المؤلفون: Ripollés-Melchor, Javier, Varela, María Luisa de Fuenmayor, Camargo, Susana Criado, Fernández, Pablo Jerez, Barrio, Álvaro Contreras del, Martínez-Hurtado, Eugenio, Casans-Francés, Rubén, Abad-Gurumeta, Alfredo, Ramírez-Rodríguez, José Manuel, Calvo-Vecino, José María

المصدر: Revista Brasileira de Anestesiologia. August 2018 68(4)

مصطلحات موضوعية: Perioperative, Enhanced recovery after surgery, Postoperative complications

الوصف: Background Enhanced recovery after surgery (ERAS) protocols consist of a set of perioperative measures aimed at improving patient recovery and decreasing length of stay and postoperative complications. We assess the implementation and outcomes of an ERAS program for colorectal surgery. Methods Single center observational study. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, 3 years before (Pre-ERAS) and 2 years after (Post-ERAS) the implementation of an ERAS protocol. Baseline characteristics of both groups were compared. The primary outcome was the number of patients with 180 days follow-up with moderate or severe complications; secondary outcomes were postoperative length of stay, and specific complications. Data were extracted from patient records. Results There were 360 patients in the Pre-ERAS group and 319 patients in the Post-ERAS Group. 214 (59.8%) patients developed at least one complication in the pre ERAS group, versus 163 patients in the Post-ERAS group (51.10%). More patients in the Pre-ERAS group developed moderate or severe complications (31.9% vs. 22.26%, p = 0.009); and severe complications (15.5% vs. 5.3%; p < 0.0001). The median length of stay was 13 (17) days in Pre-ERAS Group and 11 (10) days in the Post-ERAS Group (p = 0.034). No differences were found on mortality rates (4.7% vs. 2.5%; p = 0.154), or readmission (6.39% vs. 4.39%; p = 0.31). Overall ERAS protocol compliance in the Post-ERAS cohort was 88%. Conclusions The implementation of ERAS protocol for colorectal surgery was associated with a significantly reduction of postoperative complications and length of stay.

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الوصول الحر: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942018000400358Test

المؤلفون: Ripollés, Javier, Espinosa, Angel, Martínez-Hurtado, Eugenio, Abad-Gurumeta, Alfredo, Casans-Francés, Rubén, Fernández-Pérez, Cristina, López-Timoneda, Francisco, Calvo-Vecino, José María

المصدر: Revista Brasileira de Anestesiologia. October 2016 66(5)

مصطلحات موضوعية: Goal directed fluid therapy, Meta-analysis, Hemodynamic goal, Noncardiac surgery

الوصف: Background: The goal directed hemodynamic therapy is an approach focused on the use of cardiac output and related parameters as end-points for fluids and drugs to optimize tissue perfusion and oxygen delivery. Primary aim: To determine the effects of intraoperative goal directed hemodynamic therapy on postoperative complications rates. Methods: A meta-analysis was carried out of the effects of goal directed hemodynamic therapy in adult noncardiac surgery on postoperative complications and mortality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. A systematic search was performed in Medline PubMed, Embase, and the Cochrane Library (last update, October 2014). Inclusion criteria were randomized clinical trials in which intraoperative goal directed hemodynamic therapy was compared to conventional fluid management in noncardiac surgery. Exclusion criteria were trauma and pediatric surgery studies and that using pulmonary artery catheter. End-points were postoperative complications (primary) and mortality (secondary). Those studies that fulfilled the entry criteria were examined in full and subjected to quantifiable analysis, predefined subgroup analysis (stratified by type of monitor, therapy, and hemodynamic goal), and predefined sensitivity analysis. Results: 51 RCTs were initially identified, 24 fulfilling the inclusion criteria. 5 randomized clinical trials were added by manual search, resulting in 29 randomized clinical trials in the final analysis, including 2654 patients. A significant reduction in complications for goal directed hemodynamic therapy was observed (RR: 0.70, 95% CI: 0.62-0.79, p < 0.001). No significant decrease in mortality was achieved (RR: 0.76, 95% CI: 0.45-1.28, p = 0.30). Quality sensitive analyses confirmed the main overall results. Conclusions: Intraoperative goal directed hemodynamic therapy with minimally invasive monitoring decreases postoperative complications in noncardiac surgery, although it was not able to show a significant decrease in mortality rate.

