Conditions Associated with Worse Acceptance of a Simplified Accelerated Recovery after Surgery Protocol in Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.
Abstract Background: Accelerated Recovery after Surgery Programs were initially applied to colorectal surgery and used a multimodal care approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the non-tolerance of patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery.Methods: 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n=51) and those who did not (n=33), in order to analyze factors contributing to protocol nontolerance.Results: The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). The rates of complications and of returns to the emergency room were similar between groups. In the multivariate analysis of the subgroups, we found that prolonged surgical time, stoma creation, and the development of complications were variables that placed program acceptance at risk (p < 0.0001).Conclusions: The accelerated postoperative recovery program that was adopted, although simplified, was able to improve recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with program non-acceptance. Trial registration: Trial Registry: RBR2b4fyr - Date of registration: 03 October 2017.