Avaliação da tolerância a protocolo de recuperação pós-operatória acelerada em pacientes submetidos à cirurgia colorretal laparoscópica: estudo prospectivo e randomizado

Abstract

Colorectal surgeries are associated with increased postoperative morbimortality, causing discomfort and even suffering for patients and relatives. Until recently, the majority of the adopted measures during the pre, per, and postoperative periods were empirical. The Enhanced Recovery After Surgery (ERAS) program development is based on the premise that adopting a protocol with scientifically proven measures brings benefits to patients, allowing a faster recovery. The success of its implementation depends on patient adherence and tolerance, and intolerance can be related to several and multifactorial reasons. Objective: to assess the insuccess rate of implantation of a simplified Enhanced Recovery After Surgery Program (SERSP) protocol in patients undergoing laparoscopic colorectal surgery and the possible reasons for its non-acceptance. Method: 161 patients were randomly divided into 2 groups G1 (n = 84) submitted to the SERSP protocol and G2 group (n = 77) who received conventional postoperative care. Groups were assessed and compared with respect to factors that could affect ERAS tolerance. The G1 patients were subdivided into 2 subgroups of patients who tolerated (n = 51) or not (n = 33) the SERSP protocol, being compared to each other in relation to possible variables that could influence protocol acceptance. Results: There were 96 females (59%) and the mean age was 57.4(± 12.6 years ranging from 25 to 96 years old). The BMI ranged from 18.0 to 51.0 kg / m2 with median (Q1; Q3) 25.5kg / m2 (22.8; 28.2kg / m2). Groups were similar with respect to socio-demographic and clinical characteristics. Group 1 patients had significantly shorter length of stay, and eliminated flatus, wandered and tolerated the diet earlier (p <0.0001). The rate of tolerance to the accelerated recovery protocol was 60%.In the comparative analysis of the subgroups that accepted or not the SERSP protocol, it was observed that the prolonged surgical time, ostomy preparation and the occurrence of complications were variables that compromised the acceptance of SERSP (p <0.0001). Conclusions: The accelerated postoperative recovery protocol is capable of improving the recovery of patients undergoing laparoscopic colorectal surgery, but its use may not be tolerated by a significant number of patients. Adopting measures that can increase the success rates of these protocols could make them more effective.