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Vignali A, Elmore U, Guarneri G, De Ruvo V, Parise P, Rosati R. Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients. Updates Surg 2020; 73:111-121. [PMID: 32638264 DOI: 10.1007/s13304-020-00848-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
To identify factors associated with early deviation and delayed discharge within an Enhanced Recovery after Surgery (ERAS) pathway. This is a retrospective review of prospectively collected data of consecutive patients who underwent laparoscopic or open colorectal surgery and managed with a standardized ERAS pathway between April 2015 and October 2018. ERAS items were assessed within 48 h after surgery. Patients with early complications were excluded. The influence of factors on length of stay was calculated by univariate and multivariate analysis. A binary logistic regression was used to model a predicting score. Seven hundred and thirty-three patients met the inclusion criteria. Multivariate analysis showed that age ≥ 75 years (P = 0.02), ASA score ≥ 3 (P = 0.03), open surgery or conversion to open (P = 0.001), non-compliance with the intra-operative balanced fluid therapy (P = 0.049), failure to early removal of the urinary catheter (P = 0.001), to discontinue IV fluid (P = 0.02) and to early mobilization (P = 0.001) were independently associated with ERAS failure. The generated score had a specificity of 84% and a positive predictive value of 72%. Patients who would have a length of stay longer than the median for each surgical procedure were properly identified (Area under ROC Curve = 0.753, P < 0.001). The delayed discharge could be predicted at 48 h from the intervention. The ability of the model to weight the specific role of each statistically significant variable might be a useful tool to identify the most frail patients.
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Affiliation(s)
- Andrea Vignali
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Giovanni Guarneri
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Valentino De Ruvo
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, San Raffaele Vita-Salute University, Via Olgettina 60, 20123, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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