A Prospective Observational Study on Compliance with Enhanced Recovery Pathways and Their Impact on Postoperative Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.
Sohan Lal Solanki, Virinchi Sanapala, Reshma P Ambulkar, Vandana Agarwal, Avanish P Saklani, Amita Maheshwari
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引用次数: 0
Abstract
Background: Enhanced recovery pathways have been shown to improve postoperative morbidity and reduce hospital stay across various surgical settings. However, the implementation of Enhanced Recovery After Surgery (ERAS) pathways in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is often challenging and varies between institutions. We evaluated the impact of ERAS compliance on postoperative outcomes and return to intended oncological therapy (RIOT).
Methods: All consecutive patients operated for CRS-HIPEC between May 2021 and August 2023 were included in the study. Compliance with 30 ERAS components was collected. Postoperative complications were categorized using the Clavien-Dindo (CD) classification. Patients were followed for 30 days post-surgery to assess readmissions and delays in RIOT. Pearson correlation analysis evaluated the relationship between ERAS compliance and CD grading, length of hospital stay, readmissions, and RIOT delays. Logistic regression analysis was done to evaluate the association between percentage compliance to ERAS components and postoperative morbidity and length of hospital stay.
Results: Among 150 patients, the average compliance to ERAS components was 77.6%. There was a significant negative correlation between ERAS compliance and postoperative morbidity (r = - 0.512, p < 0.001) and RIOT (r = - 0.469, p < 0.001). Compliance with preoperative (r = - 0.222, p = 0.006) and postoperative factors (r = - 0.533, p < 0.001) significantly impacted postoperative morbidity and RIOT. Patients with less than 71.6% compliance had higher morbidity (χ2 = 19.55; p < 0.001), longer hospital stays (χ2 = 4.73; p = 0.03), and delayed RIOT (χ2 = 12.70; p < 0.001). There is significant association between increase in percentage compliance to ERAS components and reduced major postoperative complications (OR 0.79; 95% CI 0.72-0.87; p = 0.001) and reduced length of hospital stay (OR 0.89; 95% CI 0.84-0.95; p = 0.001).
Conclusion: Higher compliance is linked with reduction in postoperative morbidity, shorter hospital stays, and timely RIOT. These findings reinforce the safety profile of ERAS pathway in CRS-HIPEC. However, multicenter studies are needed to support these findings.
Registry: Clinical Trial Registry of India (CTRI/2021/02/031151).
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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