ABSTRACT
PURPOSE: The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery. MATERIALS AND METHODS: Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03864861.
Subject(s)
Bariatric Surgery , Enhanced Recovery After Surgery , Obesity, Morbid , Adult , Bariatric Surgery/adverse effects , Humans , Length of Stay , Obesity, Morbid/surgery , Patient Readmission , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective StudiesABSTRACT
Introducción La resección abdominoperineal tras radioterapia se acompaña de una alta tasa de complicaciones de la herida perineal. El propósito de este estudio retrospectivo fue evaluar los resultados de la reconstrucción perineal con un colgajo miocutáneo de músculo recto abdominal en pacientes con cáncer anal recurrente o persistente. Pacientes y método Entre 2006 y 2010, 6 pacientes varones VIH+ fueron tratados después del fracaso del tratamiento inicial con quimio-radioterapia. Tras amputación abdominoperineal, se realizó un colgajo miocutáneo de recto anterior.Resultados La media de edad fue de 36,3 años (rango: 30-42). La curación primaria de la herida perineal se consiguió en los primeros treinta días. No hubo complicaciones mayores en el postoperatorio inmediato o tras un seguimiento medio de 26,5 meses. Hubo 2 complicaciones menores (33,3%) relacionadas con la herida perineal. No hubo complicaciones de la pared abdominal. Conclusión La utilización de un colgajo miocutáneo del recto anterior del abdomen, en pacientes con cáncer anal recurrente o persistente, se asoció con un bajo índice de complicaciones perineales (AU)
Introduction Abdominoperineal resection after radiotherapy has a high rate of perineal wound complications. The aim of this retrospective study was to evaluate the results of perineal reconstruction with a rectus abdominis muscle myocutaneous flap in patients with recurrent or persistent anal cancer. Patients and method Between 2006 and 2010, six male HIV+ patients were treated after initial treatment failure with chemotherapy. An anterior rectal myocutaneous flap was performed after abdominal-perineal excision. Results The mean age was 36.3 years (range: 30-42). Primary healing of the perineal wound was achieved in the first thirty days. There were no major complications in the immediate post-surgical period or after a mean follow up of 26.5 months. There were 2 (33.3%) minor complications associated with the perineal wound. There were no complications of the abdominal wall. Conclusion The use of an anterior rectus abdominis myocutaneous flap in patients with recurrent or persistent anal cancer is associated with a low rate of perineal complications (AU)
