title: Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry.
abstract: Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection.
  
  
  
  Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I-II vs. III-IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes.
  
  
  
  Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2 %) patients without significant differences among groups (p = 0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3-6) days, length of hospital stay (LOS) was 6 (4-7) days, and both were significantly shorter by only 1 day in the groups of younger patients (p < 0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS.
  
  
  
  ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.
authors.affiliation: Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy. braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.affiliation: Department of Surgery, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Pecorelli
authors.affiliation: Department of Surgery, Prato Hospital, Prato, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scatizzi
authors.affiliation: Department of Surgery, Cuneo Hospital, Cuneo, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Borghi
authors.affiliation: Department of Surgery, Casa di Cura Città di Udine, Udine, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Missana
authors.affiliation: Department of Anesthesia, Legnano Hospital, Legnano, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Radrizzani
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D002985:Clinical Protocols; D003082:Colectomy / Q000009:adverse effects; D020878:Device Removal; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004434:Early Ambulation; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D007558:Italy; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D062885:Urinary Catheters; D014839:Vomiting / Q000517:prevention & control
chemical_list: D004040:Dietary Carbohydrates