Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan

Abstract

BackgroundJapan has one of the highest five-year relative survival rates for colorectal cancer in the world, with its own traditions of perioperative care and a unique insurance system. The benefits of enhanced recovery after surgery (ERAS) protocols in the Japanese population have yet to be clarified.MethodsWe evaluated 352 consecutive cases of colorectal cancer resection at Tokyo Metropolitan Bokutoh Hospital between July 2009 and November 2012. Of these, 95 cases were performed according to traditional protocols (traditional group), and 257 according to ERAS protocols (ERAS group), which were introduced to the hospital in July 2010. Primary endpoints included length of postoperative hospital stay, postoperative short-term morbidity, and rate of readmission within 30 days. Intensive pre-admission counselling, no pre- and postoperative fasting (provision of oral nutrition), avoidance of sodium/fluid overload, intraoperative warm-air body heating, enforced postoperative mobilization, and multimodal team care were among the main changes brought about by the introduction of ERAS protocols.ResultsThe median (interquartile range) length of postoperative hospital stay was 10 (10–12.75) days in the traditional group and seven (6–8) days in the ERAS group, i.e., a three-day reduction (p < 0.05) in the ERAS group. Moreover, the proportion of patients discharged within one week dramatically increased from 1 % to 77 % in the ERAS group. The overall incidence of grade 2 and 3 postoperative complications according to the Clavien-Dindo classification was 9.5 % in the traditional group and 9.3 % in the ERAS group, and 30-day readmission rates were 8.3 % and 6.6 % in the traditional and ERAS groups, respectively. There were no significant differences between the two groups. Although operative time and blood loss did not differ significantly between the two groups, the volume of intraoperative infusion was significantly decreased in the ERAS group (p < 0.05), possibly due to ERAS recommendations to avoid dehydration (i.e., avoidance of sodium/fluid overload, no preoperative fasting).ConclusionERAS protocols for colorectal surgery helped reduce the length of postoperative hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible and effective in Japanese settings as well.

Enhanced recovery after surgery (ERAS) versus conventional postoperative care in patients undergoing abdominal hysterectomies

“…The patients should be encouraged to start on the oral intake of clear fluids, and normal diet following surgery [15]. Oral fluid intake was started immediately after (Huibers et [17][18][19][20]. In the present study, peri-and post-operative administrated intravenous fluids were significantly lower in the ERAS group.…”

Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery

“…There have been conflicting results from many studies regarding the relationship between colorectal surgery hospital volumes and LOS 3,7,8,11–31 . Chowdhury et al, in their comprehensive systematic review, analysed 127 studies that examined surgical outcomes including LOS.…”

“…Since Adams et al 9 in 1973 and Lufte et al 10 in 1979 reported a link between provider volume and successful surgical outcomes, provider volume has been used as a surrogate measure of hospital quality. Evidence of an association between hospital or surgeon cancer surgery volume and better patient outcomes has been mixed; 3,7,8,11–31 however, previous analyses have had important limitations. A 2002 review that examined seven statistical modelling techniques used to assess association between patient factors and LOS in a cardiovascular setting found that choice of model influenced the conclusion of the analyses.…”

Jejum inferior a oito horas em cirurgias de urgência e emergência versus complicações

“…In addition, research analyzing the deployment of ERAS among patients who underwent colorectal surgery concluded that the need for infusion of liquids and hospitalization time decreased (24) .…”