Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study
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...
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| Veröffentlicht in: | Journal of clinical anesthesia 2021-11, Vol.74, p.110378-110378, Article 110378 |
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| creator | Ripolles-Melchor, Javier Marcos-Vidal, José M. Perez-Valdivieso, José R. Hernandez-Garcia, Susana Salvador-Bravo, Miguel Oteiza-Martinez, Fabiola Garcia-Erce, José A. Vázquez-Vicente, Bárbara González-López, Lourdes Barreiro-Domínguez, Erica Piñeiro-Teijeiro, Alexandra Varela-Duran, Marina Calero-Lillo, Aránzazu Ferrando-Ortolá, Carlos Ramírez Rodríguez, José M. Crisan, Cristina Rodríguez-Jiménez, Rita Fernández-Caballero, Sandra Flores-Crespo, Miguel Brugiotti, Carlo López-Doucil, Marta BEL-Marcobal, Iván González-Cogollor, Sonia Caballero-Domínguez, Mercedes Vivó-Blasco, Antonio Calvo, Marta Gimeno-Calvo, Francisco A. Tejedor-DE-LA-Fuente, Vanesa Matas, Fernando A.L.C.A.L.D.E. Benito-SAZ, Pilar Pellicer-Franco, Enrique Romero-Simó, Manuel Blasco-Segura, Teresa Jordá-Sanz, Laura DE-Miguel-Cabrera, María I. Moreno-Ballesteros, Remedios Roselló-Chornet, Marta Almenara-Almenara, Noemí Gómez-Agraz, José L. Sánchez-Cortés, Sergio Ruiz, Vicente Soriano-Giménez, Víctor Muñoz-Camarena, José M. Benavides-Buleje, Jorge Portero-Larragueta, Irene Alias, David Ruiz-Boluda, María D. García, Pablo Silva, Javier Cerdan-Santacruz, Carlos Mestres-Petit, Nuria Moreno-Castilla, Cristina Robles-Ángel, Patricia Martínez-Ruiz, Alberto Ruiz-Ucar, Elena GIL-Lapetra, Cristina Mariscal-Flores, María L. Alonso-Ramos, Irene Jiménez-Carneros, Virginia José, L. Nogués-Ramia, Eva M. Gómez, Alonso Rodríguez-Fraile, José R. DE-LA-Quintana-Gordon, Borja Senra-L, Fátima Galindo-Jara, Pablo Serrat-Puyol, Jordi Abad-Motos, Ane Abad-Gurumeta, Alfredo Ripollés-Melchor, Javier DE-Fuenmayor-Valera, María L. López-Fernández, José Martín-Martín, Almudena Suarez-DE-LA-Rica, Alejandro UÑA-Orejón, Rafael Álvarez-DEL-Vayo-Rodríguez, María J. Fernández-Rodríguez, María Rábago-Morán, José L. Duque-Mallen, Maria V. Martinez-Cabañero, Javier Hernández-Salván, Javier Ledesma-Muñoz, Beatriz Berruezo, Alberto Vega, Ximena Villahoz, Judith Aldecoa, César Bolaño-Pérez, Clara Villán-González, Teresa Cueva, L. Gine, Marta India, I. Esteve-Pérez, Neus Matarín-Olmo, Silvia Tormos-Pérez, M.P. Villarino-Villa, Laura Lorente-Herce, José M. Monje-Salazar, Cristina Orts-Micó, Francisco J. Cruces, Laura D.U.R.Á.N. Renedo-Corcóstegui, Pablo |
| description | 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.
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.
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 |
| doi_str_mv | 10.1016/j.jclinane.2021.110378 |
| format | Article |
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Marcos-Vidal, José M. ; Perez-Valdivieso, José R. ; Hernandez-Garcia, Susana ; Salvador-Bravo, Miguel ; Oteiza-Martinez, Fabiola ; Garcia-Erce, José A. ; Vázquez-Vicente, Bárbara ; González-López, Lourdes ; Barreiro-Domínguez, Erica ; Piñeiro-Teijeiro, Alexandra ; Varela-Duran, Marina ; Calero-Lillo, Aránzazu ; Ferrando-Ortolá, Carlos ; Ramírez Rodríguez, José M. ; Crisan, Cristina ; Rodríguez-Jiménez, Rita ; Fernández-Caballero, Sandra ; Flores-Crespo, Miguel ; Brugiotti, Carlo ; López-Doucil, Marta ; BEL-Marcobal, Iván ; González-Cogollor, Sonia ; Caballero-Domínguez, Mercedes ; Vivó-Blasco, Antonio ; Calvo, Marta ; Gimeno-Calvo, Francisco A. ; Tejedor-DE-LA-Fuente, Vanesa ; Matas, Fernando A.L.C.A.L.D.E. ; Benito-SAZ, Pilar ; Pellicer-Franco, Enrique ; Romero-Simó, Manuel ; Blasco-Segura, Teresa ; Jordá-Sanz, Laura ; DE-Miguel-Cabrera, María I. ; Moreno-Ballesteros, Remedios ; Roselló-Chornet, Marta ; Almenara-Almenara, Noemí ; Gómez-Agraz, José L. ; Sánchez-Cortés, Sergio ; Ruiz, Vicente ; Soriano-Giménez, Víctor ; Muñoz-Camarena, José M. ; Benavides-Buleje, Jorge ; Portero-Larragueta, Irene ; Alias, David ; Ruiz-Boluda, María