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Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study

J. Ripollés-Melchor, A. Abad-Motos, M. Cecconi, R. Pearse, S. Jaber, K. Slim, N. Francis, A. Spinelli, J. Joris, O. Ioannidis, E. Zarzava, NM. Şentürk, S. Koopman, N. Goettel, O. Stundner, T. Vymazal, P. Kocián, A. El-Hussuna, M. Pędziwiatr, J....

. 2022 ; 80 (-) : 110752. [pub] 20220408

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc22017768
E-zdroje Online Plný text

NLK ProQuest Central od 2003-01-01 do Před 2 měsíci
Nursing & Allied Health Database (ProQuest) od 2003-01-01 do Před 2 měsíci
Health & Medicine (ProQuest) od 2003-01-01 do Před 2 měsíci

STUDY OBJECTIVE: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes. DESIGN: Prospective cohort study. SETTING: European centers (185 hospitals) across 21 countries. PATIENTS: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020. INTERVENTIONS: Routine perioperative care. MEASUREMENTS: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences. RESULTS: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001). CONCLUSIONS: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.

2nd Department of General Surgery Jagiellonian University Medical College Kraków Poland

4th Surgical Department Medical School Aristotle University of Thessaloniki Thessaloniki Greece

Anesthesia and Critical Care Department Complejo Hospitalario Universitario de A Coruña A Coruña Spain

Anesthesia and Critical Care Department Hospital Universitario Donostia Donostia San Sebastián Spain

Anesthesia and Critical Care Department Vall d'Hebrón University Hospital Barcelona Spain

Anesthesia and Intensive Care Department Ramón y Cajal University Hospital Madrid Spain

Anesthesia and Reanimation CHU de Liège Université de Liège Liège Belgium

Anesthesiology and Intensive Care Medicine Institute for Oncology and Radiology of Serbia Clinic of Surgical Oncology Belgrade Serbia

Anesthesiology and Intensive Medicine Medical School Comenius University Bratislava Slovakia

Banco de Sangre y Tejidos de Navarra Servicio Navarro de Salud Osasunbidea Pamplona Spain

Barts and the London School of Medicine and Dentistry Queen Mary University London EC1M 6BQ UK

CIBER de Enfermedades Respiratorias Instituto de Salud Carlos 3 Madrid Spain

Colorectal Surgery Rectal Cancer Reference Center Centro Hospitalar do Porto Porto Portugal

Colorectal Surgery Vall d'Hebron University Hospital Barcelona Spain

Department of Advanced Medical and Surgical Sciences Università degli Studi Della Campania Luigi Vanvitelli Naples Italy

Department of Anesthesia and Critical Care Medicine Medical University of Innsbruck Innsbruck Austria

Department of Anesthesia and Critical Care Río Hortega University Hospital Valladolid Spain

Department of Anesthesia and Intensive Care Haukeland University Hospital Bergen Norway

Department of Anesthesia and Perioperative Medicine Infanta Leonor University Hospital Madrid Spain

Department of Anesthesia and Surgical Critical Care General Hospital G Papanikolaou Thessaloniki Greece

Department of Anesthesia Prehospital Emergency Medicine and Pain Therapy University Hospital Basel Basel Switzerland

Department of Anesthesiology and Critical Care Hospital Clínic Institut d'Investigació August Pi i Sunyer Barcelona Spain

Department of Anesthesiology and Intensive Care Centre Hospitalier Universitaire de Montpellier Montpellier France

Department of Anesthesiology and Intensive Care Motol University Hospital Prague Czech Republic

Department of Anesthesiology and Perioperative Medicine Hospital General Universitario de Valencia Valencia Spain

Department of Anesthesiology and Perioperative Medicine Hospital Universitario de Alava Alava Spain

Department of Anesthesiology and Perioperative Medicine Marqués de Valdecilla University Hospital Santander Spain

Department of Anesthesiology and Perioperative Medicine University of Texas MD Anderson Cancer Center Houston TX USA

