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Pirozzi BM, Siragusa L, Baldini G, Pellicciaro M, Grande M, Efrati C, Finizio R, Formica V, Del Vecchio Blanco G, Sica GS. Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic. J Clin Med 2023; 12:jcm12041425. [PMID: 36835958 PMCID: PMC9962694 DOI: 10.3390/jcm12041425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.
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Affiliation(s)
- B. M. Pirozzi
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
| | - L. Siragusa
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - G. Baldini
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Pellicciaro
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - M. Grande
- Department of Emergency, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - C. Efrati
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - R. Finizio
- Department of Medicine, Israelitic Hospital of Rome, 00148 Rome, Italy
| | - V. Formica
- Department of Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - G. S. Sica
- Department of Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Romario UF, Ascari F, De Pascale S, Bencini L, Cocozza E, Cotsoglou C, Degiuli M, Palma G, Ferrari G, Lucianetti A, Marchesi F, Merigliano S, Millo P, Navarra G, Petri R, Portolani N, Puzziello A, Rosati R, Weindelmayer J, Ercolani G, De Palma G. Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy. Updates Surg 2023; 75:141-148. [PMID: 36307670 PMCID: PMC9616397 DOI: 10.1007/s13304-022-01400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs have been developed by combining several evidence-based techniques for perioperative care, with the intention of reducing the stress response and organ dysfunction, thus allowing improved clinical results. ERAS programs have been widely adopted for colorectal surgery; however, their adoption for upper gastrointestinal surgery has been challenging even though good results have been reported in the literature. Our intent was to investigate the adoption of ERAS programs for resective gastric surgery in Italy. A survey was conducted among 20 departments of surgery belonging to the Italian Group for Research on Gastric Cancer (GC). Analysis of our survey showed that several evidence-based practices and many items of the ERAS guidelines for gastric surgery are not implemented in real practice in Italian centers dedicated to GC. This situation may be related to the hesitation of surgeons to introduce radical changes to the traditional postoperative management after gastrectomy. A multidisciplinary approach to the perioperative care of these patients is not routinely applied in many Italian centers. A strict collaboration of all clinicians involved in the perioperative care of patients undergoing gastrectomy for GC is key for the future implementation of ERAS in gastric surgery in our departments.
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Affiliation(s)
- Uberto Fumagalli Romario
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Filippo Ascari
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
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3
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Grieco M, Galiffa G, Marcellinaro R, Santoro E, Persiani R, Mancini S, Di Paola M, Santoro R, Stipa F, Crucitti A, Carlini M. Impact of the COVID-19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the "Lazio Network" Database. World J Surg 2022; 46:2288-2296. [PMID: 35972532 PMCID: PMC9380676 DOI: 10.1007/s00268-022-06694-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/18/2023]
Abstract
Background The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the “Lazio Network” project. Methods A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy. Results The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups. Conclusions The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the “Lazio Network” study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge.
Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06694-8.
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Affiliation(s)
- Michele Grieco
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy.
| | - Giampaolo Galiffa
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Rosa Marcellinaro
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | | | - Roberto Persiani
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy
| | | | | | | | | | | | - Massimo Carlini
- Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
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4
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Goodmaker CJG, Kopczynska M, Meskell R, Slade D. Paving the road to recovery: the colorectal surgery ERAS pathway during the COVID-19 pandemic. Br J Surg 2021; 108:e322-e323. [PMID: 34227658 PMCID: PMC8406880 DOI: 10.1093/bjs/znab208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/02/2022]
Affiliation(s)
- C J G Goodmaker
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - M Kopczynska
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - R Meskell
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
| | - D Slade
- Department of Colorectal Surgery, Salford Royal Hospital, Stott Lane, Salford, M6 8HD, UK
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López-Rodríguez-Arias F, Sánchez-Guillén L, Aranaz-Ostáriz V, Triguero-Cánovas D, Lario-Pérez S, Barber-Valles X, Lacueva FJ, Ramirez JM, Arroyo A. Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic. Support Care Cancer 2021; 29:7785-7791. [PMID: 34169328 PMCID: PMC8225311 DOI: 10.1007/s00520-021-06343-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/06/2021] [Indexed: 12/19/2022]
Abstract
Background Surgery remains the first curative treatment for colorectal cancer. Prehabilitation seems to attenuate the loss of lean mass in the early postoperative period. However, its long-term role has not been studied. Lockdown due to the COVID-19 pandemic has forced to carry out the prehabilitation program at home. This study aimed to assess the effect of home prehabilitation on body composition, complications, and hospital stay in patients undergoing oncological colorectal surgery. Methods A prospective and randomized clinical study was conducted in 20 patients operated of colorectal cancer during COVID-19 lockdown (13 March to 21 June 2020) in a single university clinical hospital. Patients were randomized into two study groups (10 per group): prehabilitation vs standard care. Changes in lean mass and fat mass at 45 and 90 days after surgery were measured using multifrequency bioelectrical impedance analysis. Results Prehabilitation managed to reduce hospital stay (4.8 vs 7.2 days, p = 0.052) and postoperative complications (20% vs 50%, p = 0.16). Forty-five days after surgery, the loss of lean mass decreased (1.7% vs 7.1%, p = 0.17). These differences in lean mass were attenuated at 90 days; however, the standard care group increased considerably their fat mass compared to the prehabilitation group (+ 8.72% vs − 8.16%). Conclusions Home prehabilitation has proven its effectiveness, achieving an attenuation of lean mass loss in the early postoperative period and a lower gain in fat mass in the late postoperative period. In addition, it has managed to reduce hospital stays and postoperative complications. Registration number This article is part of an ongoing, randomized, and controlled clinical trial approved by the ethics committee of our hospital and registered in ClinicalTrials.gov in August 2018 with registration number NCT03618329.
