title: Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study.
abstract: Surgical stress can influence oncological outcome and survival. The enhanced recovery after surgery (ERAS) protocol is designed to reduce perioperative stress and has been shown to reduce postoperative morbidity. We studied if adherence to ERAS is associated with increased long-term survival.
  
  
  
  Between the years 2002 and 2007, 911 consecutive patients, operated with major colorectal cancer surgery at Ersta Hospital, Stockholm, Sweden were analyzed. The histopathological reports of the resected specimen, date, and cause of death of the patients as well as postoperative CRP levels were obtained. The relation between the rate of adherence to the ERAS protocol at the time of surgery, and the short-term outcomes in relation to 5-year overall and colorectal cancer-specific survival was determined in this retrospective cohort study.
  
  
  
  In patients with ≥70 % adherence to ERAS interventions (N = 273,), the risk of 5-year cancer-specific death was lowered by 42 %, HR 0.58 (0.39-0.88, cox regression) compared to all other patients (<70 % adherence). Significant independent perioperative predictors of increased 5-year survival were avoiding overload of intravenous fluids, HR 0.53 (0.32-0.86); oral intake on the day of operation, HR 0.55 (0.34-0.78); and low CRP levels on postoperative day 1.
  
  
  
  High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery.
authors.affiliation: Department of Surgery, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. ulf.o.gustafsson@ds.se.|Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. ulf.o.gustafsson@ds.se.
authors.forename: Ulf O
authors.initials: UO
authors.lastname: Gustafsson
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Oppelstrup
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Thorell
authors.affiliation: Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.|Department of Surgery, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nygren
authors.affiliation: Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D002985:Clinical Protocols; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004434:Early Ambulation; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011184:Postoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013548:Sweden
chemical_list: D002097:C-Reactive Protein