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. 2021 Dec 31;10(1):72.
doi: 10.3390/healthcare10010072.

Perioperative Care in Colorectal Cancer Surgery before a Structured Implementation Program of the ERAS Protocol in a Regional Network. The Piemonte EASY-NET Project

Luca Pellegrino  1 , Eva Pagano  2 , Marco Ettore Allaix  3 , Mario Morino  3 , Andrea Muratore  4 , Paolo Massucco  5 , Federica Rinaldi  6 , Giovannino Ciccone  2 , Felice Borghi  1 , The Eras Colon-Rectum Piemonte Group
Affiliations

Perioperative Care in Colorectal Cancer Surgery before a Structured Implementation Program of the ERAS Protocol in a Regional Network. The Piemonte EASY-NET Project

Luca Pellegrino et al. Healthcare (Basel). .

Abstract

Background: In 2019, the Enhanced Recovery After Surgery (ERAS) protocol for colorectal cancer surgery was adopted by a minority of hospitals in Piemonte (4.3 million inhabitants, north-west Italy). The present analysis aims to compare the level of application of the ERAS protocol between hospitals already adopting it (ERAS, N = 3) with the rest of the regional hospitals (non-ERAS, N = 28) and to identify possible obstacles to its application.

Methods: All patients surgically treated for a newly diagnosed colorectal cancer during September-November 2019, representing the baseline period of a randomized controlled trial with a cluster stepped-wedge design, were included. Indicators of compliance to the ERAS items were calculated overall and for groups of items (preoperative, intraoperative and postoperative) and analyzed with a multilevel linear model adjusting for patients' characteristics, considering centers as random effects.

Results: Overall, the average level of compliance to the ERAS protocol was 56% among non-ERAS centers (N = 364 patients) and 80% among ERAS ones (N = 79), with a difference of 24% (95% CI: -41.4; -7.3, p = 0.0053). For both groups of centers, the lowest level of compliance was recorded for postoperative items (42% and 66%). Sex, age, presence of comorbidities and American Society of Anesthesiologists (ASA) score were not associated with a different probability of compliance to the ERAS protocol.

Conclusions: Several items of the ERAS protocol were poorly adopted in colorectal surgery units in the Piemonte region in the baseline period of the ERAS Colon-Rectum Piemonte study and in the ERAS group. No relevant obstacles to the ERAS protocol implementation were identified at patient level.

Keywords: ERAS protocol; colorectal cancer surgery; compliance indicators.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Level of compliance to single ERAS items by type of center (non-ERAS and ERAS). LPT = laparotomic; i.v. = intra venous; UC = urine catheter.
See this image and copyright information in PMC

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