Early non compliance to enhanced recovery pathway might be an alert for underlying complications following colon surgery. in European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology / Eur J Surg Oncol. 2024 May;50(5):106650. doi: 10.1016/j.ejso.2022.06.033. Epub 2022 Jul 1.

2024
ASL Biella
ASL Torino 3
AO Cuneo
AO Ordine Mauriziano

Tipo pubblicazione

Journal Article

Autori/Collaboratori (5)Vedi tutti...

Ficari F
General Surgery, Careggi Hospital - University of Firenze, Firenze, Italy.
Braga M
General and Emergency Surgery Dept, University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy. Electronic address: marco.braga@unimib.it.
Pellegrino L
General Surgery, Cuneo Hospital, Cuneo, Italy.

et alii...

Abstract

PURPOSE: Early non compliance to postoperative ERAS pathway has been reported in 20-30% of patients who underwent elective colon surgery. The aim of the present study is to investigate the possible relationship between early non compliance and postoperative complications. METHODS: We reviewed a prospective database including 1391 consecutively collected patients undergoing elective colon surgery in 22 Italian hospitals between January 2017 and June 2020. Early compliance to ERAS protocol was assessed on postoperative day (POD) 2. Failure of oral feeding, urinary catheter removal, intravenous fluids stop, and adequate mobilization were indicators of non compliance. Postoperative follow-up was carried out for 30 days after hospital discharge. The association among early postoperative ERAS compliance and the occurrence of complications was assessed with uni- and multivariate analysis. RESULTS: A total of 1089 (78.3%) patients had malignancy and minimally invasive surgery was successfully performed in 1174 (84.3%) patients. Postoperative morbidity occurred in 403 (29.0%) patients. At multivariate analysis, male gender, open surgery, and each of the four non compliance indicators on POD 2 were significantly associated to postoperative complications. Morbidity progressively increased from 16.8% in patients with full compliance to ERAS protocol to 47.2% in patients with two non compliance indicators and 69.2% in patients with all four indicators (p < 0.001). CONCLUSIONS: Early non compliance to ERAS protocol was significantly associated with postoperative morbidity.

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PMID : 35817632

DOI : 10.1016/j.ejso.2022.06.033

Keywords

Aged; Female; Male; Humans; Enhanced Recovery After Surgery; Postoperative Complications/epidemiology; Middle Aged; Guideline Adherence; Colonic Neoplasms/surgery; Italy; Elective Surgical Procedures; Colectomy/adverse effects; Prospective Studies; Minimally Invasive Surgical Procedures; Colon surgery; ERAS compliance; Enhanced recovery; Postoperative morbidity; Prognostic score;