A Comparative Analysis between Enhanced Recovery after Surgery and Traditional Care in the Management of Obstructive Colorectal Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Identification of Patients
2.2. Criteria of Exclusion
2.3. ERAS Protocol
- ASA (American Society of Anesthesiologists) score—a classification system used to assess and communicate a patient’s preoperative health status. The ASA score helps predict perioperative risks by categorizing patients based on their overall health and comorbidities;
- Duration of obstruction (days)—the time without gastrointestinal transit at the time of admission;
- Estimated blood loss (mL)—the assessment of intraoperative blood loss;
- Locoregional anesthesia—includes the placement of high thoracic or lumbar epidural catheters, subfascial blocks, and local anesthesia;
- Intra/postoperative IV (mL)—the volume of fluids administered intra/postoperatively;
- Time to first flatus (days)—the time until the patient first passes gas, indicating the return of gastrointestinal function;
- Time to first defecation (days)—the time until the patient first has a bowel movement, signifying the resumption of normal bowel function;
- Postoperative complications—monitored as separate variables without discovering a statistically significant difference between the two groups, which is why they were discussed generically. Complications were diagnosed within the first 30 postoperative days according to predefined criteria. Surgical staff, technical aspects of the surgery, as well as the choice of antibiotics and thromboprophylaxis, remained unchanged during the study period.
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Perioperative Protocol | Non-ERAS | ERAS |
---|---|---|
Preoperative patient education and counseling | General counseling and advice provided exclusively by surgeons | Comprehensive guidance and education offered through written brochures by surgeons, nurses, and anesthesiologists |
Preoperative fasting | No food and no drink | Oral intake should occur up to 2 h before anesthesia induction |
Perioperative fluid management | No prevention of excessive fluid intake | Goal-directed fluid management during surgery, followed by controlled fluid administration in the postoperative period |
Intraoperative hypothermia | Sometimes | No. Active body warming |
Nasogastric tube | Removed by postoperative day 3 | Removed promptly after surgery |
Postoperative nonopioid medications | Postoperative pain relief frequently depends on the administration of opioid medications via intravenous delivery | Pain management typically involves the use of nonopioid medications |
Postoperative fasting | No oral intake is permitted for three days following surgery. | Consume water two hours post-surgery; transition to oral nutritional supplements on postoperative day 1 |
Stimulation of gut motility | No | Post-surgery regular laxative (magnesium oxide) |
Mobilization care | Standard walking regimen, usually starting on postoperative day 2 | Engagement in activities outside of bed on postoperative day 1 |
Drainage tubes | Removal within 3 days postoperation | Avoided |
Data | Non-ERAS | ERAS | p |
---|---|---|---|
N | 80 | 40 | |
