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Mangone L, Mereu F, Zizzo M, Morini A, Zanelli M, Marinelli F, Bisceglia I, Braghiroli MB, Morabito F, Neri A, Fabozzi M. Outcomes before and after Implementation of the ERAS (Enhanced Recovery after Surgery) Protocol in Open and Laparoscopic Colorectal Surgery: A Comparative Real-World Study from Northern Italy. Curr Oncol 2024; 31:2907-2917. [PMID: 38920706 PMCID: PMC11202664 DOI: 10.3390/curroncol31060222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have changed perioperative care, aiming to optimize patient outcomes. This study assesses ERAS implementation effects on postoperative complications, length of hospital stay (LOS), and mortality in colorectal cancer (CRC) patients. A retrospective real-world analysis was conducted on CRC patients undergoing surgery within a Northern Italian Cancer Registry. Outcomes including complications, re-surgeries, 30-day readmission, mortality, and LOS were assessed in 2023, the year of ERAS protocol adoption, and compared with data from 2022. A total of 158 surgeries were performed, 77 cases in 2022 and 81 in 2023. In 2023, a lower incidence of postoperative complications was observed compared to that in 2022 (17.3% vs. 22.1%), despite treating a higher proportion of patients with unfavorable prognoses. However, rates of reoperations and readmissions within 30 days post-surgery increased in 2023. Mortality within 30 days remained consistent between the two groups. Patients diagnosed in 2023 experienced a statistically significant reduction in LOS compared to those in 2022 (mean: 5 vs. 8.1 days). ERAS protocols in CRC surgery yield reduced postoperative complications and shorter hospital stays, even in complex cases. Our study emphasizes ERAS' role in enhancing surgical outcomes and recovery.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.M.); (I.B.); (M.B.B.)
| | - Federica Mereu
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (M.Z.); (A.M.); (M.Z.); (M.F.)
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (M.Z.); (A.M.); (M.Z.); (M.F.)
| | - Andrea Morini
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (M.Z.); (A.M.); (M.Z.); (M.F.)
| | - Magda Zanelli
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (M.Z.); (A.M.); (M.Z.); (M.F.)
| | - Francesco Marinelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.M.); (I.B.); (M.B.B.)
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.M.); (I.B.); (M.B.B.)
| | - Maria Barbara Braghiroli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.M.); (I.B.); (M.B.B.)
| | | | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Massimiliano Fabozzi
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (M.Z.); (A.M.); (M.Z.); (M.F.)
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Buitrago-Ruiz M, Martinez-Nicolas I, Soria-Aledo V. Validation of prolonged length of stay as a reliable measure of failure to rescue in colorectal surgery. Asian J Surg 2023; 46:126-131. [PMID: 35317966 DOI: 10.1016/j.asjsur.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/10/2022] [Accepted: 02/11/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Failure-to-rescue measures a hospital's response capacity to avoid the death of a patient after a complication. The aim of this study was to validate the use of prolonged length of stay to calculate failure-to-rescue rates as a substitute for traditional coding of complications in colorectal cancer surgery. METHOD We performed a cross-sectional between-instruments agreement study. Our study population was comprised of 204 colorectal cancer surgical patients from a public academic hospital during 2017 and 2018. We obtained two failure-to-rescue indicators from administrative data: an indicator using International Classification of Diseases, tenth edition, (ICD-10) codes; and another one using a cut-off point of prolonged length of stay as a predictor of patients with complications. Then, they were compared with a reference indicator from clinical records. RESULTS Failure-to-rescue rates were between 10 and 13.64 for the study site depending on which indicator was used. A hospital stay ≥10 days had the maximum Youden's index (0.6) and an area under the ROC curve of 0.87. This was used in the failure-to-rescue indicator using prolonged length, which obtained the highest agreement (any coefficient >0.75). CONCLUSION ICD-10 codes identified complications poorly. Prolonged length of stay could be a valid replacement of ICD-10 codes when measuring failure-to-rescue in administrative databases for colorectal surgical patients.
