1 Mar 2019Article
The “Lazio Network” experience. The first Italian regional research group on the Enhanced Recovery After Surgery (ERAS) program. A collective database with 1200 patients in 2016-2017
Michele Grieco 1Graziano Pernazza 2Marcello Gasparrini 3Paola Marino 4Fabrizio Apponi 5Roberto Persiani 6Antonio Brescia 3
Affiliations
Article Info
1 General Surgery Department, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
2 Minimally Invasive and Robotic Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy
3 Department of General Surgery, “Sant’Andrea” University Hospital, “Sapienza” University of Rome, Rome, Italy
4 Department of Anesthesiology, “San Giovanni-Addolorata” Hospital, Rome, Italy
5 Department of Anesthesiology, “Sant’Andrea” University Hospital, “Sapienza” University of Rome, Rome, Italy
6 General Surgery Department, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Ann. Ital. Chir., 2019, 90(2), 157-161;
Published: 1 Mar 2019
Copyright © 2019 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
AIM: Enhanced Recovery After Surgery (ERAS) guidelines represent one of the most important steps forward in colorectal surgery in the last ten years. Despite the well-known and demonstrated positive impact on the clinical outcomes that this pathway provides, a cultural revolution in patient management is needed. This is not easy to obtain, especially in small and peripheral centers. In Italy, the diffusion of minimally invasive surgery and “fast-track” perioperative management of the patient is rapidly spreading, even in the central and southern regions. However, in these regions, the percentage of laparoscopic colorectal procedures is dramatically less than in the north of Italy. In this context, the idea of a research group based in Rome focused on the development and spreading of ERAS protocols in the Lazio Region was developed. METHODS: A research group, based in Rome, was founded in December 2016 to evaluate the diffusion of the ERAS program over the main colorectal centers of the region. This “Lazio Network” began with a group of surgeons and anesthesiologists from 5 hospitals. After one and half years, the project now includes 17 hospitals in the region. A multicenter database was created, including consecutive patients who underwent laparoscopic colorectal resection following the ERAS program in the participating centers between January 2016 and December 2017. RESULTS: Data for more than 1200 patients were collected over the observed period. The rate of minimally invasive surgery was higher compared to the regional rate (90% vs. 30%), adherence to the ERAS pathway was around 60% of the items per patient. A clinical study will result from this database. The objective is to evaluate the mean number of ERAS items applied, the most common and uncommon items applied and the influence of this application on the clinical outcomes. CONCLUSIONS: The adoption of the ERAS program is rapidly increasing even in central Italian regions, even though the total rate of minimally invasive surgery procedures still low. Benefits in terms of clinical outcomes will be evaluated from the analysis of a multi-center database of patients treated between January 2016 and December 2017, including more than 1200 patients.
Keywords
- Coloretal surgery
- ERAS guidelines
- Fast track surgery