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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....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
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
- MeSH
- délka pobytu MeSH
- dospělí MeSH
- elektivní chirurgické výkony škodlivé účinky MeSH
- kolorektální chirurgie * škodlivé účinky MeSH
- lidé MeSH
- perioperační péče metody MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- urychlená pooperační rehabilitace * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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 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 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 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 Anesthesiology and Intensive Care Motol University Hospital Prague Czech Republic
Department of Anesthesiology and Perioperative Medicine Hospital Universitario de Alava Alava Spain
Department of Anesthesiology Istanbul University School of Medicine Istanbul Turkey
Department of Anesthesiology Maasstad Hospital Rotterdam the Netherlands
Department of Anesthesiology Nicosia General Hospital Nicosia Cyprus
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 Surgery Lozano Blesa University Hospital Zaragoza Spain
Department of surgery Aalborg University Hospital Aalborg Denmark
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
Serviço de Anestesiologia Centro Hospitalar Universitário do Porto Porto Portugal
Spanish Perioperative Audit and Research Network Zaragoza Spain
Surgery Department University Hospital Leuven Leuven Belgium
The Francophone Group for Enhanced Recovery After Surgery France
Citace poskytuje Crossref.org
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- $a Ripollés-Melchor, Javier $u Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: javier.ripolles@salud.madrid.org
- 245 10
- $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)
- 520 9_
- $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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- 700 1_
- $a Abad-Motos, Ane $u Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain
- 700 1_
- $a Cecconi, Maurizio $u Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- 700 1_
- $a Pearse, Rupert $u Barts and the London School of Medicine & Dentistry, Queen Mary University London, EC1M 6BQ, UK
- 700 1_
- $a Jaber, Samir $u Department of Anesthesiology and Intensive Care, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; The Francophone Group for Enhanced Recovery After Surgery (GRACE), France
- 700 1_
- $a Slim, Karem $u The Francophone Group for Enhanced Recovery After Surgery (GRACE), France; Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- 700 1_
- $a Francis, Nader $u Department of Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
- 700 1_
- $a Spinelli, Antonino $u Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- 700 1_
- $a Joris, Jean $u The Francophone Group for Enhanced Recovery After Surgery (GRACE), France; Anesthesia and Reanimation CHU de Liège, Université de Liège, Liège, Belgium
- 700 1_
- $a Ioannidis, Orestis $u Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 700 1_
- $a Zarzava, Eirini $u Department of Anesthesia and Surgical Critical Care, General Hospital "G. Papanikolaou", Thessaloniki, Greece
- 700 1_
- $a Şentürk, Nüzhet Mert $u Department of Anesthesiology, Istanbul University School of Medicine, Istanbul, Turkey
- 700 1_
- $a Koopman, Seppe $u Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands
- 700 1_
- $a Goettel, Nicolai $u Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA; Department of Anesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
- 700 1_
- $a Stundner, Ottokar $u Department of Anesthesia and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- 700 1_
- $a Vymazal, Tomas $u Department of Anesthesiology and Intensive Care, Motol University Hospital, Prague, Czech Republic
- 700 1_
- $a Kocián, Petr $u Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- 700 1_
- $a El-Hussuna, Alaa $u Department of surgery, Aalborg University Hospital, Aalborg, Denmark; Opensource Research Collaboration, Denmark
- 700 1_
- $a Pędziwiatr, Michał $u 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- 700 1_
- $a Gudaityte, Jurate $u Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- 700 1_
- $a Latkauskas, Tadas $u Department of Surgery, Coloproctology Unit, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- 700 1_
- $a Santos, Marisa D $u Colorectal Surgery, Rectal Cancer Reference Center, Centro Hospitalar do Porto, Porto, Portugal
- 700 1_
- $a Machado, Humberto $u Serviço de Anestesiologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- 700 1_
- $a Zahorec, Roman $u Anesthesiology and Intensive Medicine, Medical School, Comenius University, Bratislava, Slovakia
- 700 1_
- $a Cvetković, Ana $u Anesthesiology & Intensive Care Medicine, Institute for Oncology and Radiology of Serbia, Clinic of Surgical Oncology, Belgrade, Serbia
- 700 1_
- $a Miric, Mirjana $u Department of Anesthesiology, Reanimatology and Intensive Care, Clinical Hospital Center Zagreb, Zagreb, Croatia
- 700 1_
- $a Georgiou, Maria $u Department of Anesthesiology, Nicosia General Hospital, Nicosia, Cyprus
- 700 1_
- $a Díez-Remesal, Yolanda $u Anesthesia & Intensive Care Department, Ramón y Cajal University Hospital, Madrid, Spain
- 700 1_
- $a Jammer, Ib $u Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- 700 1_
- $a Mena, Gabriel E $u Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 700 1_
- $a Zorrilla-Vaca, Andrés $u Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. USA
- 700 1_
- $a Marino, Marco V $u Department of General and Emergency Surgery, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
- 700 1_
- $a Suárez-de-la-Rica, Alejandro $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain
- 700 1_
- $a García-Erce, José A $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
- 700 1_
- $a Logroño-Ejea, Margarita $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Hospital Universitario de Alava, Alava, Spain
- 700 1_
- $a Ferrando-Ortolá, Carlos $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Critical Care, Hospital Clínic, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- 700 1_
- $a De-Fuenmayor-Valera, María L $u Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
- 700 1_
- $a Ugarte-Sierra, Bakarne $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, BioCruces Bizkaia Health Research Institute, Hospital Universitario de Galdakao, Galdakao, Vizcaya, Spain
- 700 1_
- $a de Andrés-Ibañez, José $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of Anesthesiology and Perioperative Medicine, Hospital General Universitario de Valencia, Valencia, Spain
- 700 1_
- $a Abad-Gurumeta, Alfredo $u Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain
- 700 1_
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- 700 1_
- $a Gómez-Ríos, Manuel A $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Anesthesia and Critical Care Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
- 700 1_
- $a Poggioli, Gilberto $u Surgery Department, Alma Mater Studiorum University of Bologna, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
- 700 1_
- $a Menzo-Wolthuis, Albert $u Surgery Department, University Hospital Leuven, Leuven, Belgium
- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
- $a Ramírez-Rodríguez, José M $u Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
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- $a EuroPOWER Study Investigators Group
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- $a Spanish Perioperative Audit and Research Network (RedGERM-SPARN)
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- $a Francophone Group for Enhanced Recovery After Surgery (GRACE)
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