Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?

Détails

ID Serval
serval:BIB_15124FD39C92
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?
Périodique
International journal of gynecological cancer
Auteur(s)
Pache B., Jurt J., Grass F., Hübner M., Demartines N., Mathevet P., Achtari C.
ISSN
1525-1438 (Electronic)
ISSN-L
1048-891X
Statut éditorial
Publié
Date de publication
20/03/2019
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Résumé
Enhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.
Retrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.
A total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I-V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).
Compliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.
Mots-clé
postoperative care, preoperative care, surgical oncology
Pubmed
Web of science
Création de la notice
15/04/2019 7:45
Dernière modification de la notice
20/08/2019 12:44
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