Juan Mata1, Julio F Fiore1,2, Nicolo Pecorelli1, Barry L Stein2, Sender Liberman2, Patrick Charlebois2, Liane S Feldman3,4. 1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada. 2. Department of Surgery, McGill University Health Centre, 1650 Cedar Ave, L9.309, Montreal, QC, H3G 1A4, Canada. 3. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada. liane.feldman@mcgill.ca. 4. Department of Surgery, McGill University Health Centre, 1650 Cedar Ave, L9.309, Montreal, QC, H3G 1A4, Canada. liane.feldman@mcgill.ca.
Abstract
INTRODUCTION: Enhanced recovery pathways (ERP) include a bundle of evidence-based preoperative, intraoperative, and postoperative interventions that together reduce morbidity and length of stay after colorectal surgery. Increased adherence with the bundle is associated with better postoperative outcomes, but adherence is lowest in the postoperative period. Identifying risk factors for lower adherence may help design quality improvement strategies. The aim of this study was to estimate the extent to which patient, procedural, and organizational factors predict adherence to postoperative ERP elements in laparoscopic colorectal surgery. METHODS: Patients in an institutional ERP registry undergoing elective laparoscopic colorectal surgery between 2012 and 2014 were analyzed. The ERP included 10 postoperative ERP elements classified into 2 groups: those requiring patient participation (PP, 5 elements, including nutritional intake and mobilization) and those provided by the clinical team (CT, 5 elements, including removal of catheters and type of analgesia). The impact of baseline and intraoperative factors on adherence was estimated using stepwise linear regression. RESULTS: A total of 223 patients were included (mean age 60, 48% male). Mean adherence was 79% to the PP bundle (range 65-93% for individual elements), and 82% for the CT bundle (range 68-98% for individual elements). The occurrence of nausea/vomiting in the first 24 h was associated with lower adherence to both bundles. In the PP bundle, patients who arrived at the ward after 6 p.m. had lower adherence. In the CT bundle, patients who had rectal resection had lower adherence while thoracic epidural was associated with higher adherence. CONCLUSIONS: With the exception of postoperative nausea and vomiting, predictors of adherence to ERP elements after colorectal surgery differed for elements requiring patient participation and those provided by the clinical team. Strategies to improve ERP adherence should target staff education and engagement of patients at risk for lower adherence.
INTRODUCTION: Enhanced recovery pathways (ERP) include a bundle of evidence-based preoperative, intraoperative, and postoperative interventions that together reduce morbidity and length of stay after colorectal surgery. Increased adherence with the bundle is associated with better postoperative outcomes, but adherence is lowest in the postoperative period. Identifying risk factors for lower adherence may help design quality improvement strategies. The aim of this study was to estimate the extent to which patient, procedural, and organizational factors predict adherence to postoperative ERP elements in laparoscopic colorectal surgery. METHODS:Patients in an institutional ERP registry undergoing elective laparoscopic colorectal surgery between 2012 and 2014 were analyzed. The ERP included 10 postoperative ERP elements classified into 2 groups: those requiring patient participation (PP, 5 elements, including nutritional intake and mobilization) and those provided by the clinical team (CT, 5 elements, including removal of catheters and type of analgesia). The impact of baseline and intraoperative factors on adherence was estimated using stepwise linear regression. RESULTS: A total of 223 patients were included (mean age 60, 48% male). Mean adherence was 79% to the PP bundle (range 65-93% for individual elements), and 82% for the CT bundle (range 68-98% for individual elements). The occurrence of nausea/vomiting in the first 24 h was associated with lower adherence to both bundles. In the PP bundle, patients who arrived at the ward after 6 p.m. had lower adherence. In the CT bundle, patients who had rectal resection had lower adherence while thoracic epidural was associated with higher adherence. CONCLUSIONS: With the exception of postoperative nausea and vomiting, predictors of adherence to ERP elements after colorectal surgery differed for elements requiring patient participation and those provided by the clinical team. Strategies to improve ERP adherence should target staff education and engagement of patients at risk for lower adherence.
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J Macfie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: Nicolò Pecorelli; Olivia Hershorn; Gabriele Baldini; Julio F Fiore; Barry L Stein; A Sender Liberman; Patrick Charlebois; Franco Carli; Liane S Feldman Journal: Surg Endosc Date: 2016-08-18 Impact factor: 4.584
Authors: Lawrence Lee; Juan Mata; Gabriela A Ghitulescu; Marylise Boutros; Patrick Charlebois; Barry Stein; A Sender Liberman; Gerald M Fried; Nancy Morin; Franco Carli; Eric Latimer; Liane S Feldman Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: Mike K Liang; Linda T Li; Andres Avellaneda; Jennifer M Moffett; Stephanie C Hicks; Samir S Awad Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766
Authors: Christopher C Thorn; Ian White; Jennie Burch; George Malietzis; Robin Kennedy; John T Jenkins Journal: Int J Colorectal Dis Date: 2016-04-26 Impact factor: 2.571
Authors: Juan Mata; Nicolò Pecorelli; Pepa Kaneva; Dan Moldoveanu; Alexandre Gosselin-Tardiff; Mohsen Alhashemi; Stephan Robitaille; Saba Balvardi; Lawrence Lee; Barry L Stein; Sender Liberman; Patrick Charlebois; Julio F Fiore; Liane S Feldman Journal: Surg Endosc Date: 2019-05-13 Impact factor: 4.584
Authors: Nicolò Pecorelli; Saba Balvardi; A Sender Liberman; Patrick Charlebois; Barry Stein; Franco Carli; Liane S Feldman; Julio F Fiore Journal: Surg Endosc Date: 2019-01-30 Impact factor: 4.584