ERAS protocol compliance impact on functional recovery in colorectal surgery

Macarena Barbero; Javier García; Isabel Alonso; Laura Alonso; Belén San Antonio-San Román; Viktoria Molnar; Carmen León; Matías Cea

doi:10.1016/j.ciresp.2020.05.010

ERAS protocol compliance impact on functional recovery in colorectal surgery

Cir Esp (Engl Ed). 2021 Feb;99(2):108-114. doi: 10.1016/j.ciresp.2020.05.010. Epub 2020 Jun 18.

[Article in English, Spanish]

Authors

Macarena Barbero¹, Javier García², Isabel Alonso³, Laura Alonso⁴, Belén San Antonio-San Román⁴, Viktoria Molnar⁴, Carmen León³, Matías Cea³

Affiliations

¹ Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España. Electronic address: mak_barbero@hotmail.com.
² Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Instituto de Investigación Sanitaria, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
³ Servicio de Cirugía General, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
⁴ Servicio Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.

PMID: 32564875
DOI: 10.1016/j.ciresp.2020.05.010

Abstract

Introduction: Compliance to ERAS protocols is a process quality measure that is associated to better outcomes. The main objective of this study is to analyze the association between protocol compliance, surgical stress and functional recovery. The secondary objective is to identify independent factors associated to functional recovery.

Methods: A prospective observational single-centre study was performed. Patients who had scheduled colorectal surgery within an ERAS program from January 2017 to June 2018 were included. We analysed the relationship between protocol compliance percentage and surgical stress (defined by C reactive protein [CRP] blood levels on postoperative 3^rd day), and functional recovery (defined by the proportion of patients who meet the discharge criteria on the 5^th PO day or before). Multivariate analysis was performed to asses independent factor associated to functional recovery.

Results: 313 were included. For every additional percentage point of compliance to the protocol 3^rd day C reactive protein plasmatic level decreases 1,46 mg/dL and increases 7% the probability to meet the discharge criteria (p < 0.001 both). Independent factors associated to functional recovery were ASA III-IV (OR 0.26; 0.14-0.48), surgical CR-POSSUM score (OR 0.68; 0.57-0.83), early mobilization (OR 4.22; 1.43-12.4) and removal of urinary catheter (OR 3.35; 1.79-6.27), p < 0,001 each of them.

Conclusion: Better compliance to ERAS protocol in colorectal surgery decreases surgical stress and accelerates functional recovery.

Keywords: Cirugía colorrectal; Colorrectal surgery; Cumplimiento del protocolo; Enhanced recovery; Estrés quirúrgico; Functional recovery; Protocol compliance; Recuperación funcional; Rehabilitación multimodal; Surgical stress.