Association between use of enhanced recovery after surgery protocols and postoperative complications after gastric surgery for cancer (POWER 4): a nationwide, prospective multicentre study.

INTRODUCTION: The effectiveness of the Enhanced Recovery After Surgery (ERAS) protocols in gastric cancer surgery remains controversial. METHODS: Multicentre prospective cohort study of adult patients undergoing surgery for gastric cancer. Adherence with 22 individual components of ERAS pathways were assessed in all patients, regardless of whether they were treated in a self-designed ERAS centre. Each centre had a three-month recruitment period between October 2019 and September 2020. The primary outcome was moderate-to-severe postoperative complications within 30 days after surgery. Secondary outcomes were overall postoperative complications, adherence to the ERAS pathway, 30 day-mortality and hospital length of stay (LOS). RESULTS: A total of 743 patients in 72 Spanish hospitals were included, 211 of them (28.4 %) from self-declared ERAS centres. A total of 245 patients (33 %) experienced postoperative complications, graded as moderate-to-severe complications in 172 patients (23.1 %). There were no differences in the incidence of moderate-to-severe complications (22.3% vs. 23.5%; OR, 0.92 (95% CI, 0.59 to 1.41); P = 0.068), or overall postoperative complications between the self-declared ERAS and non-ERAS groups (33.6% vs. 32.7%; OR, 1.05 (95 % CI, 0.70 to 1.56); P = 0.825). The overall rate of adherence to the ERAS pathway was 52% [IQR 45 to 60]. There were no differences in postoperative outcomes between higher (Q1, > 60 %) and lower (Q4, ≤ 45 %) ERAS adherence quartiles. CONCLUSIONS: Neither the partial application of perioperative ERAS measures nor treatment in self-designated ERAS centres improved postoperative outcomes in patients undergoing gastric surgery for cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03865810.

Análisis retrospectivo de las suspensiones quirúrgicas y de los factores influyentes durante 8 años / Retrospective analysis of suspended surgeries and influencing factors during an 8-year period

Introducción: El objetivo principal es la descripción y análisis de las suspensiones quirúrgicas y sus causas de nuestro hospital desde el año 2010 hasta la actualidad. Como objetivo secundario evaluamos la efectividad de una serie de medidas de mejora. Métodos: Se realizó un estudio retrospectivo analizando pacientes que estaban programados para ser intervenidos y que finalmente se suspendieron. Se realizó un análisis modal de fallos y efectos (AMFE) para analizar las causas de las suspensiones y sus consecuencias, las barreras existentes y las posibles medidas que se han implantado con el paso del tiempo. Las causas se clasificaron en atribuibles al paciente, causas administrativas y causas médicas. Resultados: Se programaron 105.403 intervenciones, en las que se originaron 3.867 suspensiones (3,66%). Entre los factores que influyen en las suspensiones describimos la especialidad quirúrgica, los pacientes ASA 4, los pacientes ancianos, los pacientes ambulatorios y los intervenidos durante el invierno. Las causas más frecuentes fueron la infección o fiebre (17,6%) dentro de las causas médicas, la falta de tiempo (26,8%) en cuanto a las administrativas, y la no comparecencia dentro de las causas del paciente (6,3%). Las causas evitables fueron el 64,8% frente al 35,2% de causas inevitables. En el análisis multivariante encontramos como factores de riesgo la edad, el turno, la estación y el servicio quirúrgico. Conclusiones: Las cancelaciones quirúrgicas tienen repercusiones a nivel de consumo de recursos materiales y humanos. Cualquier actuación para intentar reducirlas deberá ser nuestra prioridad futura para disminuir la incidencia de las mismas y mejorar la calidad asistencial

Introduction: The main objective was the description and analysis of suspended surgeries and their causes for suspension at our hospital from the year 2010 to the present. As a secondary objective, we evaluated the effectiveness of a series of measures for improvement. Methods: A retrospective study was conducted to analyze patients who were scheduled to undergo surgery that was finally suspended. A Failure Mode and Effects Analysis (FMEA) was carried out to analyze the causes of the suspensions and their consequences, any existing barriers and possible measures that have been implemented over time. The causes were classified as attributable to the patient, administrative causes and medical causes. Results: 105,403 surgeries were scheduled, 3,867 of which were suspended (3.66%). Factors that influenced the suspensions included: surgical specialty, ASA 4 patients, elderly patients, ambulatory patients and surgeries scheduled during the winter. The most frequent medical cause was infection or fever (17.6%), while the most frequent administrative and patient causes were lack of time (26.8%) and no-show (6.3%), respectively. The avoidable causes were 64.8% versus 35.2% unavoidable causes. In the multivariate analysis, risk factors included age, shift, season and surgical service. Conclusions: Surgical cancellations have repercussions on the consumption of material and human resources. Any means to reduce their incidence should be our future priority in order improve the quality of care

Retrospective analysis of suspended surgeries and influencing factors during an 8-year period. / Análisis retrospectivo de las suspensiones quirúrgicas y de los factores influyentes durante 8 años.

INTRODUCTION: The main objective was the description and analysis of suspended surgeries and their causes for suspension at our hospital from the year 2010 to the present. As a secondary objective, we evaluated the effectiveness of a series of measures for improvement. METHODS: A retrospective study was conducted to analyze patients who were scheduled to undergo surgery that was finally suspended. A Failure Mode and Effects Analysis (FMEA) was carried out to analyze the causes of the suspensions and their consequences, any existing barriers and possible measures that have been implemented over time. The causes were classified as attributable to the patient, administrative causes and medical causes. RESULTS: 105,403 surgeries were scheduled, 3,867 of which were suspended (3.66%). Factors that influenced the suspensions included: surgical specialty, ASA 4 patients, elderly patients, ambulatory patients and surgeries scheduled during the winter. The most frequent medical cause was infection or fever (17.6%), while the most frequent administrative and patient causes were lack of time (26.8%) and no-show (6.3%), respectively. The avoidable causes were 64.8% versus 35.2% unavoidable causes. In the multivariate analysis, risk factors included age, shift, season and surgical service. CONCLUSIONS: Surgical cancellations have repercussions on the consumption of material and human resources. Any means to reduce their incidence should be our future priority in order improve the quality of care.