Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study |
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| Affiliation: | 1. Dept of Anesthesiology, Complejo Asistencial Universitario de León, Spain;2. Dept of Anesthesiology, Complejo Asistencial de Segovia, Spain;3. Dep. General Surgery, Complejo Asistencial de Zamora, Spain;4. Dep. Anestesia and Critical Care, Complejo Asistencial de Zamora, Spain;5. Dept of Anaesthesiology and Perioperative Medicine, Complejo Asistencial de A Coruña, Spain;6. Dep. Anestehesiology, Complejo Asistencial Universitario de Salamanca, Spain;7. Dep. Surgery, Complejo Asistencial Universitario de Salamanca, Spain;8. Dep. Nursery, Complejo Asistencial Universitario de Salamanca, Spain;9. Dep. Anaesthesiology, Complejo Hospitalario de Navarra, Pamplona, Spain;10. Dep. Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain;11. Director Blood and Tissue Bank of Navarra, Complejo Hospitalario de Navarra, Pamplona, Spain;12. Nutrition and Endocrinology Department, Complejo Hospitalario de Navarra, Pamplona, Spain;13. Dep. Anesthesiology, Complejo Hospitalario de Toledo, Spain;14. Dep. General Surgery, Complejo Hospitalario y Universitario de Pontevedra, Spain;15. Dep Anestesia and Critical Care, Complejo Hospitalario y Universitario de Pontevedra, Spain;16. Dep. Colorectal Surgery, Fundación Hospital del Espíritu Santo; Santa Coloma de Gramanet, Spain;17. Dep. Anesthesia and Critical Care, Hospital 2 de Mayo, Barcelona, Spain;18. Dep.General and Digestive Surgery, Hospital 2 de Mayo, Barcelona, Spain;19. Dep. Anesthesiology, Hospital Clínic Universitat de Barcelona, Spain;20. Dep. General and Digestive Surgery, Hospital Clínic Universitat de Barcelona, Spain;21. Dep. Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain;22. Dep. Anesthesiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza;23. Manuela ELIA Dep.General and Digestive Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza;24. Dep. Anesthesiology, Hospital Clínico Universitario de Valencia, Spain;25. Dep. Anesthesiology, Hospital Clínico de Valladolid, Spain;26. Dep.General Surgery, Hospital Comarcal de Inca, Spain;27. Dep. Anesthesiology, Hospital Comarcal de Laredo, Spain;28. Dep. Anesthesiology, Hospital Comarcal de Vinaroz, Spain;29. Dep. Anesthesiology, Hospital Costa del Sol, Marbella, Spain;30. Dep. Surgery, Hospital de Alzira, Spain;31. Dep. Anesthesiology, Hospital Don Benito-Villanueva de la Serena, Spain;32. Dep. Surgery, Hospital de Galdacano-Usansolo, Spain;33. Dep. Anesthesiology, Hospital de Igualada, Spain;34. Dep. Surgery, Hospital de Igualada, Spain;35. Dep. Anesthesiology, Hospital de La Princesa, Madrid, Spain;36. Dep. Surgery, Hospital de La Princesa, Madrid, Spain;37. Dep. Surgery, Hospital de Manacor, Spain;38. Dep. Anesthesiology, Hospital de Manises, Spain;39. Dep. Anesthesiology, Hospital de Mérida, Spain;40. Dep. Anesthesiology, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain;41. Dep. Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain;42. Dep. Nursery, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain;43. Dep. Surgery, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain;44. Dep. Anesthesiology, Hospital de Viladecans, Spain;45. Dep. Surgery, Hospital de Viladecans, Spain;46. Dep. Anesthesiology, Hospital del Mar, Barcelona, Spain;47. Dep.General Surgery, Hospital General Mateu Orfilia, Menorca, Spain;48. Dep. Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain;49. Dep. General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain;50. Dep. Coloproctology, Hospital General Universitario José María Morales Messeguer, Murcia, Spain;51. Dep. General and Digestive Tract Surgery, Colorectal Surgery Unit, Hospital General Universitario de Alicante, Spain;52. Dep. Anesthesiology, Hospital General Universitario de Castellón, Spain;53. Dep. Anesthesiology, Hospital General Universitario de Ciudad Real, Spain;54. Dep. Anesthesiology, Hospital General Universitario de Elche, Spain;55. Dep. Anesthesiology, Hospital General Universitario de Valencia, Spain;56. Dep. Surgery, Hospital General de La Palma, Santa Cruz de Tenerife, Spain;57. Dep. Anesthesiology, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain;58. Dep. Surgery, Hospital Rafael Méndez, Lorca, Spain;59. Dep. Surgery, Hospital Reina Sofía, Murcia, Spain;60. Dep. Anesthesiology, Hospital Rey Juan Carlos, Móstoles, Spain;61. Dep. Surgery, Hospital Rey Juan Carlos, Móstoles, Spain;62. Dep. Anesthesia and Critical Care, Perioperative Medicine Research Group, Hospital Universitari i Politécnic