POWER Postoperative Outcomes Within Enhanced Recovery

The development and widespread application of ERAS, in combination with laparoscopic surgery, represent a paradigm shift in perioperative care. Furthermore, the association between laparoscopic approach and ERAS perioperative management has recently proposed as the best option for patients undergoing segmental colectomy for colon cancer.

Our aim is to conduct an international 30-day cohort study of adults undergoing in- elective gastrointestinal surgery within an ERAS protocol to provide detailed data describing post- operative complications and associated mortality. Also, to determine how implementation of an ERAS program affects postoperative complications in patients undergoing elective gastrointestinal-surgery.

1. Protocolo ; 2. Apendice 2; 3: resultados preliminares (Abstract en Euroanesthesia)


Goal directed hemodynamic therapy decresases postoperative
complications. Results from a multicenter randomized
controlled trial

Ripollés-Melchor J.1, Casans-Francés R.2, Martínez-Hurtado E.1,Álvarez-Baena L.1, Lucena E.1, Calvo-Vecino J.M.1, EAR GROUP (Evidence Anesthesia Review Group)
1Infanta Leonor Universit y Hospital, Universidad Compluense de Madrid, Dept of Anaesthesiology, Madrid, Spain, 2Hospital Clinico Univer tsitario Lozano Blesa, Dept of Anaesthesiology, Zaragoza, Spain

Background and Goal of Study: Goal directed hemodynamic therapy (GDHT) has been associated with a reduction complication rates af term mayor surgery. The aim of the study was to evaluate the postoperative complications in patients undergoing mayor elective surgery using GDHT guided by measures stroke volume (SV), mean arterial pressure (MAP) and cardiac index (CI) by esophageal Doppler monitoring (EDM) through administering fluids, inotropes and vasopressors.

Materials and methods: Prospective, multicenter, randomized, unfunded controlled trial (ISRCTN93543537). Af ter ethical committee approval and written informed consent were obtained, we enrolled adult ASA I-III patients scheduled for elective major surgery (gastrointestinal, urological, gynecological and orthopaedic). Randomization and allocation to trial group were carried out by a central computer system. In the control group (CG), intraoperative fluid therapy was administered according to conventional practice. In the GDHT group (GG), the intraoperative goals were to maintain and optimal SV, a MAP >70mmHg, and a CI >= 2.5 L/min/m2. Complications and Outcome data were recorded up to 180 days postoperatively. Primary outcome was postoperative complications.

The qualitative variables are described frequency distribution and quantitative in mean and standard deviation (SD) or median and interquartile range (IQR), if asymmetry. Study groups were compared according to the recommendations of the CONSORT standards. The study was completed by low recruitment, once reached statistical power.
Results and discussion: 450 patients were randomized to the GG (n=224 patients) or to the CG (n=226 patients). 428 were analyzed. The number of complications was significantly lower in the GG (56 complications vs. 198 complications, p<0.01); as the number of patients with complications 15% vs 27.6% p=0.001, OR: 0.46 CI 95% 0.29-0.75 (Relative Risk Reduction 56.4%), certain specific complications (Figure 1) and length of stay: Median IQR 5 (4-10) vs 7 (7-12) p 0.002.