وصف الملف: text/html

الوصول الحر: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942016000500513Test

المؤلفون: von Groote, Thilo, Meersch, Melanie, Romagnoli, Stefano, Ostermann, Marlies, Ripollés-Melchor, Javier, Schneider, Antoine Guillaume, Vandenberghe, Wim, Monard, Céline, De Rosa, Silvia, Cattin, Lucia, Rahmel, Tim, Adamzik, Michael, Parise, Diego, Candela-Toha, Angel, Haaker, Jan Gerrit, Göbel, Ulrich, Bernard, Alice, Lumlertgul, Nuttha, Fernández-Valdes-Bango, Paula, Romero Bhathal, Irene, Suarez-de-la-Rica, A, Larmann, Jan, Villa, Gianluca, Spadaro, Savino, Wulf, Hinnerk, Arndt, Christian, Putensen, Christian, García-Álvarez, Raquel, Brandenburger, Timo, Siniscalchi, Antonio, Ellerkmann, Richard, Espeter, Florian, Porschen, Christian, Sadjadi, Mahan, Saadat-Gilani, Khaschayar, Weiss, Raphael, Gerss, Joachim, Kellum, John, Zarbock, Alexander, for the BigpAK-2 Investigators, Wempe, Carola, Storck, Michael, Brix, Tobias, Meschede, Dana, Martin, Christine, Amini, Wida, Strauss, Christian, Stenger, Carina, Gründel, Matthias, Brenner, Thorsten, Berger, Marc Moritz, Freytag, Julius, Dubler, Simon, Brands, Jens, Nowak, Hartmuth, Bergmann, Lars, Unterberg, Matthias, Wolf, Alexander, Marko, Britta, Kindgen-Milles, Detlef, Huthmann, Laura, Schless, Manon, Dimski, Thomas, Pelletier, Claude, Dusse, Fabian, Wetsch, Wolfgang A, Stoll, Sandra E, Drinhaus, Hendrik, Böttiger, Bernd W, Mörer, Onnen, Harnisch, Lars-Olav, Lubjuhn, Roswitha, Heise, Daniel, Bode, Christian, Sauer, Andrea, Peukert, Konrad, Wild, Lennart, Kruse, Philippe, Menzenbach, Jan, Rosenberger, Peter, Häberle, Helene, Mirakaj, Valbona, Hermann, Sabine, Decker, Stefanie, Weigand, Markus A, Jung-König, Mona, Hölle, Tobias, Dehne, Sarah, Nusshag, Christian, Reutershan, Jörg, Prüfer, Thomas, Pielmeier, Stefan, Wimmelmeier, Indra, Scholz, Michaela, Paris, Andrea, Gallego Zapata, Isabel Christina, Pohl, Holger, Fayed, Nirmeen, Irqsusi, Marc, Dielmann, Kai, Martin, Evelyn, Koch, Tilo, Simon, Philipp, Jaschinski, Ulrich, Mück, Alexander, Deetjen, Philipp, Mehlmann, Ngoc Bich, Spieth, Peter M, Güldner, Andreas, Rand, Axel, Ragaller, Maximillian, Mirus, Martin, Bockholt, Rebecca, O’Brien, Benjamin, Ott, Sascha, Herzog, Marc, Kleine-Brüggeney, Maren, Stoppe, Christian, Cristiani, Ant Isabelle, Ohl, Marion, Silva, Monica Vieira Da, Reblo, Gilda Filipe de Castro, Hilty, Matthias, Spanaus, Katharina, Mura, Benedetta, Terreni, Eleonora, Magiotti, Francesco, Turi, Lorenzo, Baldini, Gabriele, Laici, Cristiana, Mancini, Elena, Ricci, Davide, Capozzi, Chiara, Castelli, Andrea, Greco, Massimiliano, Messina, Antonio, Cecconi, Maurizio, Castellani, Gianluca, Aceto, Romina, Danzi, Vinicio, Rigobello, Alessandro, Cal, Massimo De, Zanella, Monica, Scaramuzzo, Gaetano, Rosa, Riccardo La, Priani, Paolo, Carlo, Alberto Volta, Turi, Stefano, Monti, Giacomo, Borghi, Giovanni, Redaelli, Martina Baiardo, Marmiere, Marilena, Weerapolchai, Kittisak, Lorah, Shelley, D’Amato, Fabiola, Bociek, Aneta, Lim, Rosario, Cendreda, Benjie, Cuesta, Reynaldo Dela, Kosifidou, Eirini, Milan, Zoka, Kunst, Gudrun, Fernanda, Juliana, Clarey, Emma, Meeks, Daveena, Marczin, Nandor, Patel, Brijesh, Donovan, Jackie, Lees, Nicholas J, Scaramuzzi, Marco, Kviatkovske, Orinta, Spence, Andrew, Glass, Adam, Silversides, Jon, Turley, Christine, Quinn, Charlotte, Forni, Lui G, Haider, Syeda, Rossiter, Adam, Nasser, Syed, Creagh-Brown, Ben C, Welters, Ingeborg, Williams, Karen, Waite, Alicia, Johnston, Brian, Gilbert-Kawai, Ned, Besse-Hammer, Tatjana, Hoste, Eric, Schaubroeck, Hannah, Waele, Jan De, Hollmann, Markus W, Bauer, Wolfgang, Breel, Jenni, Klerk, Eline de, Vlaar, Alexander PJ, Grooth, Harm-Jan de, Schober, Patrick, Schwarte, Lothar, Loer, Alexander, Lorente, Juan Victor, Ruiz-Escobar, Alicia, Fernández-García, Diana, Abad-Motos, Ane, Gómez-Pérez, Nerea, Abad-Gurumeta, Alfredo, Crespo-Aliseda, Pascual, Gómez-Rojo, María, Cerro-Zaballos, Cristina, Fernández-Martín, Cristina, Martín-Montero, Eduardo, Rica, Alejandro Suarez de la, López, Carlos, Maseda, Emilio, Gutiérrez, Héctor Berges, Heredia Pérez, Maria del Pino, Reyes Bellido Fernández, Maria de los, López, Liena Izquierdo, Lourtau, Javier Valiente, Ferre Colomer, Ma Angeles, Moncho, Ma Azucena Pajares, Montero Hernández, Maria Jesús, Sancho, Esther Pérez, Matínez, Silvia Polo, Soria, Pedro Rivera, Jáuregui, Maider Puyada, Ramos, Hugo Rivera, Adrán, Marta Antelo, Bartolomé, Ramón Adalia, Menéndez, Patricia Galán, Villa, Laura Villarino, Espin, Laura Llinares, Loaiza Aldean, Yuri Santiago, MoralesAriza, Víctor, Navarro-Perez, Rosalía, Santé-Serna, Luis, Calle-Elguezabal, Pedro de la, Sánchez-Martín, Rubén, Soto, Inés De, Alcántara, Pau Vallhonrat, Cerdà, Laura Perelló, Hurtado, Gal·la Rouras, Nieto, Paula Rodriguez, Sicluna, John Narros, Molinero, Angel Molero, Nocete, Juan Pablo, Sánchez, Elena Murcia, Rimmelé, Thomas, Abrard, Stanislas, Lamblin, Antoine, Parrouffe, Marie-Luce, Bidar, Frank, Futier, Emmanuel, Aupetitgendre, Lucie, Schiff, Ugo, Paquette, Bertille, Rineau, Emmanuel, Sellier, Gaëlle, Borgnetta, Nathalie, Léger, Maxime, Lasocki, Sigismond, Legros, Vincent, Brochet, Benjamin, Floch, Thierry, Coffinet, Julien, Leclercq-Rouget, Marion

