Marianna; Monzani, Roberta; Muratore, Andrea; Pellegrino, Luca.

In: World Journal of Surgery, 20.10.2016, p. 1-8.

Research output: Contribution to journalArticle

Braga, M, Pecorelli, N, Scatizzi, M, Borghi, F, Missana, G, Radrizzani, D, Azzola, M, Beretta, L, Bima, C, Bona, S, Bouzari, H, Casiraghi, U, Ceretti, AP, Crespi, M, Ficari, F, Iuliani, R, Maspero, M, Monzani, R, Muratore, A & Pellegrino, L 2016, 'Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry', World Journal of Surgery, pp. 1-8. https://doi.org/10.1007/s00268-016-3766-9
Braga, Marco ; Pecorelli, N. ; Scatizzi, Marco ; Borghi, Felice ; Missana, Giancarlo ; Radrizzani, Danilo ; Azzola, Marco ; Beretta, Luigi ; Bima, Carlo ; Bona, Stefano ; Bouzari, Hedayat ; Casiraghi, Umberto ; Ceretti, Andrea Pisani ; Crespi, Michele ; Ficari, Ferdinando ; Iuliani, Riccardo ; Maspero, Marianna ; Monzani, Roberta ; Muratore, Andrea ; Pellegrino, Luca. / Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery : Results from the PeriOperative Italian Society Registry. In: World Journal of Surgery. 2016 ; pp. 1-8.
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abstract = "Background: Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection. Methods: Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I–II vs. III–IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes. Results: Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2 {\%}) patients without significant differences among groups (p = 0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3–6) days, length of hospital stay (LOS) was 6 (4–7) days, and both were significantly shorter by only 1 day in the groups of younger patients (p < 0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS. Conclusion: ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.",
author = "Marco Braga and N. Pecorelli and Marco Scatizzi and Felice Borghi and Giancarlo Missana and Danilo Radrizzani and Marco Azzola and Luigi Beretta and Carlo Bima and Stefano Bona and Hedayat Bouzari and Umberto Casiraghi and Ceretti, {Andrea Pisani} and Michele Crespi and Ferdinando Ficari and Riccardo Iuliani and Marianna Maspero and Roberta Monzani and Andrea Muratore and Luca Pellegrino",
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T2 - Results from the PeriOperative Italian Society Registry

AU - Braga, Marco

AU - Pecorelli, N.

AU - Scatizzi, Marco

AU - Borghi, Felice

AU - Missana, Giancarlo

AU - Radrizzani, Danilo

AU - Azzola, Marco

AU - Beretta, Luigi

AU - Bima, Carlo

AU - Bona, Stefano

AU - Bouzari, Hedayat

AU - Casiraghi, Umberto

AU - Ceretti, Andrea Pisani

AU - Crespi, Michele

AU - Ficari, Ferdinando

AU - Iuliani, Riccardo

AU - Maspero, Marianna

AU - Monzani, Roberta

AU - Muratore, Andrea

AU - Pellegrino, Luca

PY - 2016/10/20

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N2 - Background: Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection. Methods: Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I–II vs. III–IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes. Results: Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2 %) patients without significant differences among groups (p = 0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3–6) days, length of hospital stay (LOS) was 6 (4–7) days, and both were significantly shorter by only 1 day in the groups of younger patients (p < 0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS. Conclusion: ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.

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