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: a Division of Digestive and Liver Diseases, Columbia University Medical Center, Irving Cancer Research Center, New York, NY , USA ;|b Department of General-, Visceral-, Transplantation-, Vascular-, and Thoracic Surgery, University of Munich , Campus Grosshadern , Germany ;
authors.forename: B W
authors.initials: BW
authors.lastname: Renz
authors.affiliation: b Department of General-, Visceral-, Transplantation-, Vascular-, and Thoracic Surgery, University of Munich , Campus Grosshadern , Germany ;
authors.forename: M S
authors.initials: MS
authors.lastname: Kasparek
authors.affiliation: c Department of General-, Abdominal-and Vascular Surgery, Campus Benjamin Franklin , Charite Berlin ;
authors.forename: H
authors.initials: H
authors.lastname: Seeliger
authors.affiliation: a Division of Digestive and Liver Diseases, Columbia University Medical Center, Irving Cancer Research Center, New York, NY , USA ;
authors.forename: D L
authors.initials: DL
authors.lastname: Worthley
authors.affiliation: b Department of General-, Visceral-, Transplantation-, Vascular-, and Thoracic Surgery, University of Munich , Campus Grosshadern , Germany ;
authors.forename: K-W
authors.initials: KW
authors.lastname: Jauch
authors.affiliation: c Department of General-, Abdominal-and Vascular Surgery, Campus Benjamin Franklin , Charite Berlin ;
authors.forename: M E
authors.initials: ME
authors.lastname: Kreis
authors.affiliation: d Department of Surgical Oncology , University of Toronto Toronto , Ontario , Canada.
authors.forename: M J
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: c Department of General-, Abdominal-and Vascular Surgery, Campus Benjamin Franklin , Charite Berlin ;
authors.forename: M H
authors.initials: MH
authors.lastname: Mueller
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors