A Prospective Observational Study on Compliance with Enhanced Recovery Pathways and Their Impact on Postoperative Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

BACKGROUND

Enhanced recovery pathways have been shown to improve postoperative morbidity and reduce hospital stay across various surgical settings. However, the implementation of Enhanced Recovery After Surgery (ERAS) pathways in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is often challenging and varies between institutions. We evaluated the impact of ERAS compliance on postoperative outcomes and return to intended oncological therapy (RIOT).

METHODS

All consecutive patients operated for CRS-HIPEC between May 2021 and August 2023 were included in the study. Compliance with 30 ERAS components was collected. Postoperative complications were categorized using the Clavien-Dindo (CD) classification. Patients were followed for 30 days post-surgery to assess readmissions and delays in RIOT. Pearson correlation analysis evaluated the relationship between ERAS compliance and CD grading, length of hospital stay, readmissions, and RIOT delays. Logistic regression analysis was done to evaluate the association between percentage compliance to ERAS components and postoperative morbidity and length of hospital stay.

RESULTS

Among 150 patients, the average compliance to ERAS components was 77.6%. There was a significant negative correlation between ERAS compliance and postoperative morbidity (r =  - 0.512, p < 0.001) and RIOT (r =  - 0.469, p < 0.001). Compliance with preoperative (r =  - 0.222, p = 0.006) and postoperative factors (r =  - 0.533, p < 0.001) significantly impacted postoperative morbidity and RIOT. Patients with less than 71.6% compliance had higher morbidity (χ = 19.55; p < 0.001), longer hospital stays (χ = 4.73; p = 0.03), and delayed RIOT (χ = 12.70; p < 0.001). There is significant association between increase in percentage compliance to ERAS components and reduced major postoperative complications (OR 0.79; 95% CI 0.72-0.87; p = 0.001) and reduced length of hospital stay (OR 0.89; 95% CI 0.84-0.95; p = 0.001).

CONCLUSION

Higher compliance is linked with reduction in postoperative morbidity, shorter hospital stays, and timely RIOT. These findings reinforce the safety profile of ERAS pathway in CRS-HIPEC. However, multicenter studies are needed to support these findings.

REGISTRY

Clinical Trial Registry of India (CTRI/2021/02/031151).