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Affiliation(s)
- Francisco López-Rodríguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Verónica Aranaz-Ostáriz
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Daniel Triguero-Cánovas
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Sandra Lario-Pérez
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - Xavier Barber-Valles
- Center for Operations Research, Miguel Hernández University, Elche, Alicante Spain
| | - Francisco J. Lacueva
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
| | - José M. Ramirez
- Department of General Surgery, Colorectal Unit, Lozano Blesa University Clinical Hospital, Zaragoza, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Carrer Almasara 11, 03203 Elche, Alicante Spain
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Mejia OAV, Borgomoni GB, Lasta N, Okada MY, Gomes MSB, Foz MLNN, Bischoff HPG, Saruhashi T, Melro LMG, Sampaio MC, de Barros E Silva PGM, Garcia JCT, Furlan V. Safe and effective protocol for discharge 3 days after cardiac surgery. Sci Rep 2021; 11:8979. [PMID: 33903717 PMCID: PMC8076282 DOI: 10.1038/s41598-021-88582-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/12/2021] [Indexed: 01/22/2023] Open
Abstract
The Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the "TotalCor protocol". After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P ≤ 0.001) and length of hospital stay (P ≤ 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejia
- Hospital Samaritano Paulista, São Paulo, São Paulo, Brazil.
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil.
| | - Gabrielle Barbosa Borgomoni
- Hospital Samaritano Paulista, São Paulo, São Paulo, Brazil
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Nilza Lasta
- Hospital Samaritano Paulista, São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | - Valter Furlan
- Hospital Samaritano Paulista, São Paulo, São Paulo, Brazil
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Catarci M, Benedetti M, Maurizi A, Spinelli F, Bernacconi T, Guercioni G, Campagnacci R. ERAS pathway in colorectal surgery: structured implementation program and high adherence for improved outcomes. Updates Surg 2020; 73:123-137. [PMID: 33094366 DOI: 10.1007/s13304-020-00885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023]
Abstract
Although there is clear evidence that an Enhanced Recovery After Surgery (ERAS) program in colorectal surgery leads to significantly reduced morbidity rates and length of hospital stay (LOS), it is still unclear what modalities and levels of implementation of the program are necessary to achieve these results. The purpose of this study is to analyze the methods and results of the first year of structured implementation of a colorectal ERAS program in two surgical units of the Azienda Sanitaria Unica Regionale (ASUR) Marche in Italy. A two-center observational study on a prospectively maintained database was performed on 196 consecutive colorectal resections (excluding emergencies and American Society of Anesthesiologists class > III cases) over a 1-year period. More than 50 variables including adherence to the individual items of the ERAS program were considered. Primary outcomes were overall morbidity, major morbidity, mortality and anastomotic leakage rates; secondary outcomes were LOS, re-admission and re-operation. The results were evaluated by univariate and multivariate analyses through logistic regression. After a median follow-up of 39.5 days, we recorded complications in 72 patients (overall morbidity 36.7%), major complications in 14 patients (major morbidity 7.1%), 6 deaths (mortality 3.1%), anastomotic dehiscence in 9 cases (4.9%), mean overall LOS of 6.6 days, 10 readmissions (5.1%) and 13 reoperations (6.7%). The mean adherence rate to the items of the ERAS program was 85.4%, showing a significant dose-effect curve for overall and major morbidity rates, anastomotic leakage rates and LOS. The implementation methods of a colorectal ERAS program in this study led to a high adherence (> 80%) to the program items. High adherence had significant effects also on major morbidity and anastomotic leakage rates.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, Ospedale C.G. Mazzoni Ascoli Piceno, AV 5, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy. .,Direttore UOC Chirurgia Generale, Ospedale "C. e G. Mazzoni"-AV5-ASUR Marche, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
| | - Michele Benedetti
- General Surgery Unit, Ospedale C.G. Mazzoni Ascoli Piceno, AV 5, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
| | - Angela Maurizi
- General Surgery Unit, Ospedale C. Urbani Jesi (AN), AV 2, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
| | - Francesco Spinelli
- Anesthesiology Unit, Ospedale C.G. Mazzoni Ascoli Piceno, AV 5, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
| | - Tonino Bernacconi
- Anesthesiology Unit, Ospedale C. Urbani Jesi (AN), AV 2, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
| | - Gianluca Guercioni
- General Surgery Unit, Ospedale C.G. Mazzoni Ascoli Piceno, AV 5, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
| | - Roberto Campagnacci
- General Surgery Unit, Ospedale C. Urbani Jesi (AN), AV 2, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy
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