La Fe, Valencia, Spain;63. Dep. Anesthesia and Critical Care, Hospital Universitari i Politécnic La Fe, Valencia, Spain;64. Dep. Surgery, Hospital Universitari Mútua Terrassa, Spain;65. Dep. Anesthesiology, Hospital Universitario 12 de Octubre, Madrid, Spain;66. Dep. Surgery, Hospital Universitario Arnau de Vilanova, Lleida, Spain;67. Dep. Anesthesiology, Hospital Universitario Arnau de Vilanova, Lleida, Spain;68. Dep of Endocrinology & Nutrition, Hospital Universitario Arnau de Vilanova, Lleida, Spain;69. Dep of Nursing, Hospital Universitario Arnau de Vilanova, Lleida, Spain;70. Dep. Anesthesiology, Hospital Universitario Central de Asturias, Oviedo, Spain;71. Dep. Anesthesiology, Hospital Universitario Fundación Alcorcón, Spain;72. Dep. Anesthesiology, Hospital Universitario de Álava, Spain;73. Dep. Anesthesiology, Hospital Universitario de Burgos, Spain;74. Dep. Anesthesiology, Hospital Universitario de Cruces, Baracaldo, Spain;75. Dep. Surgery, Hospital Universitario de Cruces, Baracaldo, Spain;76. Dep. Surgery, Hospital Universitario de Fuenlabrada, Spain;77. Dep. Anesthesiology, Hospital Universitario de Fuenlabrada, Spain;78. Dep. Anesthesiology, Hospital Universitario de Getafe, Spain;79. Hospital Universitario de Getafe, Spain;80. Dep. Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Spain;81. Dep. Anesthesiology, Hospital Universitario de Guadalajara, Spain;82. Dep. Surgery, Hospital Universitario de Guadalajara, Spain;83. Dep. Surgery, Hospital Universitario de Guadalajara, Spain;84. Dep. Anesthesiology, Hospital Universitario de Móstoles, Spain;85. Hospital Universitario de Móstoles, Spain;86. Dep. Surgery, Hospital Universitario de Torrejón, Spain;87. Dep. Anesthesiology, Hospital Universitario de Torrejón, Spain;88. Dep. Anesthesiology, Hospital Universitario de Vic, Spain;89. Dep. Surgery, Hospital Universitario de Vic, Spain;90. Dep. Surgery, Hospital Universitario de Vic, Spain;91. Dep. Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain;92. Dep. Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain;93. Dep. Nursey, Hospital Universitario Infanta Leonor, Madrid, Spain;94. Dep. Surgery, Hospital Universitario Insular de Gran Canaria, Spain;95. Dep. Anesthesiology, Hospital Universitario La Paz, Madrid, Spain;96. Dep. Anesthesiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain;97. Dep. Anesthesiology, Hospital Universitario Miguel Servet, Zaragoza, Spain;98. Dep. Anesthesiology, Hospital Universitario ParcTaulí, Sabadell, Spain;99. Dep. Anesthesiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain;100. Dep. Surgery, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain;101. Dep. Anesthesiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain;102. Dep. Anesthesiology, Hospital Universitario Puerta del Mar, Cádiz, Spain;103. Dep. Anesthesiology, Hospital Universitario Quirón Madrid, Spain;104. Dep. Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain;105. Dep. Anesthesiology, Hospital Universitario Río Hortega, Valladolid, Spain;106. Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain;107. Dep. Anesthesiology, Hospital Universitario Son Espases, Spain;108. Dep. Surgery, Hospital Universitario Son Espases, Spain;109. Dep. Anesthesiology, Hospital Universitario Valld´Hebrón, Barcelona, Spain;110. Hospital Universitario Virgen Macarena, Sevilla, Spain;111. Dep. Surgery, Hospital Universitario Virgen de Valme, Sevilla, Spain;112. Dep. Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain;113. Dep. Anesthesiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain;114. Dep. Anesthesiology, Hospital Virgen de los Lirios de Alcoy, Spain;115. Dep. Surgery, Hospital Virgen de los Lirios de Alcoy, Spain;116. Dep. Surgery, Hospital Virgen del Puerto, Plasencia, Spain;117. Dep. Anesthesiology, Hospital Virgen del Puerto, Plasencia, Spain;118. Dep. Anesthesiology, OSI Alto Deba, Spain;1. Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain;4. Department of Surgery, Lozano Blesa Clinic University Hospital, Zaragoza, Spain;5. Department of Anesthesiology, Vall d''Hebron University Hospital, Barcelona, Spain;6. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, USA |
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| Abstract: | IntroductionAdherence 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.MethodsA 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.ResultsThe 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.ConclusionAdherence 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. |
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