Clinical outcome before and after the implementation of the ACERTO protocol.

OBJECTIVE To compare the postoperative clinical outcomes of patients undergoing cancer surgery in the Mato Grosso Cancer Hospital before and after implementation of the ACERTO protocol. METHODS We prospectively observed 271 patients during two periods: the first between April and May 2010 (n = 101) comprised patients undergoing conventional conducts (Phase 1) and the second from September to October 2010 (n = 171) formed by patients undergoing a new protocol of perioperative established by ACERTO (Phase 2). The variables examined were length of preoperative fasting, reintroduction of diet in the postoperative period, hydration volume and length of stay. RESULTS When comparing the two periods, in Phase 2 there was a decrease of approximately 50% in the time of preoperative fasting (14.7 [4-48] hours vs 7.2 [1-48] hours, p <0.001 ), a reduction of approximately 35% of the volume of intravenous fluids in the immediate postoperative period (p <0.001), 47% in the first postoperative day (p <0.001) and 28% at second PO (p = 0.04), with an overall reduction of 23% (p <0.001). There was no difference in length of postoperative hospital stay between the two phases (3.9 [0-51] vs. 3.2 [0-15] days, p = 0,52). However, in patients whose time of preoperative fasting was up to 5 hours, hospitalization time decreased by one day (3.8 [0-51] vs 2.5 [0-15] days, p = 0.03). CONCLUSION The adoption of ACERTO measures is feasible and safe in cancer patients. After implementation of the ACERTO protocol, there was reduction of intravenous fluids volume and, when the preoperative fasting was reduced, hospitalization time was shorter.