Department of Anesthesiology Istanbul University School of Medicine Istanbul Turkey

Department of Anesthesiology Maasstad Hospital Rotterdam the Netherlands

Department of Anesthesiology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Anesthesiology Nicosia General Hospital Nicosia Cyprus

Department of Anesthesiology Perioperative and Pain Medicine Brigham and Women's Hospital Harvard Medical School Boston MA USA

Department of Anesthesiology Reanimatology and Intensive Care Clinical Hospital Center Zagreb Zagreb Croatia

Department of Anesthesiology University of Florida College of Medicine Gainesville FL USA

Department of Biomedical Sciences Humanitas University Pieve Emanuele Milan Italy

Department of Clinical Research University of Basel Basel Switzerland

Department of General and Emergency Surgery Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello Palermo Italy

Department of General Surgery BioCruces Bizkaia Health Research Institute Hospital Universitario de Galdakao Galdakao Vizcaya Spain

Department of General Surgery Lozano Blesa University Hospital Zaragoza Spain

Department of Surgery 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of surgery Aalborg University Hospital Aalborg Denmark

Department of Surgery Coloproctology Unit Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania

Department of Surgery Yeovil District Hospital NHS Foundation Trust Yeovil UK

Grupo Español de Rehabilitación Multimodal Zaragoza Spain

IRCCS Humanitas Research Hospital Rozzano Milan Italy

Italian Surgical Research Group Italy

Opensource Research Collaboration Denmark

Service de Chirurgie Digestive and Unité de Chirurgie Ambulatoire Centre Hospitalier Universitaire de Clermont Ferrand Clermont Ferrand France

Serviço de Anestesiologia Centro Hospitalar Universitário do Porto Porto Portugal

Spanish Perioperative Audit and Research Network Zaragoza Spain

Surgery Department Alma Mater Studiorum University of Bologna IRCCS Azienda Ospedaliero Universitaria di Bologna Bologna Italy

Surgery Department University Hospital Leuven Leuven Belgium

The Francophone Group for Enhanced Recovery After Surgery France

Universidad Complutense de Madrid Madrid Spain

Universidad de Zaragoza Zaragoza Spain

Citace poskytuje Crossref.org

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$a Association between use of enhanced recovery after surgery protocols and postoperative complications in colorectal surgery in Europe: The EuroPOWER international observational study / $c J. Ripollés-Melchor, A. Abad-Motos, M. Cecconi, R. Pearse, S. Jaber, K. Slim, N. Francis, A. Spinelli, J. Joris, O. Ioannidis, E. Zarzava, NM. Şentürk, S. Koopman, N. Goettel, O. Stundner, T. Vymazal, P. Kocián, A. El-Hussuna, M. Pędziwiatr, J. Gudaityte, T. Latkauskas, MD. Santos, H. Machado, R. Zahorec, A. Cvetković, M. Miric, M. Georgiou, Y. Díez-Remesal, I. Jammer, GE. Mena, A. Zorrilla-Vaca, MV. Marino, A. Suárez-de-la-Rica, JA. García-Erce, M. Logroño-Ejea, C. Ferrando-Ortolá, ML. De-Fuenmayor-Valera, B. Ugarte-Sierra, J. de Andrés-Ibañez, A. Abad-Gurumeta, G. Pellino, MA. Gómez-Ríos, G. Poggioli, A. Menzo-Wolthuis, B. Castellano-Paulis, P. Galán-Menéndez, C. Aldecoa, JM. Ramírez-Rodríguez, EuroPOWER Study Investigators Group, Spanish Perioperative Audit and Research Network (RedGERM-SPARN), Francophone Group for Enhanced Recovery After Surgery (GRACE)
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$a STUDY OBJECTIVE: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes. DESIGN: Prospective cohort study. SETTING: European centers (185 hospitals) across 21 countries. PATIENTS: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020. INTERVENTIONS: Routine perioperative care. MEASUREMENTS: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences. RESULTS: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001). CONCLUSIONS: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.
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