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The CR-POSSUM Risk Calculator Predicts Failure of Enhanced Recovery after Colorectal Surgery.

B W Renz1, M S Kasparek, H Seeliger

  • 1Division of Digestive and Liver Diseases, Columbia University Medical Center, Irving Cancer Research Center, New York, NY, USA.

Acta Chirurgica Belgica
|May 30, 2015
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Predictors of failed Enhanced Recovery After Surgery (ERAS) in colorectal surgery include older age, open surgical approach, and postoperative ileus. The CR-POSSUM score can identify patients at risk for ERAS failure, aiding in personalized care.

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Area of Science:

  • Colorectal Surgery
  • Perioperative Medicine
  • Surgical Outcomes

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery and reduce hospital stay.
  • Failure to adhere to ERAS pathways can lead to prolonged hospitalization and increased healthcare costs.
  • Identifying predictors of ERAS failure is crucial for improving patient outcomes in elective colorectal surgery.

Purpose of the Study:

  • To determine predictors of ERAS failure in patients undergoing elective colorectal surgery.
  • To evaluate the clinical utility of the CR-POSSUM risk calculator in identifying patients at risk for ERAS failure.

Main Methods:

  • A prospective cohort of 55 patients undergoing elective colorectal surgery was studied.
  • Perioperative care followed an established ERAS protocol.
  • Pre-, intra-, and postoperative parameters were analyzed to identify predictors of ERAS failure, defined as prolonged hospital stay (> 7 days).

Main Results:

  • Older age, open surgical approach, intraoperative nasogastric tube placement, blood loss > 500 ml, stoma formation, and multiple intraabdominal drains were associated with ERAS failure.
  • Postoperative factors including IV fluid continuation, urinary catheter reinsertion, and postoperative ileus also predicted delayed discharge.
  • Multivariate analysis identified CR-POSSUM score, increasing BMI, and low preoperative albumin as independent predictors of ERAS failure.

Conclusions:

  • Several perioperative factors contribute to ERAS failure in routine colorectal surgery practice.
  • The CR-POSSUM score is a useful tool for identifying patients at risk of ERAS failure.
  • Early identification of at-risk patients allows for optimization of modifiable factors and better accommodation of prolonged postoperative stays.