1. Enhanced recovery after surgery in colon and rectal surgery: identification of predictive variables of failure in a monocentric series including 733 patients.
- Author
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Vignali A, Elmore U, Guarneri G, De Ruvo V, Parise P, and Rosati R
- Subjects
- Adult, Aged, Aged, 80 and over, Colonic Diseases physiopathology, Female, Frailty, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Recovery of Function, Rectal Diseases physiopathology, Retrospective Studies, Treatment Failure, Young Adult, Colon surgery, Colonic Diseases surgery, Enhanced Recovery After Surgery, Laparoscopy methods, Rectal Diseases surgery, Rectum surgery
- 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.
- Published
- 2021
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