• Javier Ripollés-Melchor, Ane Abad-Motos, Maurizio Cecconi, Rupert Pearse, Samir Jaber, Karem Slim, Nader Francis, Antonino Spinelli, Jean Joris, Orestis Ioannidis, Eirini Zarzava, Nüzhet Mert Şentürk, Seppe Koopman, Nicolai Goettel, Ottokar Stundner, Tomas Vymazal, Petr Kocián, Alaa El-Hussuna, Michał Pędziwiatr, Jurate Gudaityte, Tadas Latkauskas, Marisa D Santos, Humberto Machado, Roman Zahorec, Ana Cvetković, Mirjana Miric, Maria Georgiou, Yolanda Díez-Remesal, Ib Jammer, Gabriel E Mena, Andrés Zorrilla-Vaca, Marco V Marino, Alejandro Suárez-de-la-Rica, José A García-Erce, Margarita Logroño-Ejea, Carlos Ferrando-Ortolá, María L De-Fuenmayor-Valera, Bakarne Ugarte-Sierra, José de Andrés-Ibañez, Alfredo Abad-Gurumeta, Gianluca Pellino, Manuel A Gómez-Ríos, Gilberto Poggioli, Albert Menzo-Wolthuis, Berta Castellano-Paulis, Patricia Galán-Menéndez, César Aldecoa, José M Ramírez-Rodríguez, EuroPOWER Study Investigators Group, Spanish Perioperative Audit and Research Network (RedGERM-SPARN), and Francophone Group for Enhanced Recovery After Surgery (GRACE).
• Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain. Electronic address: javier.ripolles@salud.madrid.org.
• J Clin Anesth. 2022 Sep 1; 80: 110752.

Study ObjectiveAssess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.DesignProspective cohort study.SettingEuropean centers (185 hospitals) across 21 countries.PatientsA total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.InterventionsRoutine perioperative care.MeasurementsTwenty-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.ResultsA 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).ConclusionsTreatment 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 length of hospital stay and lower 30-day mortality.Copyright © 2022 Elsevier Inc. All rights reserved.

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