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1. Impact of the COVID-19 Pandemic on Enhanced Recovery After Surgery (ERAS) Application and Outcomes: Analysis in the “Lazio Network” Database

Author

Grieco, Michele, Galiffa, G., Marcellinaro, R., Santoro, E., Persiani, Roberto, Mancini, Stefano, Di Paola, M., Santoro, Roberto, Stipa, F., Crucitti, Antonio, Carlini, M., Spoletini, D., Russo, Giulia, Menditto, R., Palla, F., Giorgetti, G. M., Pernazza, G., Marino, P., De Luca, L., Mancini, R., Pende, V., Lirici, M., Falbo, F., D'Ugo, Domenico, Sollazzi, Liliana, Mele, Maria Cristina, Lorenzon, Laura, Gasbarrini, Antonio, Pezzuto, Roberto, Rinninella, Emanuele, Cintoni, Marco, Adducci, Enrica, Belardi, A., Bonasera, Elena, Cappelloni, D., Angeloni, Riccardo, Minieri, L., Sagnotta, A., Folliero, G., Solinas, L., Arturi, A., Ferraris, C., Capuano, G., Romeo, G., Amodio, P. M., Carnevale, S., Sansonetti, A., Tierno, S. M., Mazzari, Mario Attilio, Diamanti, P., Muccichini, L., Menghetti, D., Grieco M., Persiani R. (ORCID:0000-0002-1537-5097), Mancini S., Santoro R., Crucitti A. (ORCID:0000-0003-3496-4185), Russo G., D'Ugo D. (ORCID:0000-0001-6657-6318), Sollazzi L. (ORCID:0000-0002-2973-6236), Mele M. C. (ORCID:0000-0003-0153-5819), Lorenzon L. (ORCID:0000-0001-6736-0383), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pezzuto R., Rinninella E. (ORCID:0000-0002-9165-2367), Cintoni M. (ORCID:0000-0002-9610-0748), Adducci E. (ORCID:0000-0002-8977-762X), Bonasera E., Angeloni R., Mazzari A. (ORCID:0000-0002-7301-6834), Grieco, Michele, Galiffa, G., Marcellinaro, R., Santoro, E., Persiani, Roberto, Mancini, Stefano, Di Paola, M., Santoro, Roberto, Stipa, F., Crucitti, Antonio, Carlini, M., Spoletini, D., Russo, Giulia, Menditto, R., Palla, F., Giorgetti, G. M., Pernazza, G., Marino, P., De Luca, L., Mancini, R., Pende, V., Lirici, M., Falbo, F., D'Ugo, Domenico, Sollazzi, Liliana, Mele, Maria Cristina, Lorenzon, Laura, Gasbarrini, Antonio, Pezzuto, Roberto, Rinninella, Emanuele, Cintoni, Marco, Adducci, Enrica, Belardi, A., Bonasera, Elena, Cappelloni, D., Angeloni, Riccardo, Minieri, L., Sagnotta, A., Folliero, G., Solinas, L., Arturi, A., Ferraris, C., Capuano, G., Romeo, G., Amodio, P. M., Carnevale, S., Sansonetti, A., Tierno, S. M., Mazzari, Mario Attilio, Diamanti, P., Muccichini, L., Menghetti, D., Grieco M., Persiani R. (ORCID:0000-0002-1537-5097), Mancini S., Santoro R., Crucitti A. (ORCID:0000-0003-3496-4185), Russo G., D'Ugo D. (ORCID:0000-0001-6657-6318), Sollazzi L. (ORCID:0000-0002-2973-6236), Mele M. C. (ORCID:0000-0003-0153-5819), Lorenzon L. (ORCID:0000-0001-6736-0383), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pezzuto R., Rinninella E. (ORCID:0000-0002-9165-2367), Cintoni M. (ORCID:0000-0002-9610-0748), Adducci E. (ORCID:0000-0002-8977-762X), Bonasera E., Angeloni R., and Mazzari A. (ORCID:0000-0002-7301-6834)

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.

