Comparison of Outcomes between Obese and Non-Obese Patients in a Colorectal Enhanced Recovery After Surgery (ERAS) Program: A Single-Center Cohort Study

Introduction: Obese patients are considered at increased risk of postoperative adverse events after colorectal surgery. Objective: The objective of the present study was to compare postoperative outcomes between obese and non-obese patients undergoing elective colorectal surgery in an Enhanced Recovery After Surgery (ERAS) program. Methods: A retrospective analysis of a prospective cohort including patients who underwent elective colorectal surgery and were included in an ERAS protocol between February 2014 and December 2017 at Geneva University Hospital, Geneva, Switzerland, was performed. Postoperative outcomes of obese and non-obese patients were compared. Results: Data of 460 patients were analyzed, including 374 (81%) non-obese and 86 (19%) obese patients. Overall, there was no difference in postoperative outcomes between the 2 groups. Among patients undergoing oncologic surgery, obese subjects had a significantly higher rate of conversion to laparotomy (11.9 vs. 2.1%, p = 0.01) and longer time until return of bowel function (2.38 vs. 1.98 days, p = 0.03), without increased morbidity or longer length of stay. Conclusion: Obese and non-obese patients had similar postoperative outcomes after elective colorectal surgery with ERAS management. ERAS can potentially reduce the increased morbidity usually observed in obese patients following elective colorectal surgery.

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Caution: Increased Acute Kidney Injury in Enhanced Recovery after Surgery (ERAS) Protocols

The American Surgeon ◽

10.1177/000313481908500221 ◽

2019 ◽

Vol 85 (2) ◽

pp. 156-161 ◽

Cited By ~ 2

Author(s):

Crystal P. Koerner ◽

Alexandra G. Lopez-Aguiar ◽

Mohammad Zaidi ◽

Shelby Speegle ◽

Glen Balch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Colorectal Surgery ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Kidney Injury ◽

Morbidity And Mortality ◽

Elective Colorectal Surgery ◽

Baseline Serum ◽

Increased Risk ◽

Postoperative Aki

Minimizing perioperative fluid administration is a key component of enhanced recovery after surgery protocols (ERAS). Acute kidney injury (AKI) is a major cause of morbidity and mortality in hospitalized patients. Our aim was to assess the association of ERAS with the incidence and severity of AKI in patients undergoing elective colorectal surgery. In this single-study retrospective review, patients undergoing colorectal surgery from 2013 to 2017 were included. Primary endpoint was postoperative AKI. Secondary outcomes were hospital length of stay (LOS) and 30-day readmission. Baseline demographics and procedure types were similar between both groups. AKI was higher in the ERAS versus non-ERAS group (23 vs 9%; P = 0.002). Factors associated with increased risk of AKI on univariate regression included presence of preoperative cardiovascular risk factors (hazard ratio (HR) 3.5; 95% CI 1.3–9.7; P < 0.01), more complex colorectal operations (HR 5.1; 95% CI 1.6–16.1; P < 0.01), and management with an ERAS pathway (HR 2.9; 95% CI 1.5–5.8; P < 0.01). On multi-variable analysis, ERAS remained a significant risk factor for developing AKI (HR 3.44; 95% CI 1.5–7.7; P < 0.01). ERAS patients had a shorter hospital LOS (3.9 vs 5.9 days, P < 00.1) compared with non-ERAS patients, with no difference in 30-day readmission rates (11.5 vs 10.7%; P = 0.98). Although the incidence of AKI is higher in patients treated with ERAS protocols, the majority represent minor elevations in baseline serum creatinine and did not affect the reduction in hospital LOS associated with ERAS. Given the potential association of AKI, however, with increased long-term morbidity and mortality, ERAS protocols should be optimized to prevent postoperative AKI.

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01 / Enhanced Recovery After Surgery (ERAS) care after elective colorectal surgery in elderly patients. Outcomes of a study in the University Hospital of Guadalajara, Spain.

