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The aim of this single-center retrospective cohort study is to explore the effect of late adaptation of an ERAS protocol in a high-volume colorectal surgical unit.
The primary endpoint is the surgical outcome measured by early postoperative complications, defined by the comprehensive complications index. Secondary endpoints include amongst others LOS (length of stay), cost analysis, short-term follow-up in the ERAS group.
At Clarunis - University Center for Gastrointestinal and Liver Diseases at St. Claraspital between 2019 und 2020, all colorectal patients were treated according to a standardized perioperative protocol. As of 2021 until today, an ERAS protocol was established and all colorectal patients who met inclusion criteria participated in this program automatically as part of a new standardized care. Perioperative data was collected in a clinical information system (Phoenix - CGM Clinica Information Systeml).
In this retrospective cohort study, we compare demographic, perioperative and postoperative data among the two groups "ERAS" and "non-ERAS" using a weighted propensity score analysis for patients who underwent surgery as part of the ERAS program and for patients without a standardized ERAS protocol.
All patients treated at the colorectal unit from 2019 until August 2022 and who are considered for the analysis have given written general consent for the use of health-related data for research projects (attached to this document).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard care | |||
| ERAS |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ERAS protocol | Procedure | The main concepts of the ERAS protocol compared to standard care included the following aspects: preoperative counselling with a specially trained nurse, restrictive use of preoperative sedation, intraoperative fluid and opioid administration and drain placement, strict antiemetic prophylaxis, early mobilisation, bowel stimulation and removal of any catheters as well as early food intake. Additionally, the ERAS protocol included a 30-day telephone follow-up. |
| Measure | Description | Time Frame |
|---|---|---|
| Perioperative morbidity | Postoperative complications according to the comprehensive complication index (CCI) | 30days |
| Measure | Description | Time Frame |
|---|---|---|
| Length of stay | Length of postoperative hospital stay (days) | 30 days up to 3 months |
| Cost analysis | All costs and incomes for every single case is assessed to calculate the loss or revenue. This data is obtained from the in-hospital financial department. If a patient is readmitted for a complication within 30 days, the costs and incomes for the readmission is added to the case of the initial operation. |
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Inclusion Criteria:
Exclusion Criteria:
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All patients undergoing a colorectal procedure between 2019 and August 2022 at colorectal unit, Santa Clara Hospital, Basel
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| Name | Affiliation | Role |
|---|---|---|
| Daniel Steinemann, PD Dr. | University Hospital, Basel, Switzerland | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St. Clara Hospital | Basel | 4058 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38091109 | Derived | Susstrunk J, Mijnssen R, von Strauss M, Muller BP, Wilhelm A, Steinemann DC. Enhanced recovery after surgery (ERAS) in colorectal surgery: implementation is still beneficial despite modern surgical and anesthetic care. Langenbecks Arch Surg. 2023 Dec 13;409(1):5. doi: 10.1007/s00423-023-03195-7. |
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Currently, there is no plan to shared IPD.
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| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
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|
| 30 days up to 3 months |
| Readmission rate | Rate of readmission within 30 days after the operation | 30 days |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |