Trial reportBMJ quality & safety2024
Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial.
Trial report in BMJ quality & safety, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 17 citations in OpenAlex.
- Integration of Precision Medicine into ERAS Pathways: A Conceptual Framework, Current Feasibility and Challenges.Journal of personalized medicine · 2026Review
- Pragmatic Criteria for Early Discharge After Laparoscopic Colorectal Surgery: Safety and Applicability Outside ERAS Programs.Journal of clinical medicine · 2026Article
- Enhanced Recovery After Surgery (ERAS) and Surgical Site Infections (SSIs).Antibiotics (Basel, Switzerland) · 2026Review
- Perioperative Anesthesia Strategies for the Prevention of Postoperative Nausea and Vomiting Within Enhanced Recovery After Surgery Pathways: A Clinical Narrative Review.Journal of clinical medicine · 2026Review
- Review
- Implementation of an enhanced recovery after surgery (ERAS) program in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: study protocol for a prospective multicenter interventional trial (EPICH study).Pleura and peritoneum · 2025Article
- Natural Orifice Specimen Extraction Surgery yields superior long-term oncological outcomes compared to traditional laparoscopic surgery in stage II-III rectal cancer.American journal of cancer research · 2025Article
- Analysis of risk factors for prolonged intensive care unit stay after colorectal cancer surgery.Frontiers in oncology · 2025Article
- Risk factors of anastomotic leak in colorectal cancer: a multicentric study in a Latin American country.Ecancermedicalscience · 2024Article
- Potentially Preventable Mortality After Elective Colorectal Cancer Surgery: Insights From a National Surgical Mortality Audit.ANZ journal of surgeryArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEnhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and in a large population. We aimed to assess the impact of the implementation of an ERAS protocol in colorectal cancer surgery in the entire region of Piemonte, Italy, supported by an audit and feedback (A&F) intervention.
methodsA large, stepped wedge, cluster randomised trial enrolled patients scheduled for elective surgery at 29 general surgery units (clusters). At baseline (first 3 months), standard care was continued in all units. Thereafter, four groups of clusters began to adopt the ERAS protocol successively. By the end of the study, each cluster had a period in which standard care was maintained (control) and a period in which the protocol was applied (experimental). ERAS implementation was supported by initial training and A&F initiatives. The primary endpoint was length of stay (LOS) without outliers (>94th percentile), and the secondary endpoints were outliers for LOS, postoperative medical and surgical complications, quality of recovery and compliance with ERAS items.
resultsOf 2626 randomised patients, 2397 were included in the LOS analysis (1060 in the control period and 1337 in the experimental period). The mean LOS without outliers was 8.5 days during the control period (SD 3.9) and 7.5 (SD 3.5) during the experimental one. The adjusted difference between the two periods was a reduction of -0.58 days (95% CI -1.07, -0.09; p=0.021). The compliance with ERAS items increased from 52.4% to 67.3% (estimated absolute difference +13%; 95% CI 11.4%, 14.7%). No difference in the occurrence of complications was evidenced (OR 1.22; 95% CI 0.89, 1.68).
conclusionImplementation of the ERAS protocol for colorectal cancer, supported by A&F approach, led to a substantial improvement in compliance and a reduction in LOS, without meaningful effects on complications.
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