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Clin Nutr ESPEN. 2018 Jun;25:139-144. doi: 10.1016/j.clnesp.2018.03.003. Epub 2018 Mar 30.

Identification of core items in the enhanced recovery pathway.

Author information

1
Department of Surgery, Vita-Salute University, San Raffaele Hospital, Milan, Italy. Electronic address: braga.marco@hsr.it.
2
Department of Surgery, Prato Hospital, Italy.
3
Department of Surgery, Cuneo Hospital, Italy.
4
Department of Surgery, Casa di Cura Città di Udine, Italy.
5
Department of Anesthesiology, Legnano Hospital, Italy.
6
Department of Anesthesiology, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
7
Department of Anesthesiology - Vita-Salute University San Raffaele Hospital, Milan, Italy.
8
Department of Surgery - Humanitas Hospital IRCCS, Milan, Italy.
9
Department of Surgery - Cantù Hospital, Italy.
10
Department of Surgery - Candiolo Hospital, Turin, Italy.
11
Department of Surgery - Luigi Sacco Hospital, Milan, Italy.
12
Department of Surgery - Cottolengo Hospital Turin, Italy.
13
Department of Surgery - Mauriziano Hospital Turin, Italy.
14
Department of Surgery - San Paolo Hospital, Italy.
15
Department of Surgery - Cuneo Hospital, Italy.
16
Department of Surgery - Vita-Salute University San Raffaele Hospital, Milan, Italy.
17
Department of Surgery - Careggi Hospital, University of Florence, Italy.

Abstract

BACKGROUND & AIMS:

The Enhanced Recovery After Surgery (ERAS) pathway represents an optimal approach in patients undergoing colorectal surgery but complexity in implementing its items could limit its application. The aim of this study is to identify possible core items within an ERAS pathway following elective colorectal resection.

METHODS:

This is a retrospective review of data prospectively collected between January 2014 and September 2015 by 14 Italian Hospitals in an electronic registry dedicated to an ERAS protocol. 722 patients undergoing elective colorectal surgery within an ERAS protocol have been included in the study. Adherence to ERAS items was assessed in all patients. A secondary analysis was restricted to pre- and intraoperative ERAS items. Time to readiness for discharge (TRD) was the primary endpoint of the study. Postoperative overall morbidity was the secondary endpoint.

RESULTS:

Multivariate analyses showed that active intraoperative warming (p = 0.008), early stop of intravenous fluids (p = 0.0001), and early removal of urinary catheter (p = 0.0001) were associated to a shorter TRD, while early stop of intravenous fluids (p < 0.001) also reduced morbidity. When the analysis was restricted to pre- and intraoperative items, removal of NGT at the end of surgery had an independent role to shorten TRD (p < 0.001) and to reduce overall morbidity (p = 0.019), while the absence of oral bowel preparation reduced postoperative overall morbidity (p = 0.021).

CONCLUSIONS:

In implementing an ERAS pathway, hospitals could initially focus on active intraoperative warming, early stop of intravenous fluids, early removal of urinary catheter, removal of NGT at the end of surgery, and absence of oral bowel preparation, keeping on continuous effort to apply the complete ERAS protocol.

KEYWORDS:

Colorectal surgery; Core ERAS items; Enhanced recovery; Hospital stay; Postoperative morbidity

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