Published
2022

2. The 'Lazio Network' experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016-2017

Author

Grieco, M, Pernazza, G, Gasparrini, M, Marino, P, Apponi, F, Persiani, R, Brescia, A, D'Ugo, D, Sollazzi, L, Mele, Mc, Gasbarrini, A, Lorenzon, L, Tirelli, F, Lirosi, Mc, Rinninnella, E, Cintoni, M, Adducci, E, Benucci, C, De Luca, L, Pezzatini, M, Troisi, F, Romeo, G, Carlini, M, Spoletini, D, Palla, F, Giorgetti, Gm, Coppola, R, Spagnolo, G, Emerenziani, S, Longo, G, Tomassini, F, Simonetti, F, Fradeani, E, Passafiume, F, Maglio, R, Bonapasta, Sa, Crucitti, A, Santoro, E, Mazzari, A, Diamanti, P, Muccichini, L, Menghetti, D, Pedulla, G, Donadio, R, Marini, P, Ricci, G, Persichetti, R, Stipa, F, Russo, G, Firmi, L, Mancini, S, Belardi, A, Bonasera, E, Cappelloni, D, Angeloni, R, Minieri, L, Palmieri, Rm, Amodio, Pm, Cicia, S, Vecchiarelli, P, Paiolo, P, Sacchi, M, De Stefano, M, Palladino, M, Pietrosanti, F, Santoro, R, Sandri, Gbl, Sansonetti, A, Coccetti, B, Di Paola, M, Arturi, A, Ferraris, C, Capuano, G, Persiani, R (ORCID:0000-0002-1537-5097), D'Ugo, D (ORCID:0000-0001-6657-6318), Sollazzi, L (ORCID:0000-0002-2973-6236), Mele, MC (ORCID:0000-0003-0153-5819), Gasbarrini, A (ORCID:0000-0002-7278-4823), Lorenzon, L (ORCID:0000-0001-6736-0383), Adducci, E (ORCID:0000-0002-8977-762X), Spagnolo, G (ORCID:0000-0002-5762-2164), Crucitti, A (ORCID:0000-0003-3496-4185), Grieco, M, Pernazza, G, Gasparrini, M, Marino, P, Apponi, F, Persiani, R, Brescia, A, D'Ugo, D, Sollazzi, L, Mele, Mc, Gasbarrini, A, Lorenzon, L, Tirelli, F, Lirosi, Mc, Rinninnella, E, Cintoni, M, Adducci, E, Benucci, C, De Luca, L, Pezzatini, M, Troisi, F, Romeo, G, Carlini, M, Spoletini, D, Palla, F, Giorgetti, Gm, Coppola, R, Spagnolo, G, Emerenziani, S, Longo, G, Tomassini, F, Simonetti, F, Fradeani, E, Passafiume, F, Maglio, R, Bonapasta, Sa, Crucitti, A, Santoro, E, Mazzari, A, Diamanti, P, Muccichini, L, Menghetti, D, Pedulla, G, Donadio, R, Marini, P, Ricci, G, Persichetti, R, Stipa, F, Russo, G, Firmi, L, Mancini, S, Belardi, A, Bonasera, E, Cappelloni, D, Angeloni, R, Minieri, L, Palmieri, Rm, Amodio, Pm, Cicia, S, Vecchiarelli, P, Paiolo, P, Sacchi, M, De Stefano, M, Palladino, M, Pietrosanti, F, Santoro, R, Sandri, Gbl, Sansonetti, A, Coccetti, B, Di Paola, M, Arturi, A, Ferraris, C, Capuano, G, Persiani, R (ORCID:0000-0002-1537-5097), D'Ugo, D (ORCID:0000-0001-6657-6318), Sollazzi, L (ORCID:0000-0002-2973-6236), Mele, MC (ORCID:0000-0003-0153-5819), Gasbarrini, A (ORCID:0000-0002-7278-4823), Lorenzon, L (ORCID:0000-0001-6736-0383), Adducci, E (ORCID:0000-0002-8977-762X), Spagnolo, G (ORCID:0000-0002-5762-2164), and Crucitti, A (ORCID:0000-0003-3496-4185)

Abstract

AIM: Enhanced Recovery After Surgery (ERAS) guidelines represent one of the most important steps forward in colorectal surgery in the last ten years. Despite the well-known and demonstrated positive impact on the clinical outcomes that this pathway provides, a cultural revolution in patient management is needed. This is not easy to obtain, especially in small and peripheral centers. In Italy, the diffusion of minimally invasive surgery and "fast-track" perioperative management of the patient is rapidly spreading, even in the central and southern regions. However, in these regions, the percentage of laparoscopic colorectal procedures is dramatically less than in the north of Italy. In this context, the idea of a research group based in Rome focused on the development and spreading of ERAS protocols in the Lazio Region was developed.METHODS: A research group, based in Rome, was founded in December 2016 to evaluate the diffusion of the ERAS program over the main colorectal centers of the region. This "Lazio Network" began with a group of surgeons and anesthesiologists from 5 hospitals. After one and half years, the project now includes 17 hospitals in the region. A multicenter database was created, including consecutive patients who underwent laparoscopic colorectal resection following the ERAS program in the participating centers between January 2016 and December 2017.RESULTS: Data for more than 1200 patients were collected over the observed period. The rate of minimally invasive surgery was higher compared to the regional rate (90% vs. 30%), adherence to the ERAS pathway was around 60% of the items per patient. A clinical study will result from this database. The objective is to evaluate the mean number of ERAS items applied, the most common and uncommon items applied and the influence of this application on the clinical outcomes.CONCLUSIONS: The adoption of the ERAS program is rapidly increasing even in central Italian regions, even though the total rate of minimall

