Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols

Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols

Ban KA, Berian JR, Liu JB, Ko CY, Feldman LS, Thacker JKM (2018) Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum. 2018 Jul;61(7):847-853.

What is already known:

A patient’s underlying diagnosis necessitating surgery is one of a number of factors previously shown to affect outcomes for patients undergoing colorectal surgery outside of an ERAS programme. Inflammatory bowel disease and acute mesenteric ischaemia appear to confer the highest risk of adverse outcomes alongside non-elective surgery and pre-existing comorbidities.

What this paper adds:

This paper looks retrospectively at outcomes for patients enrolled in an ERAS programme to see whether the underlying diagnosis remains an important predictor of outcome. Patients with neoplastic disease were found to be significantly more likely to have an ASA grade of III to V and have a higher risk of undergoing open surgery. Although ERAS compliance did not significantly differ between the diagnosis groups, overall compliance was generally underwhelming with only around a third of patients complying with 10 or more elements. This was a database analysis covering multiple centres thus details of individual ERAS programmes are not given. Overall, patients with IBD still appear to be at highest risk of serious complications despite the use of ERAS elements. It was noted that the extent of surgery in IBD patients was higher than in cancer or diverticular disease patients. The authors do comment on possible selection bias resulting from IBD patients being less likely to be enrolled on ERAS programmes or that those who were had a lower disease burden. The authors conclude that tailoring the patient education element of ERAS programmes for IBD patients may help improve their outcomes.

Ben Morrison, Guildford. @blouism