title: Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery?
abstract: There is evidence that implementation of enhanced recovery after surgery (ERAS) protocols into colorectal surgery reduces complication rate and improves postoperative recovery. However, most published papers on ERAS outcomes and length of stay in hospital (LOS) include patients undergoing open resections. The aim of this pilot study was to determine the factors affecting recovery and LOS in patients after laparoscopic colorectal surgery for cancer combined with ERAS protocol. One hundred and forty-three consecutive patients undergoing elective laparoscopic resection were prospectively evaluated. They were divided into two subgroups depending on their reaching the targeted length of stay-LOS (75 patients in group 1-≤4 days, 68 patients in group 2->4 days). A univariate and multivariate logistic regression analysis was performed to assess for factors (demographics, perioperative parameters, complications and compliance with the ERAS protocol) independently associated with LOS of 4 days or longer. The median LOS in the entire group was 4 days. The postoperative complication rate was higher (18.7 vs. 36.7 %), and the compliance with ERAS protocol was lower (91.2 vs. 76.7 %) in group 2. There was an association between the pre- and postoperative compliance and the subsequent complications. In uni- and multivariate analysis, the lack of balanced fluid therapy (OR 3.87), lack of early mobilization (OR 20.74), prolonged urinary catheterization (OR 4.58) and use of drainage (OR 2.86) were significantly associated with prolonged LOS. Neither traditional patient risk factors nor the stage of the cancer was predictive of the duration of hospital stay. Instead, compliance with the ERAS protocol seems to influence recovery and LOS when applied to laparoscopic colorectal cancer surgery.
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland. michal.pedziwiatr@uj.edu.pl.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pisarska
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Kisielewski
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Matłok
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Major
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Wierdak
authors.affiliation: 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.|Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Kopernika 21, 31-501, Kraków, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000639:trends*; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors
keywords: Colorectal cancer; Compliance with protocol; Enhanced recovery after surgery; Fast-track surgery; Laparoscopy; Perioperative care