مصطلحات موضوعية: Intensive care

الوصف: Introduction Previous studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation. Methods and analysis The BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage. Ethics and dissemination The BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Mu&x0308;nster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. ...

وصف الملف: text/html

العلاقة: http://bmjopen.bmj.com/cgi/content/short/13/3/e070240Test; http://dx.doi.org/10.1136/bmjopen-2022-070240Test

الإتاحة: https://doi.org/10.1136/bmjopen-2022-070240Test
http://bmjopen.bmj.com/cgi/content/short/13/3/e070240Test

المؤلفون: Abad‐Motos, Ane, Ripollés‐Melchor, Javier, Jericó, Carlos, Bisbe, Elvira, Basora, Misericordia, Colomina, Maria J., Becerra‐Bolaños, Ángel, Bermúdez‐López, María, Massa‐Gómez, Cristina, Albaladejo‐Magdalena, Javier, Solar‐Herrera, Ana, Pérez‐Chrzanowska, Hanna, Yárnoz, Carlos, Fedriani‐de‐Matos, Jacobo José, Blanco‐Del‐Val, Beatriz, Fabián‐González, David, Bellver, Jorge, Redondo‐Enríquez, Juan M., Serrat‐Puyol, Jordi, Abad‐Gurumeta, Alfredo, Zorrilla‐Vaca, Andrés, Aldecoa, César, García‐Erce, José Antonio

المصدر: Acta Anaesthesiologica Scandinavica ; volume 67, issue 5, page 629-639 ; ISSN 0001-5172 1399-6576

الوصف: Background Preoperative anaemia is associated with poor outcomes in surgical patients, but the preoperative haemoglobin cut‐off that determines lower morbidity in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is not well established. Methods Planned secondary analysis of data collected during a multicentre cohort study of patients undergoing THA and TKA in 131 Spanish hospitals during a single 2‐month recruitment period. Anaemia was defined as haemoglobin <12 g dl −1 for females and < 13 g dl −1 for males. The primary outcome was the number of patients with 30‐day in‐hospital postoperative complications according to European Perioperative Clinical Outcome definitions and specific surgical TKA and THA complications. Secondary outcomes included the number of patients with 30‐day moderate‐to‐severe complications, red blood cell transfusion, mortality, and length of hospital stay. Binary logistic regression models were constructed to assess association between preoperative Hb concentrations and postoperative complications, and variables significantly associated with the outcome were included in the multivariate model. The study sample was divided into 11 groups based on preoperative Hb values in an effort to identify the threshold at which increased postoperative complications occurred. Results A total of 6099 patients were included in the analysis (3818 THA and 2281 TKA), of whom 8.8% were anaemic. Patients with preoperative anaemia were more likely to suffer overall complications (111/539, 20.6% vs. 563/5560, 10.1%, p < .001) and moderate‐to‐severe complications (67/539, 12.4% vs. 284/5560, 5.1%, p < .001). Multivariable analysis showed preoperative haemoglobin ≥14 g dl −1 was associated with fewer postoperative complications. Conclusion Preoperative haemoglobin ≥14 g dl −1 is associated with a lower risk of postoperative complications in patients undergoing primary TKA and THA.

الإتاحة: https://doi.org/10.1111/aas.14217Test

المؤلفون: Ripollés-Melchor, Javier, Ruiz-Escobar, Alicia, Fernández-Valdes-Bango, Paula, Lorente, Juan V., Jiménez-López, Ignacio, Abad-Gurumeta, Alfredo, Carrasco-Sánchez, Laura, Monge-García, M. Ignacio

المصدر: Frontiers in Anesthesiology ; volume 2 ; ISSN 2813-480X

الوصف: Intraoperative hypotension is common and has been associated with adverse events, including acute kidney failure, myocardial infarction, and stroke. Since blood pressure is a multidimensional and measurable variable, artificial intelligence and machine learning have been used to predict it. To date, studies have shown that the prediction and prevention of hypotension can reduce the incidence of hypotension. This review describes the development and evaluation of an artificial intelligence predictive algorithm called Hypotension Prediction (HPI), which can predict hypotension up to 15 min before it occurs.

الإتاحة: https://doi.org/10.3389/fanes.2023.1138175Test

المؤلفون: Lorente, Juan V., Ripollés-Melchor, Javier, Jiménez, Ignacio, Becerra, Alejandra I., Mojarro, Irene, Fernández-Valdes-Bango, Paula, Fuentes, Maria A., Moreno, Ana, Agudelo, Maria E., Villar-Pellit de la Vega, Angel, Ruiz-Escobar, Alicia, Cortés, Azahara, Venturoli, Rocio, Quintero, Ana, Acedo, Guadalupe M., Abad-Motos, Ane, Gómez, Peña, Abad-Gurumeta, Alfredo, Monge-García, Manuel I.