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Affiliation(s)
| | | | - Victor Soria-Aledo
- Morales Meseguer General University Hospital Murcia, Spain; Surgery Department, University of Murcia Murcia, Spain; Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain.
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Martínez-Escribano C, Arteaga Moreno F, Cuesta Peredo D, Blanco Gonzalez FJ, De la Cámara-de las Heras JM, Tarazona Santabalbina FJ. Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS ®) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15299. [PMID: 36430017 PMCID: PMC9691222 DOI: 10.3390/ijerph192215299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of this study was to determine whether the inclusion of older patients undergoing elective colorectal cancer resection in the Enhanced Recovery After Surgery (ERAS®) programme could improve clinical outcomes during hospital admission. METHODS A before-and-after study in ≥70-year-old patients electively admitted for colorectal cancer resection was designed. In total, 213 patients were included in the ERAS® group, and 158 were included in the control group. RESULTS The average age was 77.9 years old (SD 5.31) and 57.14% of them were men, with a Charlson Index score of 3.42 (SD 3.32). The ERAS® group presented a lower transfusion rate of 42 (19.7%), compared to 75 (47.5%) in the control group (p < 0.001). The crude odds ratio (OR) for transfusion was 0.27 (95% CI 0.17-0.43; p < 0.001), and the adjusted odds ratio was 0.26 (95% CI 0.14-0.48; p < 0.001). The ERAS® group had a lower percentage of patients with moderate-severe malnutrition on admission, at 23.4% (37 patients) against 36.2% in the control group (42 patients) (p = 0.023), with an OR of 0.47 (95% CI 0.29-0.75; p < 0.002) and an adjusted OR of 0.48 (95% CI 0.29-0.78; p = 0.003). The number of patients who required admission to the intensive care unit (ICU) was also markedly lower: 54 from the ERAS® group (25.4%) versus 71 from the control group (44.9%) (p < 0.001). CONCLUSIONS The inclusion of ≥70-year-old adults in the ERAS® programme resulted in a decrease in transfusions, number of erythrocyte concentrates transfused, and number of ICU admissions, along with improved nutritional status.
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Affiliation(s)
- Cristina Martínez-Escribano
- Anaesthesiology, Resuscitation and Therapeutics of Pain, Hospital Universitario de la Ribera, Ctra de Corbera, km 1, 46600 Alzira, Valencia, Spain
- Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Valencia, Spain
| | - Francisco Arteaga Moreno
- Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Valencia, Spain
| | - David Cuesta Peredo
- Quality of Care Department, Hospital Universitario de la Ribera, 46600 Alzira, Valencia, Spain
| | | | | | - Francisco J. Tarazona Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, 46600 Alzira, Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
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Martínez-Escribano C, Arteaga Moreno F, Pérez-López M, Cunha-Pérez C, Belenguer-Varea Á, Cuesta Peredo D, Blanco González FJ, Tarazona-Santabalbina FJ. Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort. Nutrients 2022; 14:nu14010207. [PMID: 35011082 PMCID: PMC8746820 DOI: 10.3390/nu14010207] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period
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Affiliation(s)
- Cristina Martínez-Escribano
- Anesthesiology and Resuscitation, Hospital Universitario de la Ribera, 46600 Valencia, Spain;
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
| | - Francisco Arteaga Moreno
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
| | - Marcos Pérez-López
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
| | - Cristina Cunha-Pérez
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
| | - Ángel Belenguer-Varea
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
- Division of Geriatrics, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - David Cuesta Peredo
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
- Quality Management, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | | | - Francisco J. Tarazona-Santabalbina
- School of Doctorate, Catholic University of Valencia, San Vicente Martir, 46600 Valencia, Spain; (F.A.M.); (M.P.-L.); (C.C.-P.); (Á.B.-V.); (D.C.P.)
- Division of Geriatrics, Hospital Universitario de la Ribera, 46600 Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
- Correspondence:
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