title: The CR-POSSUM Risk Calculator Predicts Failure of Enhanced Recovery after Colorectal Surgery.
abstract: OBJECTIVE
  To determine predictors of failed enhanced recovery after surgery (ERAS) in patients after elective colorectal surgery.
  
  
  METHODS
  A cohort of 55 patients undergoing elective colorectal surgery was monitored prospectively. Perioperative care was based on a previously established protocol for ERAS. Pre-, intra-, and postoperative parameters were analyzed to elicit predictors of ERAS failure. ERAS failure was defined as prolonged hospital stay (> 7 days). The risk calculator CR-POSSUM was evaluated for its clinical utility.
  
  
  RESULTS
  Body mass index (BMI) or the American Society of Anesthesiologists score (ASA) was not associated with ERAS failure on univariate analysis, but patients that failed ERAS were significantly older (64 y vs 54 y ; p = 0.023). Prolonged length of stay (> 7 days) was also associated with an open approach (p = 0.009), intraoperative nasogastric tube placement (p = 0.005), blood loss > 500 ml (p = 0.008), stoma formation (p = 0.006) and insertion of more than one intraabdominal drain during surgery (p = 0.005). Postoperative continuation of intravenous fluids (p = 0.027), reinsertion of urinary catheter (p = 0.045) and postoperative ileus (p = 0.020) were also strongly associated with delayed discharge on univariate analysis. After multivariate analysis the preoperative parameters CR-POSSUM score (p = 0.022), increasing BMI (p = 0.014) and preoperative albumin level (p = 0.031) were all independently associated with failure of ERAS.
  
  
  CONCLUSIONS
  A variety of perioperative factors contribute to failure of ERAS in routine practice. CR-POSSUM can help to identify patients at risk for possible failure of ERAS. This may help to optimize avoidable factors, or accommodate those patients likely to require a longer post-operative stay.
authors.affiliation: Division of Digestive and Liver Diseases, Columbia University Medical Center, Irving Cancer Research Center, New York, NY, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Renz
authors.forename: M S
authors.initials: MS
authors.lastname: Kasparek
authors.forename: H
authors.initials: H
authors.lastname: Seeliger
authors.forename: D L
authors.initials: DL
authors.lastname: Worthley
authors.forename: K-W
authors.initials: KW
authors.lastname: Jauch
authors.forename: M E
authors.initials: ME
authors.lastname: Kreis
authors.forename: M J
authors.initials: MJ
authors.lastname: Smith
authors.forename: M H
authors.initials: MH
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects*; D003108:Colonic Diseases / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012002:Rectal Diseases / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017211:Treatment Failure