Age | 68.3 ± 8.17 | 66.4 ± 9.88 | 0.4372 |
Gender | |||
Males | 44 (55%) | 24 (60%) | 0.3628 |
Females | 36 (45%) | 16 (40%) | |
BMI | 29.83 ± 4.6 | 27.05 ± 4.93 | 0.0478 |
ASA grades | |||
II | 36 (45%) | 18 (45%) | 0.9557 |
III | 34 (42.5%) | 18 (45%) | |
IV | 5 (12.5%) | 4 (10%) | |
Hb | 11.575 ± 2.04 | 10.93 ± 2.01 | 0.2394 |
Albumin | 3.57 ± 0.47 | 3.51 ± 0.59 | 0.7594 |
Tumor location | |||
Right/left side | 29 (36.25%)/51 (63.75%) | 14 (35%)/26 (65%) | 0.2343 |
Ascending colon | 13 (16.25%) | 7 (17.5%) | 0.9415 |
Hepatic flexure | 8 (10%) | 4 (10%) | |
Transverse colon | 8 (10%) | 3 (7.5%) | |
Splenic flexure | 5 (6.25%) | 2 (5%) | |
Descending colon | 10 (12.5%) | 6 (15%) | |
Sigmoid colon | 12 (15%) | 5 (12.5%) | |
Recto-sigmoid junction | 11 (13.75%) | 7 (17.5%) | |
Superior rectus | 13 (16.25%) | 6 (15%) |
Surgical Procedure | Non-ERAS (n = 80) | ERAS (n = 40) | p |
---|---|---|---|
HD | 26 (32.5%) | 18 (45%) | 0.2657 |
HS | 20 (25%) | 8 (20%) | |
RRS | 22 (27.5%) | 14 (35%) | |
RS | 12 (15%) | 0 |
Data | Non-ERAS n = 80 | ERAS n = 40 | p |
---|---|---|---|
Duration of obstruction (d) | 5.95 | 5.75 | 0.8742 |
Operative time (min) | 154.12 ± 38.7 | 175.5 ± 52.11 | 0.1260 |
Estimated blood loss (mL) | 327.5 ± 221.8 | 305 ± 216.97 | 0.5542 |
Locoregional anesthesia | 10 (12.5%) | 32 (80%) | 0.0000 |
Intraoperative IV | 5.08 ± 1.35 | 2.67 ± 0.97 | 0.0000 |
Postoperative IV | 20.8 ± 9.01 | 5.15 ± 2.42 | 0.0000 |
Stoma | 54 (79.41%) | 7 (20.59%) | 0.0103 |
Drainage days | 5.45 ± 3.79 | 1.25 ± 1.61 | 0.0000 |
Time to first flatus (d) | 2.45 ± 2.57 | 2.5 ± 1.63 | 0.4791 |
Time to first defecation (d) | 3.90 ± 3.74 | 3.7 ± 2.31 | 0.7877 |
Length of hospital stay (d) | 10.75 ± 5.3 | 6.85 ± 2.39 | 0.0002 |
Postoperative complications | 48 (60%) | 20 (50%) | 0.2386 |
Analgesia Type | Non-ERAS n = 80 | ERAS n = 40 |
---|---|---|
NSAIDs | 9 (11.25) | 0 |
B | 0 | 6 (15%) |
EC | 10 (12.5%) | 12 (30%) |
EC + AINS | 0 | 2 (5%) |
EC + B | 0 | 8 (20%) |
EC + L | 0 | 2 (5%) |
L | 0 | 6 (15%) |
L + B | 0 | 2 (5%) |
OP | 34 (42.5%) | 2 (5%) |
OP + AINS | 24 (30%) | 0 |
STD | 3 (3.75%) | 0 |
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Mihăilescu, A.-A.; Onisâi, M.; Alexandru, A.; Teodorescu, M.; Aliuș, C.; Blendea, C.-D.; Neagu, Ș.-I.; Șerban, D.; Grădinaru, S. A Comparative Analysis between Enhanced Recovery after Surgery and Traditional Care in the Management of Obstructive Colorectal Cancer. Medicina 2024, 60, 1319. https://doi.org/10.3390/medicina60081319
Mihăilescu A-A, Onisâi M, Alexandru A, Teodorescu M, Aliuș C, Blendea C-D, Neagu Ș-I, Șerban D, Grădinaru S. A Comparative Analysis between Enhanced Recovery after Surgery and Traditional Care in the Management of Obstructive Colorectal Cancer. Medicina. 2024; 60(8):1319. https://doi.org/10.3390/medicina60081319
Chicago/Turabian StyleMihăilescu, Alexandra-Ana, Minodora Onisâi, Adrian Alexandru, Matei Teodorescu, Cătălin Aliuș, Corneliu-Dan Blendea, Ștefan-Ilie Neagu, Dragoș Șerban, and Sebastian Grădinaru. 2024. "A Comparative Analysis between Enhanced Recovery after Surgery and Traditional Care in the Management of Obstructive Colorectal Cancer" Medicina 60, no. 8: 1319. https://doi.org/10.3390/medicina60081319