The Impact of the Enhanced Recovery After Surgery (ERAS) Protocol on Colorectal Surgery in a Portuguese Tertiary Hospital

Catarina Lopes; Mariana Vaz Gomes; Manuel Rosete; Ana Almeida; Luisa Isabel Silva; José Guilherme Tralhão

doi:10.20344/amp.18284

Autores

Catarina Lopes Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculty of Medicine. University of Coimbra. Coimbra.
Mariana Vaz Gomes Centro Hospitalar Universitário Coimbra https://orcid.org/0000-0001-6894-775X
Manuel Rosete Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculty of Medicine. University of Coimbra. Coimbra.
Ana Almeida Anaesthesiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra.
Luisa Isabel Silva Anaesthesiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. https://orcid.org/0000-0002-4574-819X
José Guilherme Tralhão Surgery Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculty of Medicine. University of Coimbra. Coimbra. Coimbra Institute for Clinical and Biomedical Research. Area of Environment Genetics and Oncobiology. Faculty of Medicine. University of Coimbra. Coimbra.

DOI:

https://doi.org/10.20344/amp.18284

Resumo

Introdução: Os benefícios do programa multimodal Enhanced Recovery After Surgery® (ERAS) têm sido descritos em todo o mundo. A adoção de várias estratégias peri-operatórias traduz-se numa melhoria dos cuidados de saúde prestados com ganhos para o doente e para a instituição. O objetivo deste estudo foi reportar os resultados da implementação do programa ERAS® na cirurgia colorretal num hospital terciário.
Material e Métodos: Neste estudo unicêntrico observacional foram incluídos 534 doentes submetidos a cirurgia colorretal entre dezembro 2018 e maio de 2021. Foram criados dois grupos: antes e depois da implementação do programa ERAS® com o objetivo primário de comparar a morbilidade aos 30 dias. Foi também avaliado o tempo de internamento, a taxa de reinternamento, reintervenção e a mortalidade entre os grupos.
Resultados: O grupo pré-ERAS era constituído por 102 doentes e o grupo ERAS por 432 doentes. Verificou-se uma redução significativa na morbilidade aos 30 dias (37,3% vs 26,5%, p < 0,05), no tempo de internamento (7 dias vs 5 dias, p < 0,001) e na taxa de readmissão (12,9% vs 6%, p < 0,05) após a implementação do programa.
Conclusão: O protocolo ERAS® na cirurgia colorretal foi implementado com sucesso e segurança no nosso hospital, contribuindo para uma melhoria dos cuidados peri-operatórios prestados aos doentes.

Downloads

Não há dados estatísticos.

Referências

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152:292–8. DOI: https://doi.org/10.1001/jamasurg.2016.4952

Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr.2012;31:783–800. DOI: https://doi.org/10.1016/j.clnu.2012.08.013

Nygren J, Thacker J, Carli F, Fearon KC, Norderval S, Lobo DN, et al. Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31:801-16. DOI: https://doi.org/10.1016/j.clnu.2012.08.012

Kaye A, Urman R, Rappaport Y, Siddaiah H, Cornett E, Belani K, et al. Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings. J Anaesthesiol Clin Pharmacol. 2019;35:40. DOI: https://doi.org/10.4103/joacp.JOACP_51_18

Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60:289–334. DOI: https://doi.org/10.1111/aas.12651

Lohsiriwat V. Enhanced recovery after surgery vs conventional care in emergency colorectal surgery. World J Gastroenterol. 2014;20:13950–5. DOI: https://doi.org/10.3748/wjg.v20.i38.13950

Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146:571–7. DOI: https://doi.org/10.1001/archsurg.2010.309

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae

Bragg D, El-Sharkawy AM, Psaltis E, Maxwell-Armstrong CA, Lobo DN. Postoperative ileus: Recent developments in pathophysiology and management. Clin Nutr. 2015;34:367-76. DOI: https://doi.org/10.1016/j.clnu.2015.01.016

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784–91. DOI: https://doi.org/10.1001/jamasurg.2017.0904

Ban K, Berian J, Ko C. Does implementation of Enhanced Recovery After Surgery (ERAS) protocols in colorectal surgery improve patient outcomes? Clin Colon Rectal Surg. 2019;32:109–13. DOI: https://doi.org/10.1055/s-0038-1676475

Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS, Gan TJ, et al. Enhanced Recovery after Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59:1212–31. DOI: https://doi.org/10.1111/aas.12601

Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Enhanced Recovery After Surgery (ERAS) protocols for colorectal cancer in Japan. BMC Surg. 2015;15:90. DOI: https://doi.org/10.1186/s12893-015-0079-0