المصدر: Frontiers in Anesthesiology ; volume 2 ; ISSN 2813-480X

الوصف: Background Intraoperative hypotension (IOH) is associated with increased morbidity and mortality after major abdominal surgery but remains significant even when using goal-directed hemodynamic therapy (GDHT) protocols. The Hypotension Prediction Index (HPI) is a machine learning-derived parameter that predicts arterial hypotension. We tested the hypothesis that an HPI-based protocol reduces the duration and severity of hypotension compared with a GDHT protocol during major abdominal surgery. Methods This is a parallel-arm double-blinded multicenter randomized trial involving adult patients undergoing elective major abdominal surgery at five centers. Patients were optimized according to a previously recommended GDHT protocol (GDHT group) or the HPI value (HPI group). Hemodynamic optimization in both groups started 15 min after the surgical incision. The primary outcome was the intraoperative time-weighted average of mean arterial pressure under 65 mmHg (TWA-MAP < 65 mmHg). Other metrics for IOH and secondary outcomes, including TWA below individual baseline values of intraoperative tissue oxygenation (StO 2 ), postoperative AKIRisk, postoperative complications, length of stay, and 30-day mortality, were explored. Results Eighty patients were randomized (40 patients in each group). TWA-MAP < 65 mmHg was 0.06 (25th–75th interquartile range: 0–0.27) mmHg in the GDTH group vs. 0 (0–0.04) mmHg in the HPI group ( p = 0.015). Total time with MAP < 65 mmHg per patient was 4.6 (0–21) min in the GDHT group and 0 (0–3) min in the HPI group ( p = 0.008). The TWA below the baseline StO 2 was 0.40% (0.12%–2.41%) in the GDHT group and 0.95% (0.15%–3.20%) in the HPI group ( p = 0.353). The AKIRisk values obtained in the GDHT group were 0.30 (0.14–0.53) and 0.34 (0.15–0.67) in the GDHT and HPI groups ( p = 0.731), respectively. Both groups had similar postoperative complications, length of stay, and 30-day mortality. Conclusions An HPI-based protocol reduced intraoperative hypotension compared with a standard ...

الإتاحة: https://doi.org/10.3389/fanes.2023.1193886Test

المؤلفون: Ripollés-Melchor, Javier, Carrasco-Sánchez, Laura, Tomé-Roca, José L., Aldecoa, César, Zorrilla-Vaca, Andres, Lorente-Olazábal, Juan V., Colomina, María J., Pérez, Ana, Jiménez-López, Juan I., Navarro-Pérez, Rosalía, Abad-Gurumeta, Alfredo, Monge-García, Manuel I., Ruiz-Escobar, Alicia, Fernánez-Valdes-Bango, Paula, Espinosa, Ángel V., Pradera, María A. Fuentes, Rueda, Azahara Cortes, Adell-Perez, Ana B., Agarrista-Aguirrezabala, Iker, Amelburu-Egoscozabal, Marta

المصدر: Trials; 4/29/2024, Vol. 25 Issue 1, p1-19, 19p

مصطلحات موضوعية: SURGICAL complications, ABDOMINAL surgery, KIDNEYS, CLINICAL trials, RANDOMIZED controlled trials, HOSPITAL admission & discharge, ACUTE kidney failure

مستخلص: Background: Acute kidney injury (AKI) is a significant postoperative complication associated with increased mortality and hospital costs. Hemodynamic strategies, such as goal-directed therapy, might reduce AKI risk. Predicting and proactively managing intraoperative hypotension may be helpful. This trial aims to investigate if a preemptive hemodynamic strategy guided by the hypotension prediction index (HPI) can decrease the incidence of moderate-to-severe AKI within 30 days following major elective abdominal surgery. Methods: This is an open-label, controlled, multicenter, randomized clinical trial that involves daily patient follow-up until hospital discharge. Inclusion criteria are patients aged over 65 and/or categorized as ASA III or IV physical status, undergoing major elective abdominal surgery (general, urological, or gynecological procedures) via laparoscopic or open approach under general or combined anesthesia. Intervention: In the intervention group, hemodynamic management will be based on the HPI and the advanced functional hemodynamic variables provided by the Hemosphere platform and the AcumenIQ® sensor (Edwards Lifesciences). The primary outcome is the incidence of moderate-to-severe AKI within 7 days post-surgery. Secondary outcomes include postoperative complications and 30-day mortality. Discussion: This study explores the potential of HPI-guided hemodynamic management in reducing AKI after major elective abdominal surgery, with implications for postoperative outcomes and patient care. Trial registration: ClinicalTrials.gov NCT05569265. Registered on October 6, 2022. [ABSTRACT FROM AUTHOR]

