Determinants of late recovery following elective colorectal surgery. Late recovery within ERAS pathway

Abstract

Abstract Background. Despite the application of enhanced recovery protocol a considerable proportion of patients has a late recovery. The identification of possible determinants of late recovery might be crucial to implement perioperative protocols and to plan tailored pathways. Objective. The aim of this study is to identify possible determinants of late recovery. Design.Retrospective observational study based on a prospectively collected dedicated register. Setting.22 Italian hospital with high volume colorectal surgery and trained in enhanced recovery protocols. Patients.Patients with elective colorectal resection for cancer of benign disease. Main outcome measures. Recovery on postoperative day two. Results. A total of 1536 patients were included in the analysis. The overall median adherence to preoperative and intraoperative enhanced recovery protocols item was 75.0% (66.6%- 83.3%). A late recovery was observed in 488 (31.8%) patients. Multiple regression analysis showed that six enhanced recovery protocols items had an independent positive impact on postoperative recovery: pre-admission counseling (OR 2.596), preoperative carbohydrate drink (OR 1.948), intraoperative fluid infusions <7mL/kg/h (OR 1.662), avoiding thoracic epidural analgesia(OR 2.137), removal of naso-gastric tube at the end of surgery (OR 4.939) and successful laparoscopy (OR 2.341). The late recovery rate progressively declined with the increasing adherence to these six positive items reaching 13.0% when all the items were applied (r= -0.99 p<0.001). Limitations. Retrospective analysis of a register including data from many different centers and the large case mix of patients. Conclusions: The implementation of identified items by the multiprofessional staff seems crucial to enhance the short-term recovery following colorectal surgery.