Adherence to the acceleration of total postoperative recovery protocol and perioperative complications in cancer patients.
Silvia Paulino Ribeiro Albanese, Caroline Tolentino Sanches, Karine Silva de Oliveira and 3 others
PMID 41313639WHAT IT FOUND
In 229 ICU patients after cancer surgery, 157 had complications and 27 died.
Adherence to fluid limits, early refeeding, and nausea prevention was associated with fewer complications; age and immediate postoperative SOFA were linked to death.
Key findings
01Postoperative complications occurred in 157 patients (68.5%) and hospital mortality was 27 patients (11.8%).
02Adherence to ACERTO recommendations was associated with fewer complications; fluid resuscitation <= 30 mL/kg was followed in 111 patients intraoperatively and 206 postoperatively, and nausea/vomiting prophylaxis was prescribed in 213 intraoperatively and 229 postoperatively.
03Age and immediate postoperative SOFA score were independent risk factors for death.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-center retrospective design, so results may not apply to other hospitals or patients outside this ICU. Convenience sample from July to December 2021, not random, and 70 of 299 eligible cases were excluded for missing records or short ICU stays. ACERTO was not formally implemented, so adherence reflects routine practice, not a controlled intervention. Medical records were incomplete for some variables, including intraoperative fluid losses, limiting fluid-balance calculations. Small sample size may have limited detection of relevant risk factors for death. The study reports associations, not proof that adherence caused fewer complications or that age and SOFA caused death.
The easy way to misread this
Do not conclude that following ACERTO recommendations prevents complications or death. This was a retrospective, single-center observational cohort, the protocol was not formally implemented, and the study did not test the intervention, so the association may be influenced by other care factors.