scholarly journals Influence of the Enhanced Recovery After Surgery Protocol on Postoperative Inflammation and Short-term Postoperative Surgical Outcomes After Colorectal Cancer Surgery

2020 ◽  
Vol 36 (4) ◽  
pp. 264-272
Author(s):  
Heba Essam Jaloun ◽  
In Kyu Lee ◽  
Min Ki Kim ◽  
Na Young Sung ◽  
Suhail Abdullah Al Turkistania ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Complication Rate ◽  
Surgical Outcomes ◽  
Inflammatory Markers ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Short Term ◽  
Colorectal Cancer Surgery ◽  
High Compliance ◽  
Eras Protocol

Purpose: Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes.Methods: Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database.Results: The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the duration required for leukocytes to normalize were reduced in patients following the ERAS protocol (P ≤ 0.001). Other inflammatory markers, such as lymphocyte count (P = 0.008), neutrophil/lymphocyte ratio (P = 0.032), and C-reactive protein level (P ≤ 0.001), were lower in the ERAS protocol group. High compliance ( ≥ 70%) was strongly associated with the complication rate and the LOS (P = 0.008 and P ≤ 0.001, respectively).Conclusion: ERAS protocols decrease early postoperative inflammation and improves short-term postoperative recovery outcomes such as complication rate and the LOS. High compliance ( ≥ 70%) with the ERAS protocol elements accelerates the positive effects of ERAS on surgical outcomes; however, the effect on inflammation was very small.

scholarly journals Is It Possible to Maintain High Compliance with the Enhanced Recovery after Surgery (ERAS) Protocol?—A Cohort Study of 400 Consecutive Colorectal Cancer Patients

2018 ◽  
Vol 7 (11) ◽  
pp. 412 ◽  
Author(s):  
Magdalena Pisarska ◽  
Natalia Gajewska ◽  
Piotr Małczak ◽  
Michał Wysocki ◽  
Piotr Major ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Short Term ◽  
Entire Study ◽  
High Compliance ◽  
Eras Protocol ◽  
Mean Compliance

The aim of our study was to evaluate the implementation and degree of adherence to the Enhanced Recovery after Surgery (ERAS) protocol in a group of 400 patients operated laparoscopically for colorectal cancer, and to assess its impact on the short-term results. The prospective study included patients with histologically confirmed colorectal cancer undergoing elective laparoscopic resection from years 2012 to 2017. For the purpose of further analysis, patients were divided into four groups: 100 consecutive patients were in each group. There were no statistically significant differences between groups in demographic parameters. The mean compliance with the ERAS protocol in the entire study group was 84.8%. Median adherence differed between the groups 76.9% vs. 92.3% vs. 84.6% vs. 84.6%, respectively (p < 0.0001). There were statistically significant differences between groups in the tolerance of oral diet (54% vs. 83% vs. 83% vs. 64%) and mobilization (74% vs. 92% vs. 91% vs. 94%) on the first postoperative day. In subsequent groups, time to first flatus decreased (2.5 vs. 2.1 vs. 2.0 vs. 1.7 days, p = 0.0001). There were no statistical differences in the postoperative morbidity rate between groups (p = 0.4649). The median length of hospital stay in groups was 5 vs. 4 vs. 4 vs. 4 days, respectively (p = 0.0025). Maintaining high compliance with the ERAS protocol is possible, despite the slight decrease that occurs within a few years after its implementation. This decrease in compliance does not affect short-term results, which are comparable to those shortly after overcoming the learning curve.

scholarly journals Implementation of the ERAS (Enhanced Recovery After Surgery) protocol for colorectal cancer surgery in the Piemonte Region with an Audit and Feedback approach: study protocol for a stepped wedge cluster randomised trial: a study of the EASY-NET project

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047491
Author(s):  
Eva Pagano ◽  
Luca Pellegrino ◽  
Federica Rinaldi ◽  
Valentina Palazzo ◽  
Danilo Donati ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Randomised Trial ◽  
Audit And Feedback ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Colorectal Cancer Surgery ◽  
Cluster Randomised ◽  
Eras Protocol

