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- Title
Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study.
- Authors
Ripollés-Melchor, Javier; Ramírez-Rodríguez, José M; Casans-Francés, Rubén; Aldecoa, César; Abad-Motos, Ane; Logroño-Egea, Margarita; García-Erce, José Antonio; Camps-Cervantes, Ángels; Ferrando-Ortolá, Carlos; Suarez de la Rica, Alejandro; Cuellar-Martínez, Ana; Marmaña-Mezquita, Sandra; Abad-Gurumeta, Alfredo; Calvo-Vecino, José M.; POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM)
- Abstract
<bold>Importance: </bold>Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care.<bold>Objective: </bold>To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery.<bold>Design, Setting, and Participants: </bold>The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up.<bold>Exposures: </bold>Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol.<bold>Main Outcomes and Measures: </bold>The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay.<bold>Results: </bold>Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates.<bold>Conclusions and Relevance: </bold>An increase in ERAS adherence appears to be associated with a decrease in postoperative complications.
- Publication
JAMA Surgery, 2019, Vol 154, Issue 8, p725
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2019.0995