BACKGROUND/AIMS: Enhanced recovery after surgery (ERAS) protocols for elective colorectal surgery reduce the intensity of postoperative complications, hospital stays and costs. Improvements in clinical outcome are directly proportional to the adherence to the recommended pathway (compliance). The aim of the present study was to analyze reasons for the non-compliance of colorectal surgeries with the ERAS protocol. METHODS: A consecutive cohort of patients undergoing elective colorectal surgery was prospectively analyzed with regards to the surgery's compliance with the ERAS protocol. The reason for every single protocol deviation was documented and the decision was categorized based on whether it was medically justified or not. RESULTS: During the 8-month study period, 76 patients were included. The overall compliance with 22 ERAS items was 76% (96% in the preoperative, 82% in the perioperative, and 63% in the postoperative period). The decision to deviate from the clinical pathway was mainly a medical decision, while patients and nurses were responsible in 26 and 14% of the cases, respectively. However, reasons for non-compliance were medically justified in 78% of the study participants. CONCLUSION: 'Non-compliance' with the ERAS protocol was observed mostly in the postoperative period. Most deviations from the pathway were decided by doctors and in a majority of cases it appeared that they were due to a medical necessity rather than non-compliance. However, almost a quarter of deviations that were absolutely required are still amenable to improvement.
BACKGROUND/AIMS: Enhanced recovery after surgery (ERAS) protocols for elective colorectal surgery reduce the intensity of postoperative complications, hospital stays and costs. Improvements in clinical outcome are directly proportional to the adherence to the recommended pathway (compliance). The aim of the present study was to analyze reasons for the non-compliance of colorectal surgeries with the ERAS protocol. METHODS: A consecutive cohort of patients undergoing elective colorectal surgery was prospectively analyzed with regards to the surgery's compliance with the ERAS protocol. The reason for every single protocol deviation was documented and the decision was categorized based on whether it was medically justified or not. RESULTS: During the 8-month study period, 76 patients were included. The overall compliance with 22 ERAS items was 76% (96% in the preoperative, 82% in the perioperative, and 63% in the postoperative period). The decision to deviate from the clinical pathway was mainly a medical decision, while patients and nurses were responsible in 26 and 14% of the cases, respectively. However, reasons for non-compliance were medically justified in 78% of the study participants. CONCLUSION: 'Non-compliance' with the ERAS protocol was observed mostly in the postoperative period. Most deviations from the pathway were decided by doctors and in a majority of cases it appeared that they were due to a medical necessity rather than non-compliance. However, almost a quarter of deviations that were absolutely required are still amenable to improvement.
Authors: Jonas Jurt; Juliette Slieker; Pierre Frauche; Valerie Addor; Josep Solà; Nicolas Demartines; Martin Hübner Journal: World J Surg Date: 2017-10 Impact factor: 3.352
Authors: Pietro Maria Lombardi; Michele Mazzola; Alessandro Giani; Sara Baleri; Marianna Maspero; Paolo De Martini; Monica Gualtierotti; Giovanni Ferrari Journal: Updates Surg Date: 2021-05-20
Authors: Julia R Berian; Kristen A Ban; Jason B Liu; Christine L Sullivan; Clifford Y Ko; Julie K M Thacker; Liane S Feldman Journal: JAMA Surg Date: 2018-04-01 Impact factor: 14.766
Authors: Michał Pędziwiatr; Judene Mavrikis; Jan Witowski; Alexandros Adamos; Piotr Major; Michał Nowakowski; Andrzej Budzyński Journal: Med Oncol Date: 2018-05-09 Impact factor: 3.064