Adherence to Enhanced Recovery After Surgery (ERAS) care may be inversely related to postoperative complications in patients undergoing elective colorectal surgery, according to results from a study published in JAMA Surgery.

A team of investigators for the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study aimed to distinguish management strategies in patients who underwent colorectal surgery and to investigate the link between individual components of the ERAS protocols and postoperative complications.

A total of 2084 adults (61.7% men; mean age, 68 years) scheduled for elective colorectal surgery who had 1 month of follow-up after receiving or not receiving care at an ERAS center were included in the study.

The primary outcome was moderate to severe postoperative complications within 30 days following surgery; secondary outcomes included adherence to enhanced recovery pathways, mortality, readmissions, reoperation rates, and length of hospital stay.

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Of the total cohort, 879 patients presented with postoperative complications and 566 had moderate to severe complications. Fewer patients experienced complications in the ERAS group compared with the non-ERAS group (25.2% vs 30.3%, respectively; odds ratio [OR], 0.77). A 63.6% overall ERAS protocol adherence rate was observed.

Compared with patients with low ERAS adherence rates, patients with the highest ERAS adherence rates had fewer moderate to severe complications (OR, .034), overall complications (OR, 0.33), and mortality (OR, 0.27).

“The POWER study shows that having a protocol is not enough to improve outcomes, but an increase in adherence to ERAS items is associated with a decrease in postoperative complications; therefore, continuous auditing to ERAS and postoperative outcomes is essential,” concluded the investigators.

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Ripollés-Melchor J, Ramirez-Rodriguez JM, Casans-Frances R, et al; for the POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the postoperative outcomes within enhanced recovery after surgery protocol (POWER) study [published May 8, 2019]. JAMA Surg.doi:10.1001/jamasurg.2019.0995