Tavis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg. 2016;29:246-52. DOI: https://doi.org/10.1055/s-0036-1584501

Harnsberger C, Maykel J, Alavi K. Postoperative ileus. Clin Colon Rectal Surg. 2019;32:166–70. DOI: https://doi.org/10.1055/s-0038-1677003

Pak H, Maghsoudi LH, Soltanian A, Gholami F. Surgical complications in colorectal cancer patients. Ann Med Surg. 2020;55:13–8. DOI: https://doi.org/10.1016/j.amsu.2020.04.024

Ju YU, Min BW. A review of bowel preparation before colorectal surgery. Ann Coloproctology. 2021;37:75–84. DOI: https://doi.org/10.3393/ac.2020.04.01

Toh JW, Harlaar J, Di Re A, Pathmanathan N, El Khoury T, Ctercteko G. Understanding the role of mechanical bowel preparation and oral antibiotics prior to elective colorectal surgery. Ann Laparosc Endosc Surg. 2019;4:47. DOI: https://doi.org/10.21037/ales.2019.05.01

Liu H, Yang P, Han S, Zhang Y, Zhu H. The application of enhanced recovery after surgery and negative-pressure wound therapy in the perioperative period of elderly patients with colorectal cancer. BMC Surg. 2021;21:336. DOI: https://doi.org/10.1186/s12893-021-01331-y

Ceretti AP, Maroni N, Longhi M, Giovenzana M, Santambrogio R, Barabino M, et al. Risk factors for prolonged postoperative ileus in adult patients undergoing elective colorectal surgery: an observational cohort study. Rev Recent Clin Trials. 2018;13:295–304. DOI: https://doi.org/10.2174/1574887113666180521111153

Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531–41. DOI: https://doi.org/10.1007/s00268-013-2416-8

Ripollés-Melchor J, Fuenmayor-Varela ML de, Criado Camargo S, Jerez Fernández P, Contreras del Barrio Á, Martínez-Hurtado E, et al. Enhanced recovery after surgery protocol versus conventional perioperative care in colorectal surgery. A single center cohort study. Braz J Anesthesiol Engl Ed. 2018;68:358–68. DOI: https://doi.org/10.1016/j.bjane.2018.01.007

Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-9. DOI: https://doi.org/10.1161/01.CIR.100.10.1043

Schenning KJ, Deiner SG. Postoperative delirium in the geriatric patient. Anesthesiol Clin. 2015;33:505–16. DOI: https://doi.org/10.1016/j.anclin.2015.05.007

Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, et al. Standardization of care: Impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220:430–43. DOI: https://doi.org/10.1016/j.jamcollsurg.2014.12.042

Carrão A, Ribeiro D, Manso M, Oliveira J, Féria L, Ghira M, et al. ERAS® program in a Portuguese hospital: results from elective colorectal surgery after one year of implementation. Acta Med Port. 2020;33:568–75. DOI: https://doi.org/10.20344/amp.11158

Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434–40. DOI: https://doi.org/10.1016/j.clnu.2010.01.004

Batool F, Collins SD, Albright J, Ferraro J, Wu J, Krapohl GL, et al. A regional and national database comparison of colorectal outcomes. JSLS. 2018;22:e2018.00031. DOI: https://doi.org/10.4293/JSLS.2018.00031

Zhuang C Le, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a metaanalysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667–78. DOI: https://doi.org/10.1097/DCR.0b013e3182812842

Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 Cases. Dis Colon Rectum. 2012;55:1300–10. DOI: https://doi.org/10.1097/DCR.0b013e31826ab4dd

Walter CJ, Maxwell-Armstrong C, Pinkney TD, Conaghan PJ, Bedforth N, Gornall CB, et al. A randomised controlled trial of the efficacy of ultrasoundguided transversus abdominis plane (TAP) block in laparoscopic colorectal surgery. Surg Endosc. 2013;27:2366–72. DOI: https://doi.org/10.1007/s00464-013-2791-0

Barletta JF, Asgeirsson T, Senagore AJ. La influencia de las dosis de opioides por via intravenosa sobre la oclusión intestinal postoperatoria. Ann Pharmacother. 2011;45:916–23. DOI: https://doi.org/10.1345/aph.1Q041

Arrick L, Mayson K, Hong T, Warnock G. Enhanced recovery after surgery in colorectal surgery: Impact of protocol adherence on patient outcomes. J Clin Anesth. 2019;55:7–12. DOI: https://doi.org/10.1016/j.jclinane.2018.12.034