Proposal and Validation of a New Classification of Surgical Outcomes after Colorectal Resections within an Enhanced Recovery Programme

Giovanni D Tebala; Waseem Hameed; Salomone Di Saverio; Gaetano Gallo; Giles Bond-Smith

doi:10.1155/2021/8864555

Proposal and Validation of a New Classification of Surgical Outcomes after Colorectal Resections within an Enhanced Recovery Programme

Surg Res Pract. 2021 May 11:2021:8864555. doi: 10.1155/2021/8864555. eCollection 2021.

Authors

Giovanni D Tebala¹, Waseem Hameed², Salomone Di Saverio³, Gaetano Gallo⁴, Giles Bond-Smith¹

Affiliations

¹ Surgical Emergency Unit, John Radcliffe Hospital, Oxford University NHS Foundation Trust, Oxford, UK.
² General Surgery Department, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.
³ General Surgery Department, University of Insubria, Varese, Italy.
⁴ General Surgery Department, Magna Graecia University, Catanzaro, Italy.

Abstract

Background: Advantages of Enhanced Recovery (ER) programmes in colorectal surgery have already been demonstrated, but heterogeneity exists with respect to the choice of compared outcomes. A comprehensive classification aimed at standardizing the reporting of surgical outcomes has been proposed and validated.

Method: Clinical variables of 231 patients who underwent colorectal resections within an ER programme from 2013-2018 were analysed. Their outcomes have been reported according to a new classification in 5 classes and 11 subclasses. Prognostic variables have been identified.

Results: Seventy-nine patients (34.2%) had an optimal class 1 outcome. Almost half of the patients had an uneventful recovery after being discharged after day 4 (2a). Only two patients (0.9%) were discharged early and then readmitted for a minor ailment (2b). Total morbidity was 12.6% (3a-5). Perioperative mortality was 2.6% (5). Young age, laparoscopic resection, and years of experience with ER have been identified as independent prognostic factors towards a totally positive outcome.

Conclusions: The proposed outcome classification is a simple and objective tool to report the surgical outcome in clinical studies. Its implementation seems to be appropriate, in particular, in the field of ER protocols in colorectal surgery, but it can have a wider application in any other surgical subspeciality.