: Copyright of Trials is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Ripollés-Melchor, Javier, Abad-Motos, Ane, Cecconi, Maurizio, Pearse, Rupert, Jaber, Samir, Slim, Karem, Francis, Nader, Spinelli, Antonino, Joris, Jean, Ioannidis, Orestis, Zarzava, Eirini, Şentürk, Nüzhet Mert, Koopman, Seppe, Goettel, Nicolai, Stundner, Ottokar, Vymazal, Tomas, Kocián, Petr, El-Hussuna, Alaa, Pędziwiatr, Michał, Gudaityte, Jurate, Latkauskas, Tadas, Santos, Marisa, Machado, Humberto, Zahorec, Roman, Cvetković, Ana, Miric, Mirjana, Georgiou, Maria, Díez-Remesal, Yolanda, Jammer, Ib, Mena, Gabriel, Zorrilla-Vaca, Andrés, Marino, Marco, Suárez-De-La-Rica, Alejandro, García-Erce, José, Logroño-Ejea, Margarita, Ferrando-Ortolá, Carlos, De-Fuenmayor-Valera, María, Ugarte-Sierra, Bakarne, de Andrés-Ibañez, José, Abad-Gurumeta, Alfredo, Pellino, Gianluca, Gómez-Ríos, Manuel, Poggioli, Gilberto, Menzo-Wolthuis, Albert, Castellano-Paulis, Berta, Galán-Menéndez, Patricia, Aldecoa, César, Ramírez-Rodríguez, José

المساهمون: Physiologie & médecine expérimentale du Cœur et des Muscles U 1046 (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier), CHU Clermont-Ferrand

المصدر: ISSN: 0952-8180 ; Journal of Clinical Anesthesia ; https://hal.science/hal-03638152Test ; Journal of Clinical Anesthesia, 2022, 80, pp.110752. ⟨10.1016/j.jclinane.2022.110752⟩.

مصطلحات موضوعية: ERAS, Colorectal surgery, Optimization, Enhanced recovery, Postoperative complications, Perioperative management, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie

الوصف: International audience ; Study objective: Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.Design: Prospective cohort study.Setting: European centers (185 hospitals) across 21 countries.Patients: A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.Interventions: Routine perioperative care.Measurements: Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences.Results: A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79–1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5–9] vs. 8 [6–10] days; OR 0.82; 95%CI, 0.78–0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%–65%]. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53–0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02–0.42; P = 0.002) and shorter hospital stay (6 [4–8] vs. 7 [5–10] days; OR 0.74; 95%CI, 0.69–0.79; P < 0.001).Conclusions: Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter ...

العلاقة: hal-03638152; https://hal.science/hal-03638152Test; https://hal.science/hal-03638152/documentTest; https://hal.science/hal-03638152/file/2022%20Ripolles%20Melchor%20et%20al.,%20Association%20between.pdfTest

الإتاحة: https://doi.org/10.1016/j.jclinane.2022.110752Test
https://hal.science/hal-03638152Test
https://hal.science/hal-03638152/documentTest
https://hal.science/hal-03638152/file/2022%20Ripolles%20Melchor%20et%20al.,%20Association%20between.pdfTest

المؤلفون: GÓMEZ-RÍOS, Manuel Á., ABAD-GURUMETA, Alfredo

المصدر: Minerva Anestesiologica; May2024, Vol. 90 Issue 5, p356-358, 3p

المؤلفون: Abad Gurumeta, Alfredo

مرشدي الرسالة: Gilsanz Rodríguez, Fernando (dir.), Universidad Autónoma de Madrid. Departamento de Cirugía

مصطلحات موضوعية: Medicina, Anestesia en Pediatría - Tesis doctorales

الوصف: Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Cirugía. Fecha de lectura: 12 de Diciembre de 2007

الوصول الحر: http://hdl.handle.net/10486/2485Test