10.26226/morressier.5aeb0ace07b0d6001a79ae78 ◽

2018 ◽

Author(s):

Victor Jiménez Guitian

Keyword(s):

Colorectal Surgery ◽

Elderly Patients ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

University Hospital ◽

Elective Colorectal Surgery ◽

The University ◽

Surgery In Elderly

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The role of carbohydrate drinks in preoperative nutrition for elective colorectal surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x13137608455136 ◽

2011 ◽

Vol 93 (7) ◽

pp. 504-507 ◽

Cited By ~ 28

Author(s):

C Jones ◽

SA Badger ◽

R Hannon

Keyword(s):

Colorectal Surgery ◽

English Language ◽

Literature Search ◽

Enhanced Recovery ◽

Elective Surgery ◽

Major Change ◽

Bowel Function ◽

Elective Colorectal Surgery ◽

Increased Risk ◽

Operative Recovery

INTRODUCTION Traditionally, patients have been fasted from midnight on the night before elective surgery. With the advent of the enhanced recovery programme for elective colorectal surgery, there has been a major change in established practice with patients able to continue with clear fluids up to two hours prior to surgery and solids up to six hours prior to surgery. It has been suggested that nutritional supplements in the immediate pre-operative period enhance post-operative recovery. The aim of this review was therefore critically to appraise the evidence available regarding the use of pre-operative carbohydrate (CHO) supplements for elective colorectal surgery. METHODS A literature search was performed using: PubMed, MEDLINE®, Athens and Google Scholar. The following keywords were used: ‘pre-operative’, ‘carbohydrate supplements’, ‘enhanced recovery’ and ‘colorectal surgery’, singly or in combination. To ensure an up-to-date literature search, the search was restricted to the last ten years. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. Only English language articles were included. CONCLUSIONS The use of CHO drinks pre-operatively in colorectal surgery is both safe and effective. There is no increased risk of aspiration and it results in a shorter hospital stay, a quicker return of bowel function and less loss of muscle mass. On the basis of this evidence, the use of pre-operative CHO drinks should be standard in elective colorectal patients. Further research is nevertheless required for those with diabetes mellitus.

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ERAS® Program in a Portuguese Hospital: Results from Elective Colorectal Surgery after One Year of Implementation

Acta Médica Portuguesa ◽

10.20344/amp.11158 ◽

2020 ◽

Vol 33 (9) ◽

pp. 568

Author(s):

André Carrão ◽

Daniel Ribeiro ◽

Maria Manso ◽

Joana Oliveira ◽

Luís Féria ◽

...

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Bowel Function ◽

Control Group ◽

Elective Colorectal Surgery ◽

Improve Patient

Introduction: The Enhanced Recovery After Surgery® program comprises the implementation of various perioperative measures that reduce surgical stress and ultimately improve patient recovery and outcome. The purpose of this study is to evaluate the first-year compliance and clinical outcomes after implementation of the Enhanced Recovery After Surgery® program in elective colorectal surgery in our hospital.Material and Methods: An analysis was performed on the 210 patients who underwent elective colorectal surgery from May 2016 to December 2017. The group of patients that underwent surgery after the protocol implementation (Enhanced Recovery After Surgery® group) was compared to a conventional care control group (pre- Enhanced Recovery After Surgery® group). Differences between the two groups were adjusted using Propensity Score matching. The main outcomes were length of stay, return of bowel function, complications and mortality. The evolution of compliance with Enhanced Recovery After Surgery® principles was also analyzed.Results: After propensity score matching, 112 patients were included in the present study: 56 patients formed the pre-Enhanced Recovery After Surgery® group and 56 the Enhanced Recovery After Surgery® group. The overall adherence to the protocol increased from 35.7% to 80.8%. There was a decrease in length of stay, time to return of bowel function and medical complications.Discussion: The Enhanced Recovery After Surgery® program is safe and seems to shorten length of stay and improve patient recovery and clinical outcome.Conclusion: This study showed that the implementation of the Enhanced Recovery After Surgery® program was possible in Hospital Beatriz Ângelo, with a positive impact in the immediate postoperative recovery of colorectal patients.

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