Published
2019

3. The 'Lazio Network' experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016-2017

Author

Grieco, M., Pernazza, G., Gasparrini, M., Marino, P., Apponi, F., Persiani, Roberto, Brescia, A., D'Ugo D, Sollazzi, Liliana, Mele, Maria Cristina, Gasbarrini, Antonio, Lorenzon, L., Tirelli, F., Lirosi, Mc, Rinninnella, E., Cintoni, M., Adducci, Enrica, Benucci, C., Luca, L., Pezzatini, M., Troisi, F., Romeo, G., Carlini, M., Spoletini, D., Palla, F., Giorgetti, Gm, Coppola, R., Antonio G. Spagnolo, Emerenziani, S., Longo, G., Tomassini, F., Simonetti, F., Fradeani, E., Passafiume, F., Maglio, R., Bonapasta, Sa, Crucitti, Antonio, Santoro, E., Mazzari, A., Diamanti, P., Muccichini, L., Menghetti, D., Pedulla, G., Donadio, R., Marini, P., Ricci, G., Persichetti, R., Stipa, F., Russo, G., Firmi, L., Mancini, S., Belardi, A., Bonasera, E., Cappelloni, D., Angeloni, R., Minieri, L., Palmieri, Rm, Amodio, Pm, Cicia, S., Vecchiarelli, P., Paiolo, P., Sacchi, M., Stefano, M., Palladino, M., Pietrosanti, F., Santoro, R., Sandri, Gbl, Sansonetti, A., Coccetti, B., Di Paola, M., Arturi, A., Ferraris, C., and Capuano, G.

Subjects
Time Factors, Databases, Factual, Colon, Rectum, Italy, Settore MED/41 - ANESTESIOLOGIA, ERAS guidelines, Humans, Coloretal surgery, Laparoscopy, Guideline Adherence, Enhanced Recovery After Surgery, Digestive System Surgical Procedures, Fast track surgery, Program Evaluation
Abstract

Enhanced Recovery After Surgery (ERAS) guidelines represent one of the most important steps forward in colorectal surgery in the last ten years. Despite the well-known and demonstrated positive impact on the clinical outcomes that this pathway provides, a cultural revolution in patient management is needed. This is not easy to obtain, especially in small and peripheral centers. In Italy, the diffusion of minimally invasive surgery and "fast-track" perioperative management of the patient is rapidly spreading, even in the central and southern regions. However, in these regions, the percentage of laparoscopic colorectal procedures is dramatically less than in the north of Italy. In this context, the idea of a research group based in Rome focused on the development and spreading of ERAS protocols in the Lazio Region was developed.A research group, based in Rome, was founded in December 2016 to evaluate the diffusion of the ERAS program over the main colorectal centers of the region. This "Lazio Network" began with a group of surgeons and anesthesiologists from 5 hospitals. After one and half years, the project now includes 17 hospitals in the region. A multicenter database was created, including consecutive patients who underwent laparoscopic colorectal resection following the ERAS program in the participating centers between January 2016 and December 2017.Data for more than 1200 patients were collected over the observed period. The rate of minimally invasive surgery was higher compared to the regional rate (90% vs. 30%), adherence to the ERAS pathway was around 60% of the items per patient. A clinical study will result from this database. The objective is to evaluate the mean number of ERAS items applied, the most common and uncommon items applied and the influence of this application on the clinical outcomes.The adoption of the ERAS program is rapidly increasing even in central Italian regions, even though the total rate of minimally invasive surgery procedures still low. Benefits in terms of clinical outcomes will be evaluated from the analysis of a multi-center database of patients treated between January 2016 and December 2017, including more than 1200 patients.Coloretal surgery, ERAS guidelines, Fast track surgery.Le linee guida ERAS rappresentano uno dei più importanti passi avanti in chirurgia colorettale degli ultimi dieci anni. Nonostante i gli evidenti e dimostrati benefici che questo percorso può generare sugli outcomes clinici, è necessaria una rivoluzione culturale riguardo alla gestione clinica del paziente. Questo non è facile da ottenere, specialmente nei piccoli ospedali periferici. In Italia la diffusione della chirurgia mini-invasiva e della gestione clinica dei pazienti secondo una cosiddetta “fast-track” sono in rapida diffusione. Questo sta avvenendo anche nelle regioni del centro e del sud, nonostante in quest’ultime la percentuale di interventi di chirurgia colorettale mini invasivi sono drammaticamente minori rispetto al nord Italia. In questo contesto è nato a Roma il progetto “Lazio Network”, un gruppo di ricerca la cui finalità è quella dello sviluppo e diffusione dei protocolli ERAS nella Regione Lazio. Il gruppo di ricerca è nato nel Dicembre del 2016 con il progetto iniziale di valutare la diffusione dell’applicazione del protocollo ERAS nei principali centri di chirurgia colorettale della Regione. Il “Lazio Network” nasce dalla collaborazione di chirurghi, anestesisiti ed infermieri di 5 ospedali di Roma. Dopo solo un anno e mezzo il gruppo contava la partecipazione di 17 ospedali della Regione Lazio. E’ stato quindi creato un database online multicentrico includendo tutti i pazienti sottoposti a chirurgia resettiva colorettale, in un contesto di percorso ERAS dal Gennaio 2016 al Dicembre 2017. Questo progetto ha permesso di raccogliere ed analizzare i dati di oltre 1200 pazienti.

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