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

B W Renz^1,2, M S Kasparek², H Seeliger³

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

Acta Chirurgica Belgica

|July 8, 2016

Summary

Predictors of failed Enhanced Recovery After Surgery (ERAS) in colorectal patients include older age, open surgery, and postoperative ileus. The CR-POSSUM score, BMI, and albumin levels can identify at-risk patients for longer hospital stays.

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Area of Science:

Colorectal Surgery
Surgical Outcomes
Patient Recovery Protocols

Background:

Enhanced Recovery After Surgery (ERAS) protocols aim to optimize patient recovery.
Failure to adhere to ERAS pathways can lead to prolonged hospital stays and increased healthcare costs.

Purpose of the Study:

To identify predictors of ERAS failure in patients undergoing elective colorectal surgery.
To evaluate the utility of the CR-POSSUM risk calculator in predicting ERAS failure.

Main Methods:

Prospective cohort study of 55 patients undergoing elective colorectal surgery.
Analysis of pre-, intra-, and postoperative parameters to identify ERAS failure predictors.
ERAS failure defined as prolonged hospital stay (> 7 days).

Main Results:

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

Conclusions:

Multiple perioperative factors influence ERAS success in clinical practice.
The CR-POSSUM score can aid in identifying high-risk patients for ERAS failure.
Early identification allows for optimization of modifiable factors and management of prolonged recovery.