Association Between Compliance to an Enhanced Recovery Protocol and Outcome After Elective Surgery for Gastric Cancer. Results from a Western Population‐Based Prospective Multicenter Study

Abstract

Background The association between compliance to an enhanced recovery protocol (ERAS) and outcome after surgery for gastric cancer has been poorly investigated, particularly in Western patients. The aim of the study was to evaluate whether the rate of adherence to the ERAS program was correlated with outcome and time of discharge. Methods A prospective, observational, multicenter study was designed to be performed at Italian referral centers for gastric surgery. The protocol was discussed and approved by the Italian Research Group on Gastric Cancer. Twentythree ERAS domains were applied. A multivariate logistic regression was used to assess the association between ERAS compliance and overall and major complication rates. The Poisson regression model (measured as mean ratios) was used to assess the association of ERAS compliance rate and length of stay (LOS). Results Eight centers participated and 290 subjects with a median age of 73 years were enrolled. The overall rates of adherence to pre-, intra-, and postoperative ERAS items were 69.8%, 60.3%, and 82.5%, respectively. At the multivariate model, there was an association between overall rate of morbidity and an overall ERAS compliance rate greater than 70% (OR 0.413; 95% CI 0.235-0.7240; P 0.002). A similar association was found for major complications (OR 0.328; 95% CI 0.151-0.709; P 0.005). The Poisson regression showed that in patients with ERAS compliance rate [70%, LOS was reduced of approximately 20% (mean ratio 0.812; 95% CI 0.694-0.950; P 0.009). Conclusions These results suggest a moderate compliance to an ERAS program and a significant association between adherence and outcomes.Luca Gianotti and Uberto Fumagalli Romario have equally contributed to first authorship.

Enhanced Recovery Protocol Versus Conventional Perioperative Management For Three-Dimensional Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study

“…There was also comparable 30-day readmission rate between groups. Similar to our study, recent population-based prospective multicenter study from Western countries reported that it could be possible to gain a 10% reduction in hospital stay for every 10% increase in ERAS compliance [30]. Correlation between morbidity and ERAS compliance rate was also observed [30].…”

Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single‐center phase II clinical trial for safety and efficacy

“…The ERAS CP completion rate of 77.2% was within our expected range (75.4‐85.4%) and was comparable to the completion rates in previous studies (60.3%‐79.6%) . Therefore, ERAS CP components might be applicable to patients with gastric cancer.…”

“…The ERAS CP completion rate of 77.2% was within our expected range (75.4-85.4%) and was comparable to the completion rates in previous studies (60.3%-79.6%). 15,16 Therefore, ERAS CP components might be applicable to patients with gastric cancer. The components of the ERAS CP that differed most from those of our conventional CP were the start of oral feeding on POD 1 and discharge on POD 4.…”

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

“…The PCPh may also engage in quality and performance improvement projects and research focused on evaluating the impact of medication management and stewardship‐related interventions within ERPs . Studies have assessed compliance with an ERP as a key indicator for the benefits of the pathway . The PCPh can play a major role in order set creation and electronic medical record documentation of ERP interventions to aid in standardization, pathway compliance assessment, and actions from data collection.…”

“…40,41 Studies have assessed compliance with an ERP as a key indicator for the benefits of the pathway. 42,43 The PCPh can play a major role in order set creation and electronic medical record documentation of ERP interventions to aid in standardization, pathway compliance assessment, and actions from data collection.…”