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The influence of the implementation of ERAS recommendations on the results in patients in colorectal surgery: a retrospective and comparative study


Authors: J. Richtarová 1,2;  I. Satinský 2,3 ;  P. Schwarz 2;  T. Skoblej 2;  E. Mrázková 1,4,5
Authors place of work: Ústav epidemiologie a ochrany veřejného zdraví Lékařská fakulta, Ostravská univerzita v Ostravě Vedoucí ústavu: doc. MUDr. Rastislav Maďar, Ph. D., MBA, FRCPS 1;  Mezioborová jednotka intenzivní péče Nemocnice Havířov Primář: MUDr. Igor Satinský, Ph. D. 2;  Ústav nelékařských zdravotnických studií Fakulta veřejných politik, Slezská univerzita v Opavě Vedoucí ústavu: PhDr. Zdeňka Římovská, Ph. D. 3;  Oddělení ORL Nemocnice s poliklinikou Havířov Primář: MUDr. Eva Mrázková, Ph. D. 4;  Centrum pro poruchy sluchu a rovnováhy, Ostrava 5
Published in the journal: Prakt. Lék. 2022; 102(3): 125-139
Category: Of different specialties

Summary

Introduction: The aim of this study was a comparison of postoperative care with selected elements of the ERAS (Enhanced Recovery After Surgery) protocol: optimal analgesia, non-aggressive fluid replacement, nausea and vomiting prevention, early oral or enteral intake, early removal of drains, nasogastric tubes and permanent urinary catheters, early rehabilitation.

Patients and methods: Data were obtained based on established criteria from the medical documentation of a selected group of patients after planned intestinal resections, with a stay in the intensive care unit (ICU) of at least 48 hours. The research group was composed of patients hospitalised in two surgical ICUs. Seventy-nine patients were included in the study at the medical facility in Karviná (ICU 1), and one hundred and seven patients were enrolled in Havířov (ICU 2).

Results: Based on a retrospective analysis of the information obtained, it is evident that specific partial procedures from the ERAS protocol were implemented at both ICU workplaces. A statistically significant difference was found in the optimal postoperative analgesia (epidural catheter) and adherence to fluid restriction up to 2.5 litres. Furthermore, statistically significant differences in srovthe frequency of laparoscopies, early oral and enteral intake, early removal of drains, nasogastric tubes and permanent urinary catheters were noted.

Conclusion: The level of ERAS implementation in the monitored workplaces differs in individual steps, but these differences did not lead to different results in the mentioned study. It is demonstrably impossible to determine which elements of the ERAS concept significantly affect the final results.

Keywords:

surgery – postoperative complications – perioperative care – Enhanced Recovery After Surgery – fast-track surgery – length of hospital stay


Zdroje

1. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006. Dostupné z: https://doi.org/10.1002/14651858.CD004080. pub2

2. Braga M, Pecorelli N, Scatizzi M, Borghi F, Missana G, Radrizzani D. Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry. PeriOperative Italian Society World J Surg 2016, Oct 20.

3. Brower RG. Consequences of bed rest. Crit Care Med 2009; 37: S422–S428.

4. Carmichael JC, Keller DS, Baldini G, et al. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017; 60: 761–784.

5. de Leede EM, van Leersum NJ, Kroon HM, et al. Multicentre randomised clinical trial of the effect of chewing gum after abdominal surgery. Br J Surg 2018; 105: 820–828.

6. Fiore JF Jr, Castelino T, Pecorelli N, et al. Ensuring early mobilisation within an enhanced recovery program for colorectal surgery: a randomised controlled trial. Ann Surg 2017; 266: 223–231.

7. Gustafsson UO, Thorell A, Soop M, et al. Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery. Br J Surg 2009; 96: 1358–1364.

8. Gustafsson UO, Hausel J, Thorell A, et al. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011; 146: 571–577.

9. Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 2013; 37: 259–284. Dostupné z: https://doi.org/10.1007/s00268- 012-1772-0

10. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 2019; 43: 659–695. Dostupné z: https://doi. org/10.1007/s00268-018-4844-y

11. Hansen CT, Sorensen M, Moller C, et al. Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: a double-blind, placebo-controlled randomised study. Am J Obstet Gynecol 2007; 196(311): e311–e317.

12. Harper CM, Lyles YM. Physiology and complications of bed rest. J Am Geriatr Soc 1988; 36: 1047–1054.

13. Chen Z, Liu A, Cen Y. Fast-track program vs tradional care in surgery for gastric cancer. World Journal of Gastroenterology 2014; 20(2): 578–583.

14. Kehlet H. ERAS implementation-time to move forward. Ann Surg 2018; 16. doi: 10.1097/ANE.0000000000002720 [Epub ahead of print].

15. Kursa MB, Rudnicki WR. Feature Selection with the Boruta Package. J Stat Soft 2010; 36: 1–13. doi: 10.18637/jss.v036.i11

16. Lassen K, Kjaeve J, Fetveit T, et al. Allowing normal food at will after major upper gastrointestinal surgery does not increase morbidity: a randomised multicenter trial. Ann Surg 2008; 247: 721–729.

17. Lau C, Phillips E, Bresee C, et al. Early use of low residue diet is superior to clear liquid diet after elective colorectal surgery: a randomised controlled trial. Ann Surg 2014; 260: 641–647.

18. Lemanu D, Singh PP, MacCormick A, Arroll B, Hill A. Effect of Preoperative Exercise on Cardiorespiratory Function and Recovery After Surgery: a Systematic Review. World Journal of Surgery 2013; 37: 711–720.

