Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

Power Investigators Group (including all Researchers participating in POWER Study)

doi:10.1016/j.jclinane.2021.110378

Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

Power Investigators Group (including all Researchers participating in POWER Study)

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

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®) 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.

Original language	English (US)
Article number	110378
Journal	Journal of Clinical Anesthesia
Volume	74
DOIs	https://doi.org/10.1016/j.jclinane.2021.110378
State	Published - Nov 2021

Keywords

Anesthesiology
Colorectal surgery
Enhanced recovery after surgery
Guideline adherence
Perioperative medicine
Quality improvement

ASJC Scopus subject areas

Anesthesiology and Pain Medicine

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10.1016/j.jclinane.2021.110378

Cite this

@article{8897d112cb674904a515f57ad56d6aaf,

title = "Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study",

abstract = "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{\textregistered}) 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.",

keywords = "Anesthesiology, Colorectal surgery, Enhanced recovery after surgery, Guideline adherence, Perioperative medicine, Quality improvement",

author = "{Power Investigators Group (including all Researchers participating in POWER Study)} and Andres Zorrilla-Vaca and Stone, {Alexander B.} and Javier Ripolles-Melchor and Ane Abad-Motos and Ramirez-Rodriguez, {Jose M.} and Patricia Galan-Menendez and Mena, {Gabriel E.} and Grant, {Michael C.} and Cristina Garcia-Perez and Eva Higuera-M{\'i}guelez and Marcos-Vidal, {Jos{\'e} M.} and Mar{\'i}a Merino-Garc{\'i}a and Rubio-L{\'o}pez, {Ana B.} and Pascual-Diez, {Mar{\'i}a E.} and Garc{\'i}a-Miguel, {Francisco J.} and Cabezudo-Sanjose, {Luis R.} and Ruth Mart{\'i}nez-D{\'i}az and Sara Alegr{\'i}a-Rebollo and Gonz{\'a}lez-Rodr{\'i}guez, {Jos{\'e} L.} and Vega-Cruz, {Mar{\'i}a S.} and Gema Mart{\'i}nez-Rag{\"u}{\'e}s and G{\'o}mez-R{\'i}os, {Manuel A.} and Eva Mosquera-Rodr{\'i}guez and Sara Del-R{\'i}o-Regueira and Domingo Bustos-Garc{\'i}a and S{\'a}nchez-Conde, {Mar{\'i}a P.} and Antonio Rodr{\'i}guez-Calvo and Hern{\'a}ndez-Valero, {Mar{\'i}a A.} and Mar{\'i}a Angoso-Clavijo and Gonz{\'a}lez-Fern{\'a}ndez, {Luis M.} and Bravo-Ria{\~n}o, {Miguel A.} and Arnes-Mu{\~n}oz, {Mar{\'i}a V.} and Perez-Valdivieso, {Jos{\'e} R.} and Marta Martin-Vizcaino and Susana Hernandez-Garcia and Yoldi-Murillo, {Francisco J.} and Miguel Salvador-Bravo and Manuela Rubial-Alvarez and Fabiola Oteiza-Martinez and Enrique Balen-Rivera and Garcia-Erce, {Jos{\'e} A.} and Ana Zugasti-Murillo and Petrina-J{\'a}uregui, {Mar{\'i}a E.} and Filadelfo Bustos-Molina and Daniel Paz-Mart{\'i}n and B{\'a}rbara V{\'a}zquez-Vicente and Lourdes Gonz{\'a}lez-L{\'o}pez and Conrado M{\'i}nguez-Mar{\'i}n and Susana Diz-Jueguen and Jaime Seoane-Antelo",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2021",

month = nov,

doi = "10.1016/j.jclinane.2021.110378",

language = "English (US)",

volume = "74",

journal = "Journal of Clinical Anesthesia",

issn = "0952-8180",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery

T2 - Secondary analysis of a multicenter study

AU - Power Investigators Group (including all Researchers participating in POWER Study)

AU - Zorrilla-Vaca, Andres

AU - Stone, Alexander B.

AU - Ripolles-Melchor, Javier

AU - Abad-Motos, Ane

AU - Ramirez-Rodriguez, Jose M.

AU - Galan-Menendez, Patricia

AU - Mena, Gabriel E.

AU - Grant, Michael C.

AU - Garcia-Perez, Cristina

AU - Higuera-Míguelez, Eva

AU - Marcos-Vidal, José M.

AU - Merino-García, María

AU - Rubio-López, Ana B.

AU - Pascual-Diez, María E.

AU - García-Miguel, Francisco J.

AU - Cabezudo-Sanjose, Luis R.

AU - Martínez-Díaz, Ruth

AU - Alegría-Rebollo, Sara

AU - González-Rodríguez, José L.

AU - Vega-Cruz, María S.

AU - Martínez-Ragüés, Gema

AU - Gómez-Ríos, Manuel A.

AU - Mosquera-Rodríguez, Eva

AU - Del-Río-Regueira, Sara

AU - Bustos-García, Domingo

AU - Sánchez-Conde, María P.

AU - Rodríguez-Calvo, Antonio

AU - Hernández-Valero, María A.

AU - Angoso-Clavijo, María

AU - González-Fernández, Luis M.

AU - Bravo-Riaño, Miguel A.

AU - Arnes-Muñoz, María V.

AU - Perez-Valdivieso, José R.

AU - Martin-Vizcaino, Marta

AU - Hernandez-Garcia, Susana

AU - Yoldi-Murillo, Francisco J.

AU - Salvador-Bravo, Miguel

AU - Rubial-Alvarez, Manuela

AU - Oteiza-Martinez, Fabiola

AU - Balen-Rivera, Enrique

AU - Garcia-Erce, José A.

AU - Zugasti-Murillo, Ana

AU - Petrina-Jáuregui, María E.

AU - Bustos-Molina, Filadelfo

AU - Paz-Martín, Daniel

AU - Vázquez-Vicente, Bárbara

AU - González-López, Lourdes

AU - Mínguez-Marín, Conrado

AU - Diz-Jueguen, Susana

AU - Seoane-Antelo, Jaime

PY - 2021/11

Y1 - 2021/11

N2 - 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®) 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.

AB - 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®) 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.

KW - Anesthesiology

KW - Colorectal surgery

KW - Enhanced recovery after surgery

KW - Guideline adherence

KW - Perioperative medicine

KW - Quality improvement

UR - http://www.scopus.com/inward/record.url?scp=85107903302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85107903302&partnerID=8YFLogxK

U2 - 10.1016/j.jclinane.2021.110378

DO - 10.1016/j.jclinane.2021.110378

M3 - Article

C2 - 34144497

AN - SCOPUS:85107903302

SN - 0952-8180

VL - 74

JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

M1 - 110378

ER -

Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

Abstract

Keywords

ASJC Scopus subject areas

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