IntroductionThe ERAS protocol (Enhanced Recovery After Surgery) is a multimodal pathway aimed to reduce surgical stress and to allow a rapid postoperative recovery. Application of the ERAS protocol to colorectal cancer surgery has been limited to a minority of hospitals in Italy. To promote the systematic adoption of ERAS in the entire regional hospital network in Piemonte an Audit and Feedback approach (A&F) has been adopted together with a cluster randomised trial to estimate the true impact of the protocol on a large, unselected population.MethodsA multicentre stepped wedge cluster randomised trial is designed for comparison between standard perioperative management and the management according to the ERAS protocol. The primary outcome is the length of hospital stay (LOS). Secondary outcomes are: incidence of postoperative complications, time to patients’ recovery, control of pain and patients’ satisfaction. With an A&F approach the adherence to the ERAS items is monitored through a dedicated area in the study web site. The study includes 28 surgical centres, stratified by activity volume and randomly divided into four groups. Each group is randomly assigned to a different activation period of the ERAS protocol. There are four activation periods, one every 3 months. However, the planned calendar and the total duration of the study have been extended by 6 months due to the COVID-19 pandemic.The expected sample size of about 2200 patients has a high statistical power (98%) to detect a reduction of LOS of 1 day and to estimate clinically meaningful changes in the other endpoints.Ethics and disseminationThe study protocol has been approved by the Ethical Committee of the coordinating centre and by all participating centres. Study results will be timely circulated within the hospital network and published in peer-reviewed journals.Trial registration numberNCT04037787.

The impact of compliance with Enhanced Recovery After Surgery (ERAS) protocol on short and long-term outcomes in patients after laparoscopic colorectal cancer surgery

2021 ◽  
Vol 8 ◽  
pp. 31-35
Author(s):  
Magdalena Pisarska-Adamczyk
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Long Term Results ◽  
Surgical Trauma ◽  
Short Term ◽  
Eras Protocol ◽  
The Impact

Patients undergoing surgery for colorectal cancer are a special group of patients. Not only performed resections are extensive, but also the underlying disease significantly depletes regenerative capacities of the body. It is well known that every surgical procedure is associated with an injury, the size of which is proportional to the type and extent of the intervention. The size of surgical trauma in postoperative period is proportional to the increase in insulin resistance which delays convalescence and increases the risk of postoperative complications. Hence, for several years, a specific program had been developed and introduced to reduce trauma associated with the surgery and its adverse consequences. The use of a modern multimodal care protocol for Enhanced Recovery After Surgery(ERAS) served this purpose. The aim of the study was to determine the impact of compliance to ERAS protocol on short-term results in a group of patients operated for colorectal cancer. In the next stage, it was checked whether it is possible to maintain high compliance of the protocol for a long time. Finally, I tried to determine the relationship between the compliance and distant oncological results. Consecutive patients with colon or rectal cancer undergoing laparoscopic resection were included in the study. In all patients the 16-item ERAS protocol was applied. The use of ERAS protocol improves short-term results: accelerates convalescence, reduces morbidity and reduces the length of hospital stay. However, its impact on short-term results correlates with the level of protocol implementation. The higher compliance with the protocol, the better the short-term results. Maintaining a high level of implementation of the protocol is possible despite the slight decrease over time. However, this has no adverse effect on short-term results. The compliance with ERAS protocol seems to also affect long-term results. Low compliance with ERAS protocol, along with the higher stage of cancer and postoperative complications, is an independent factor worsening long-term survival.

scholarly journals Perioperative Care in Colorectal Cancer Surgery before a Structured Implementation Program of the ERAS Protocol in a Regional Network. The Piemonte EASY-NET Project

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 72
Author(s):  
Luca Pellegrino ◽  
Eva Pagano ◽  
Marco Ettore Allaix ◽  
Mario Morino ◽  
Andrea Muratore ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Enhanced Recovery ◽  
Controlled Trial ◽  
Baseline Period ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
North West ◽  
Implementation Program ◽  
American Society ◽  
Eras Protocol

Background: In 2019, the Enhanced Recovery After Surgery (ERAS) protocol for colorectal cancer surgery was adopted by a minority of hospitals in Piemonte (4.3 million inhabitants, north-west Italy). The present analysis aims to compare the level of application of the ERAS protocol between hospitals already adopting it (ERAS, N = 3) with the rest of the regional hospitals (non-ERAS, N = 28) and to identify possible obstacles to its application. Methods: All patients surgically treated for a newly diagnosed colorectal cancer during September–November 2019, representing the baseline period of a randomized controlled trial with a cluster stepped-wedge design, were included. Indicators of compliance to the ERAS items were calculated overall and for groups of items (preoperative, intraoperative and postoperative) and analyzed with a multilevel linear model adjusting for patients’ characteristics, considering centers as random effects. Results: Overall, the average level of compliance to the ERAS protocol was 56% among non-ERAS centers (N = 364 patients) and 80% among ERAS ones (N = 79), with a difference of 24% (95% CI: −41.4; −7.3, p = 0.0053). For both groups of centers, the lowest level of compliance was recorded for postoperative items (42% and 66%). Sex, age, presence of comorbidities and American Society of Anesthesiologists (ASA) score were not associated with a different probability of compliance to the ERAS protocol. Conclusions: Several items of the ERAS protocol were poorly adopted in colorectal surgery units in the Piemonte region in the baseline period of the ERAS Colon-Rectum Piemonte study and in the ERAS group. No relevant obstacles to the ERAS protocol implementation were identified at patient level.

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