19. Li K, Zhou Z, Chen Z, et al. „Fast Track“ nasogastric decompression of rectal cancer surgery. Front Med 2011; 5: 306–309.

20. Lobo DN. Fluid overload and surgical outcome: another piece in the jigsaw. Ann Surg 2009; 249: 186–188.

21. Muller SA, Rahbari NN, Schneider F, et al. Randomised clinical trial on the effect of coffee on postoperative ileus following elective colectomy. Br J Surg 2012; 99: 1530–1538.

22. Nelson R, Edwards S, Tse B. Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007. Dostupné z: https://doi.org/10.1002/14651858.CD004929. pub3

23. Olsén M, Wennberg E. Fast-Track Concepts in Major Open Upper Abdominal and Thoracoabdominal Surgery: A Review. World Journal of Surgery 2011; 35: 2586–2593.

24. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/ (accesses on 28 November 2019).

25. Robertson N, Gallacher PJ, Peel N, Garden OJ, Duxbury M, Lassen K, Parks RW. Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB (Oxford) 2012; 14(10): 700–708.

26. RStudio Team. RStudio: Integrated Development for R.Studio, Inc. Boston: MA. http://www.rstudio.com/ (accesses on 28 November 2019).

27. Ryska O, Šerclová Z, Antoš F. Jak jsou dodržovány postupy moderní perioperační péče (ERAS) na chirurgických pracovištích v České republice – výsledky národní studie. Rozhl Chir 2013; 92(8): 435–442.

28. Satinský I, Schwarz P. Koncept fast track surgery a ošetřovatelský proces. In: Sborník příspěvků V. slezské vědecké konference ošetřovatelství s mezinárodní účastí. Opava 2010; 241–243.

29. Shin Ch, Long DR, McLean D, et al. Effects of intraoperative fluid management on postoperative outcomes: a hospital registry study. Ann Surg 2018; 267: 1084–1092.

30. Smart NJ, White P, Allison AS, Ockrim JB, Kennedy RH, Francis NK. Deviation and failure of enhanced recovery after surgery following laparoscopic colorectal surgery: early prediction model. Colorectal Dis 2012; 14(10): e727–734.

31. Smedley F, Bowling T, James M, et al. Randomised clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg 2004; 91: 983–990.

32. Stubbs BM, Badcock KJ, Hyams C, Rizal FE, Warren S, Francis D. A prospective study of early removal of the urethral catheter after colorectal surgery in patients having epidural analgesia as part of the Enhanced Recovery After Surgery programme. Colorectal Dis 2013; 15(6): 733–736.

33. Thacker JK, Mountford WK, Ernst FR, et al. Perioperative fluid utilisation variability and association with outcomes: considerations for enhanced recovery efforts in sample US surgical populations. Ann Surg 2016; 263: 502–510.

34. Thompson EG, Gower ST, Beilby DS, Wallace S, Tomlinson S, Guest GD, Cade R, Serpell JS, Myles PS. Enhanced recovery after surgery program for elective abdominal surgery at three Victorian hospitals. Anaesth Intensive Care 2012; 40(3): 450–459.

35. Varadhan KK, Lobo DN. A meta-analysis of randomised controlled trials of intravenous fluid therapy in major elective open abdominal surgery: getting the balance right. Proc Nutr Soc 2010; 69: 488–498.

36. Vlug M, Bartels S, Wind J, Ubbink D, Hollmann M, Bemelman W. On behalf of the collaborative LAFA study group: Which fast track elements predict early recovery after colon cancer surgery? Colorectal Disease 2011; 14: 1001–1008.

37. Vymazal T. Fast-track není jen fyziologická anestezie. Anesteziologie a intenzivní medicína 2014; 25(2): 82–87.

38. Vymazal T, Kocián P, Přikryl P, Hodyc D, Hoch J. ERAS v české nemocnici – utopie, nebo realita? Anesteziologie a intenzivní medicína 2018; 29: 317–321.

39. Wisely JC, Barclay KL. Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. ANZ J Surg 2016; 86(11): 883–888.

40. Yip VS, Dunne DF, Samuels S, Tan CY, Lacasia C, Tang J, Burston C, Malik HZ, Poston GJ, Fenwick SW. Adherence to early mobilisation: Key for successful enhanced recovery after liver resection. Eur J Surg Oncol 2016; 42(10): 1561–1567.

41. Yoshikawa K, Shimada M, Wakabayashi G, et al. Effect of daikenchuto, a traditional japanese herbal medicine, after total gastrectomy for gastric cancer: a multicenter, randomised, double-blind, placebo-controlled, phase II trial. J Am Coll Surg 2015; 221: 571–578.

42. Zhang HY, Zhao CL, Xie J, et al. To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Colorectal Dis 2016; 31: 951–960.

43. Zhang X, et al. Enhanced recovery after surgery on multiple clinical outcomes: Umbrella review of systematic reviews and meta-analyses. Medicine (Baltimore) 2020; 99(29): e20983.

44. Zhuang CL, Ye XZ, Zhang CJ, et al. Early versus traditional postoperative oral feeding in patients undergoing elective colorectal surgery: a meta-analysis of randomised clinical trials. Dig Surg 2013; 30: 225–232.

45. Zingg U, Miskovic D, Pasternak I, et al. Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomised trial. Int J Colorectal Dis 2008; 23: 1175–1183.

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