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
N1 - Funding Information:
Michael Grant receives salary support from the Agency for Healthcare Research and Quality (AHRQ; HHSP233201500020I) and he served on the execute board of the ERAS Cardiac Society. Gabriel Mena has an academic grant from Pacira Pharmaceuticals. Javier Ripolles-Melchor receives honoraria as a consultant for Edwards Lifesciences and Fresenius Kabi. All other authors have no competing interests.
Funding Information:
Michael Grant receives salary support from the Agency for Healthcare Research and Quality (AHRQ; HHSP233201500020I ) and he served on the execute board of the ERAS Cardiac Society. Gabriel Mena has an academic grant from Pacira Pharmaceuticals. Javier Ripolles-Melchor receives honoraria as a consultant for Edwards Lifesciences and Fresenius Kabi. All other authors have no competing interests.
Publisher Copyright:
© 2021 Elsevier Inc.
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
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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 -