Good compliance to enhanced recovery program improves outcome after colorectal surgery
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and Other Interventional Techniques
Good compliance to enhanced recovery program improves outcome after colorectal surgery A. Hartman1 · D. Leonard1 · C. Trefois1 · C. Remue1 · R. Bachmann1 · N. Abbes Orabi1 · I. Lupu2 · B. Robu2 · A. Steyaert2 · A. Kartheuser1 Received: 30 March 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 = 24 h IV infusion ≥ day 2 No NSAIDs No epidural Demographic data Age Male BMI Tobacco Comorbidities Neoplasia Laparotomy
Length of hospitalization p value
Complication Severity of complication (Dindo–Clavien ≥ 3) p value
CI (95%)
p value CI (95%)
p value
Rehospitalization within 30 days postoperative p value
0.00003 NS 0.00526 0.01777 NS 0.00043 NS NS
NS NS 0.03102 0.03614 0.00087 0.0001 0.03389 NS
NS NS 4.28 (1.21—15.39) NS NS 13.4 (2.31–81.8) NS NS
NS NS 0.0246 NS NS 0.0047 NS NS
NS NS 6.45 (1.69–26.52) NS NS 21.03 (3.28–160.01) NS NS
NS NS 0.0067 NS NS 0.00163 NS NS
NS NS NS NS NS NS NS NS
NS NS NS NS NS NS NS
NS 0.03766 NS NS 0.00877 0.00693 0.01455
0.95 (0.9–1) 3.79 (1.16–15.24) NS NS NS NS 8.12 (1.16–40.27)
0.0318 0.0266 NS 0.0349 NS NS 0.0121
0.94 (0.9–1) 4.55 (1.21–22.73) 1.25 (1.02–1.6) 4.02 (1.01–16.69) NS NS 8.43 (1.27–55.77)
0.0379 0.0242 0.0268 0.0477 NS NS 0.0283
NS NS NS NS NS NS NS
Reintervention
NGT nasal-gastric tube, NSAIDs non-steroids anti-inflammatory drugs, CI confidence interval risk
outcomes, which are similar to other studies [10–14]. In fact, the current literature clearly shows that the higher the adhesion to an enhanced recovery program (ERP), the easier the postoperative recovery, the lower the complications, and the shortened hospitalization [15, 16]. In addition, our data show an increase of complication Din
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