Higher Adherence to ERAS Society (R) Recommendations is Associated with Shorter Hospital Stay Without an Increase in Postoperative Complications or Readmissions in Bariatric Surgery: the Association Between Use of Enhanced Recovery After Surgery Protocols and Postoperative Complications after Bariatric Surgery (POWER 3) Multicenter Observational Study
Por:
Ripollés-Melchor J, Sánchez-Santos R, Abad-Motos A, Gimeno-Moro AM, Díez-Remesal Y, Jove-Alborés P, Aragó-Chofre P, Ortiz-Sebastian S, Sánchez-Martín R, Ramírez-Rodríguez JM, Trullenque-Juan R, Valentí-Azcárate V, Ramiro-Ruiz Á, Correa-Chacón OC, Batalla A, Gimeno-Grauwinkel C, Sanahuja-Blasco JM, González-Valverde FM, Galán-Menéndez P, Díez-Zapirain MJ, Vilallonga R, Zorrilla-Vaca A, Pascual-Bellosta AM, Martínez-Ubieto J, Carrascosa-Mirón T, Ruiz-Escobar A, Martín-García-Almenta E, Suárez-de-la-Rica A, Bausili M, Palacios-Cordoba Á, Olvera-García MM, Meza-Vega JA, Sánchez-Pernaute A, Abad-Gurumeta A, Ferrando-Ortola C, Martín-Vaquerizo B, Torres-Alfonso JR, Aguado-Sánchez S, Sánchez-Cabezudo-Noguera F, García-Erce JA, Aldecoa C and POWER 3 Study Investigators Group
Publicada:
1 abr 2022
Ahead of Print:
1 feb 2022
Resumen:
Purpose The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery.
Materials and Methods Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences
Results We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes
Conclusions Higher adherence to ERAS Society (R) recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions.
Filiaciones:
Ripollés-Melchor J:
Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Sánchez-Santos R:
Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain
Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain
Abad-Motos A:
Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain.
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain.
Gimeno-Moro AM:
Department of Anesthesia and Perioperative Medicine, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
Díez-Remesal Y:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of Anesthesia and Perioperative Medicine, Ramón y Cajal University Hospital, Madrid, Spain
Jove-Alborés P:
Department of General Surgery, University Hospital of Vigo, Galicia Sur Research Institute (IISGS), Vigo, Spain
Aragó-Chofre P:
Department of General Surgery, Hospital Universitario de Manises, Manises, Spain
Ortiz-Sebastian S:
Department of General Surgery, Alicante University Hospital, Alicante, Spain
Sánchez-Martín R:
Department of Anesthesia and Perioperative Medicine, Clínico San Carlos University Hospital, Madrid, Spain
Ramírez-Rodríguez JM:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
Universidad de Zaragoza, Zaragoza, Spain
:
Department of General Surgery, Doctor Peset University Hospital, Valencia, Spain
Valentí-Azcárate V:
Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain
CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
Ramiro-Ruiz Á:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of Anesthesia and Perioperative Medicine, 12 de Octubre University Hospital, Madrid, Spain
Correa-Chacón OC:
Department of Anesthesia and Perioperative Medicine, Santa Lucía Hospital, Cartagena, Spain
Batalla A:
Department of Anesthesiology and Perioperative Medicine, Sant Pau University Hospital, Barcelona, Spain
Gimeno-Grauwinkel C:
Department of Anesthesia and Perioperative Medicine, Mataró University Hospital, Mataró, Spain
Sanahuja-Blasco JM:
Department of Anesthesia and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
González-Valverde FM:
Department of General Surgery, Reina Sofía University Hospital, Murcia, Spain
Galán-Menéndez P:
Department of Anesthesia and Perioperative Medicine, Vall d´Hebrón University Hospital, Barcelona, Spain
Díez-Zapirain MJ:
Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain
Vilallonga R:
Department of General Surgery, Bariatric surgery Department, Vall d´Hebrón University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
Zorrilla-Vaca A:
Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Pascual-Bellosta AM:
Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain
Martínez-Ubieto J:
Department of Anesthesiology and Perioperative Medicine, Miquel Servet University Hospital, Zaragoza, Spain
Carrascosa-Mirón T:
Department of General Surgery, Getafe University Hospital, Getafe, Spain
Ruiz-Escobar A:
Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Martín-García-Almenta E:
Department of General Surgery, Clínico San Carlos University Hospital, Madrid, Spain
Suárez-de-la-Rica A:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of Anesthesia and Perioperative Medicine, Marqués de Valdecilla University Hospital, Santander, Spain
Bausili M:
Department of Anesthesia and Perioperative Medicine, Clínica Diagonal, Esplugues de Llobregat, Spain
Palacios-Cordoba Á:
Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
Olvera-García MM:
Department of Anesthesia and Perioperative Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
Meza-Vega JA:
Department of Anesthesia and Perioperative Medicine, Hospital de Barcelona, Barcelona, Spain
Sánchez-Pernaute A:
Spanish Society of Obesity Surgery (SECO), San Juan de Alicante, Spain
Department of General Surgery, Clínico San Carlos University Hospital, Madrid, Spain
Abad-Gurumeta A:
Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Ferrando-Ortola C:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of Anesthesia and Critical Care, Hospital Clínic de Barcelona, Barcelona, Spain
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
Martín-Vaquerizo B:
Department of Anesthesia and Perioperative Medicine, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
Torres-Alfonso JR:
Department of General Surgery. Fundación Jiménez-Díaz, Madrid, Spain
Aguado-Sánchez S:
Department of Anesthesia and Perioperative Medicine, Hospital del Mar, Barcelona, Spain
Sánchez-Cabezudo-Noguera F:
Department of General Surgery, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Spain
García-Erce JA:
Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
Aldecoa C:
Spanish Perioperative Audit and Research Network (RedGERM), Grupo Español de Rehabilitación Multimodal (GERM), Gran Vía del Este 80, 28031, Madrid, Spain
Department of Anesthesia and Perioperative Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
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