Key result
Poor adherence (<80% compliance) to an Enhanced Recovery Pathway was an independent predictor of developing postoperative complications, increasing the odds by 1.9 times in open surgery and 1.6 times in minimally invasive surgery.
Why the study?
Data on the feasibility and safety of enhanced recovery programs in resource-limited settings are scarce.
Does high compliance with an enhanced recovery pathway improve postoperative outcomes in patients undergoing elective colorectal cancer surgery?
Observational (n=937)
No
Does high compliance with an enhanced recovery pathway improve postoperative outcomes in patients undergoing elective colorectal cancer surgery?
Odds Ratio: 1.9
Increased adherence (≥ 80%) to an enhanced recovery pathway is associated with significantly reduced postoperative complications and shorter hospital stay in both open and minimally invasive colorectal cancer surgery in a resource-limited setting.
≥80% enhanced recovery compliance was associated with fewer complications and shorter stays after colorectal cancer surgery; hypothesis-generating and requires randomized confirmation.
Background Enhanced recovery program (ERP) has demonstrated improved postoperative outcomes with increased adherence to pathway. However, there is scarce data on feasibility and safety in resource limited setting. The objective was to assess compliance with ERP and its impact on postoperative outcomes and return to intended oncological treatment (RIOT). Methods A single center prospective observational audit was conducted from 2014–2019, in elective colorectal cancer surgery. Before implementation, multi-disciplinary team was educated regarding ERP. Adherence to ERP protocol and its elements was recorded. Impact of quantum of adherence (≥ 80% vs. <80%) to ERP on postoperative morbidity, mortality, readmission, stay, re-exploration, functional GI recovery, surgical-specific complications, and RIOT was evaluated for open and minimal invasive surgery (MIS). Results During study, 937 patients underwent elective colorectal cancer surgery. Overall Compliance with ERP was 73.3%. More than 80% compliance was observed in 332 (35.4%) patients in the entire cohort. Patients with < 80% compliance had significantly higher overall, minor and surgery-specific complications, longer postoperative stay, delayed functional GI recovery for both Open and MIS procedures. RIOT was observed in 96.5% patients. Duration to RIOT significantly was shorter following Open surgery with ≥ 80% compliance. Poor adherence to ERP was identified as one of the independent predictors for developing postoperative complications. Conclusion The study demonstrates beneficial impact on postoperative outcomes with increased adherence to ERP following open and minimally invasive surgery for colorectal cancer. Within a resource limited setting, ERP was found to feasible, safe, and effective in both open and minimally invasive colorectal cancer surgery.
No takes yet. Share an insight, caveat, or question.
Thomas et al. (2022) conducted an observational in Colorectal cancer (n=937). Enhanced Recovery Pathway (ERP) compliance < 80% vs. ERP compliance ≥ 80% was evaluated on Overall postoperative complications (OR 1.9). Poor adherence (<80% compliance) to an Enhanced Recovery Pathway was an independent predictor of developing postoperative complications, increasing the odds by 1.9 times in open surgery and 1.6 times in minimally invasive surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: