Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery

BACKGROUND: High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery. OBJECTIVE: To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery. DESIGN: Retrospective analysis of a prospective database. PATIENTS: Adults (≥ 18 years old) who underwent elective colorectal resection with anastomosis for benign and malignant disease. SETTINGS: Prospective enrolment in 78 centers in Italy from 2019 to 2021. INTERVENTIONS: All the outcomes were measured at 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed for the outcomes. After univariate analyses, independent predictors of the endpoints were identified through logistic regression analyses, presenting odds ratios and 95% confidence intervals. MAIN OUTCOME MEASURES: Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event. RESULTS: An adverse event was recorded in 2,321 out of 8,359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary endpoints were identified among patient- (age, American Society of Anesthesiologists class, nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage, reoperation) variables. Enhanced recovery pathway adherence > 70% independently reduced failure to rescue rates. LIMITATIONS: Clustering from multicenter data, and unmeasured confounding from observational data. CONCLUSIONS: Following elective colorectal resection, adherence > 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract.