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Master Thesis

Réhabilitation accélérée après chirurgie colorectale au CHU de Nice : étude avant-après mise en place du protocole GRACE

Abstract : Introduction: enhanced recovery after surgery (ERAS) programs now lie at the heart of peri-operative medecine. Morbi-mortality decrease in colorectal surgery (CRS) has proven their efficacy. In 2018, a preliminary study in the digestive surgery unit of Nice University Hospital showed incomplete observance of the ERAS program in CRS. Meanwhile, our unit implemented the GRACE (a french acronym for ERAS French Speaking Group) protocol. We therefore measured how this protocol impacted observance of the ERAS measures and the results of this change in practice on CRS peri-operative morbimortality. Methods: all patients with CRS between november 2019 and november 2020 (P2 : 2nd period) were included in our observational retrospective study. Data from the preliminary study (P1 : 1st period) was also included. The primary endpoint was the comparison of implementation level of ERAS measures in CRS between P1 and P2. The secondary endpoints were the morbidity rate (complications and/or revision surgery and/or nosocomial infections), the mortality rate ten days after surgery and the mean hospital stay. Statistically significant variables during bivariate analysis (p<0,05) were included in a multivariate logistic regression model following a backward stepwise variable selection using Akaike Information Criterion (AIC). Results: data from 289 patients was included and analysed. 93 patients were from P1 and 196 from P2. The mean level of implementation of ERAS was significantly improved between P2 (58%) and P1 (49%) p=0,004. Within ERAS measures, patient information (Odds Ratio (OR) : 4,11 [1,40 ; 15,26] p=0,018), post-surgical nausea or vomiting prevention (OR : 2,97 [1,50 ; 6,02] p=0,002) and analgesia optimization (OR : 4,24 [2,13 ; 8,67] p<0,001) marked observance improvement between P1 and P2 (Table 1). No significant differences were noted for length of hospital stay, morbimortality except for nosocomial infections in bivariate analysis (P1 : 27,5% vs P2 : 13,3% p=0,006). In multivariate analysis, the absence of optimal analgesia (OR: 1,95 [1,07; 3,54] p=0,03) as well as the presence of surgical drainage (OR: 3,30 [1,87; 5,88] p<0,001) increases the risk of post-surgical morbidity event. Conclusions: improvement of ERAS measures observance in our unit since the implementation of GRACE protocol has been beneficial on CRS peri operative morbidity. Despite these favourable results, adherence to protocol can be optimized and encourages us to further our effort in order to improve peri operative care of our CRS patients.
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Master Thesis
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Submitted on : Monday, June 7, 2021 - 3:25:52 PM
Last modification on : Tuesday, December 7, 2021 - 4:10:58 PM


  • HAL Id : dumas-03252149, version 1


Léonore Gindre. Réhabilitation accélérée après chirurgie colorectale au CHU de Nice : étude avant-après mise en place du protocole GRACE. Médecine humaine et pathologie. 2021. ⟨dumas-03252149⟩



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