The Enhanced Recovery After Surgery (ERAS) care protocol has been shown to improve outcomes compared with traditional care in certain types of surgery.
To assess the association of use of the ERAS ...protocols with complications in patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
This multicenter, prospective cohort study included patients recruited from 131 centers in Spain from October 22 through December 22, 2018. All consecutive adults scheduled for elective THA or TKA were eligible for inclusion. Patients were stratified between those treated in a self-designated ERAS center (ERAS group) and those treated in a non-ERAS center (non-ERAS group). Data were analyzed from June 15 through September 15, 2019.
Total hip or knee arthroplasty and perioperative management. Sixteen individual ERAS items were assessed in all included patients, whether they were treated at a center that was part of an established ERAS protocol or not.
The primary outcome was postoperative complications within 30 days after surgery. Secondary outcomes included length of stay and mortality.
During the 2-month recruitment period, 6146 patients were included (3580 women 58.2%; median age, 71 interquartile range (IQR), 63-76 years). Of these, 680 patients (11.1%) presented with postoperative complications. No differences were found in the number of patients with overall postoperative complications between ERAS and non-ERAS groups (163 10.2% vs 517 11.4%; odds ratio OR, 0.89; 95% CI, 0.74-1.07; P = .22). Fewer patients in the ERAS group had moderate to severe complications (73 4.6% vs 279 6.1%; OR, 0.74; 95% CI, 0.56-0.96; P = .02). The median overall adherence rate with the ERAS protocol was 50.0% (IQR, 43.8%-62.5%), with the rate for ERAS facilities being 68.8% (IQR, 56.2%-81.2%) vs 50.0% (IQR, 37.5%-56.2%) at non-ERAS centers (P < .001). Among the patients with the highest and lowest quartiles of adherence to ERAS components, the patients with the highest adherence had fewer overall postoperative complications (144 10.6% vs 270 13.0%; OR, 0.80; 95% CI, 0.64-0.99; P < .001) and moderate to severe postoperative complications (59 4.4% vs 143 6.9%; OR, 0.62; 95% CI, 0.45-0.84; P < .001) and shorter median length of hospital stay (4 IQR, 3-5 vs 5 IQR, 4-6 days; OR, 0.97; 95% CI, 0.96-0.99; P < .001).
An increase in adherence to the ERAS program was associated with a decrease in postoperative complications, although only a few ERAS items were individually associated with improved outcomes.
Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients. The objective of this study was to ...assess the characteristics and ouctome of ICU-acquired infections in COVID-19 patients. We conducted a retrospective single-centre, case-control study including 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical, and microbiological features, and outcome of ICU-acquired infections. Fifty-seven patients (40.7%) developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5–11) of admission and was significantly associated with the APACHE II score (
p
= 0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%), and urinary tract infection (8%) that were produced by a wide spectrum of Gram-positive (55%) and Gram-negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2–5.9,
p
= 0.015) and a longer ICU stay (
p
< 0.001). Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection, and it is associated with a high mortality and longer course of ICU stay.
Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.
Prospective cohort study.
European centers (185 hospitals) ...across 21 countries.
A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.
Routine perioperative care.
Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences.
A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79–1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 5–9 vs. 8 6–10 days; OR 0.82; 95%CI, 0.78–0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% 48%–65%. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53–0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02–0.42; P = 0.002) and shorter hospital stay (6 4–8 vs. 7 5–10 days; OR 0.74; 95%CI, 0.69–0.79; P < 0.001).
Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.
•Enhanced Recovery After Surgery (ERAS®) pathway in colorectal surgery is important.•The ERAS pathway must adhere to ERAS Society guidelines for optimal outcomes.•Adherence to ERAS guidelines was low in self-declared ERAS and non-ERAS centers.•Treatment in self-declared ERAS centers does not guarantee improved outcomes.•Improved outcomes can result upon strong compliance with ERAS-pathway interventions.
Purpose
The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements ...on patient outcomes following elective bariatric surgery.
Materials and Methods
Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences
Results
We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73–1.79;
P
= .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 IQR 2–3 vs. 3 IQR 2–4 days, 0.85; 95% CI, 0.62–1.17;
P
= .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 IQR 2–3 vs. 3 IQR 2–4 days, 1.54; 95% CI, 1.09–2.17;
P
= .015), while there were no differences in the other outcomes
Conclusions
Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions.
Trial Registration
ClinicalTrials.gov Identifier: NCT03864861
Graphical abstract
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