Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study
Por:
Zorrilla-Vaca, A, Stone, AB, Ripolles-Melchor, J, Abad-Motos, A, Ramirez-Rodriguez, JM, Galan-Menendez, P, Mena, GE, Grant, MC, Batalla A., Azparren G., Bastitta M., Felipe M., Cueva L., Gine M., Gómez-Caro A.M., India I., Piñol S., Renedo Corcóstegui, Pablo
Publicada:
1 nov 2021
Ahead of Print:
1 jun 2021
Resumen:
Introduction: Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.
Methods: A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS (R)) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.
Results: The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P < 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P < 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P < 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI-3.03 to -1.74, P < 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P < 0.01) were negatively associated with adherence.
Conclusion: Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.
Filiaciones:
Zorrilla-Vaca, A:
Univ Texas MD Anderson Canc Ctr, Dept Anesthesiol & Perioperat Med, Houston, TX 77030 USA
Brigham & Womens Hosp, Dept Anesthesiol Perioperat & Pain Med, 75 Francis St, Boston, MA 02115 USA
Stone, AB:
Brigham & Womens Hosp, Dept Anesthesiol Perioperat & Pain Med, 75 Francis St, Boston, MA 02115 USA
Ripolles-Melchor, J:
Infanta Leonor Univ Hosp, Dept Anesthesia & Crit Care, Madrid, Spain
Abad-Motos, A:
Infanta Leonor Univ Hosp, Dept Anesthesia & Crit Care, Madrid, Spain
Ramirez-Rodriguez, JM:
Lozano Blesa Clin Univ Hosp, Dept Surg, Zaragoza, Spain
Galan-Menendez, P:
Vall dHebron Univ Hosp, Dept Anesthesiol, Barcelona, Spain
Mena, GE:
Univ Texas MD Anderson Canc Ctr, Dept Anesthesiol & Perioperat Med, Houston, TX 77030 USA
Grant, MC:
Johns Hopkins Univ Hosp, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21287 USA
Batalla A.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Azparren G.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Bastitta M.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Felipe M.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Cueva L.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Gine M.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Gómez-Caro A.M.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
India I.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Piñol S.:
Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
Renedo Corcóstegui, Pablo:
Dep. Anesthesiology, OSI Alto Deba
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