D. ; García, Pablo ; Silva, Javier ; Cerdan-Santacruz, Carlos ; Mestres-Petit, Nuria ; Moreno-Castilla, Cristina ; Robles-Ángel, Patricia ; Martínez-Ruiz, Alberto ; Ruiz-Ucar, Elena ; GIL-Lapetra, Cristina ; Mariscal-Flores, María L. ; Alonso-Ramos, Irene ; Jiménez-Carneros, Virginia ; José, L. ; Nogués-Ramia, Eva M. ; Gómez, Alonso ; Rodríguez-Fraile, José R. ; DE-LA-Quintana-Gordon, Borja ; Senra-L, Fátima ; Galindo-Jara, Pablo ; Serrat-Puyol, Jordi ; Abad-Motos, Ane ; Abad-Gurumeta, Alfredo ; Ripollés-Melchor, Javier ; DE-Fuenmayor-Valera, María L. ; López-Fernández, José ; Martín-Martín, Almudena ; Suarez-DE-LA-Rica, Alejandro ; UÑA-Orejón, Rafael ; Álvarez-DEL-Vayo-Rodríguez, María J. ; Fernández-Rodríguez, María ; Rábago-Morán, José L. ; Duque-Mallen, Maria V. ; Martinez-Cabañero, Javier ; Hernández-Salván, Javier ; Ledesma-Muñoz, Beatriz ; Berruezo, Alberto ; Vega, Ximena ; Villahoz, Judith ; Aldecoa, César ; Bolaño-Pérez, Clara ; Villán-González, Teresa ; Cueva, L. ; Gine, Marta ; India, I. ; Esteve-Pérez, Neus ; Matarín-Olmo, Silvia ; Tormos-Pérez, M.P. ; Villarino-Villa, Laura ; Lorente-Herce, José M. ; Monje-Salazar, Cristina ; Orts-Micó, Francisco J. ; Cruces, Laura D.U.R.Á.N. ; Renedo-Corcóstegui, Pablo</creator><creatorcontrib>Ripolles-Melchor, Javier ; Marcos-Vidal, José M. ; Perez-Valdivieso, José R. ; Hernandez-Garcia, Susana ; Salvador-Bravo, Miguel ; Oteiza-Martinez, Fabiola ; Garcia-Erce, José A. ; Vázquez-Vicente, Bárbara ; González-López, Lourdes ; Barreiro-Domínguez, Erica ; Piñeiro-Teijeiro, Alexandra ; Varela-Duran, Marina ; Calero-Lillo, Aránzazu ; Ferrando-Ortolá, Carlos ; Ramírez Rodríguez, José M. ; Crisan, Cristina ; Rodríguez-Jiménez, Rita ; Fernández-Caballero, Sandra ; Flores-Crespo, Miguel ; Brugiotti, Carlo ; López-Doucil, Marta ; BEL-Marcobal, Iván ; González-Cogollor, Sonia ; Caballero-Domínguez, Mercedes ; Vivó-Blasco, Antonio ; Calvo, Marta ; Gimeno-Calvo, Francisco A. ; Tejedor-DE-LA-Fuente, Vanesa ; Matas, Fernando A.L.C.A.L.D.E. ; Benito-SAZ, Pilar ; Pellicer-Franco, Enrique ; Romero-Simó, Manuel ; Blasco-Segura, Teresa ; Jordá-Sanz, Laura ; DE-Miguel-Cabrera, María I. ; Moreno-Ballesteros, Remedios ; Roselló-Chornet, Marta ; Almenara-Almenara, Noemí ; Gómez-Agraz, José L. ; Sánchez-Cortés, Sergio ; Ruiz, Vicente ; Soriano-Giménez, Víctor ; Muñoz-Camarena, José M. ; Benavides-Buleje, Jorge ; Portero-Larragueta, Irene ; Alias, David ; Ruiz-Boluda, María D. ; García, Pablo ; Silva, Javier ; Cerdan-Santacruz, Carlos ; Mestres-Petit, Nuria ; Moreno-Castilla, Cristina ; Robles-Ángel, Patricia ; Martínez-Ruiz, Alberto ; Ruiz-Ucar, Elena ; GIL-Lapetra, Cristina ; Mariscal-Flores, María L. ; Alonso-Ramos, Irene ; Jiménez-Carneros, Virginia ; José, L. ; Nogués-Ramia, Eva M. ; Gómez, Alonso ; Rodríguez-Fraile, José R. ; DE-LA-Quintana-Gordon, Borja ; Senra-L, Fátima ; Galindo-Jara, Pablo ; Serrat-Puyol, Jordi ; Abad-Motos, Ane ; Abad-Gurumeta, Alfredo ; Ripollés-Melchor, Javier ; DE-Fuenmayor-Valera, María L. ; López-Fernández, José ; Martín-Martín, Almudena ; Suarez-DE-LA-Rica, Alejandro ; UÑA-Orejón, Rafael ; Álvarez-DEL-Vayo-Rodríguez, María J. ; Fernández-Rodríguez, María ; Rábago-Morán, José L. ; Duque-Mallen, Maria V. ; Martinez-Cabañero, Javier ; Hernández-Salván, Javier ; Ledesma-Muñoz, Beatriz ; Berruezo, Alberto ; Vega, Ximena ; Villahoz, Judith ; Aldecoa, César ; Bolaño-Pérez, Clara ; Villán-González, Teresa ; Cueva, L. ; Gine, Marta ; India, I. ; Esteve-Pérez, Neus ; Matarín-Olmo, Silvia ; Tormos-Pérez, M.P. ; Villarino-Villa, Laura ; Lorente-Herce, José M. ; Monje-Salazar, Cristina ; Orts-Micó, Francisco J. ; Cruces, Laura D.U.R.Á.N. ; Renedo-Corcóstegui, Pablo ; Power Investigators Group (including all Researchers participating in POWER Study)</creatorcontrib><description>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.
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.
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.
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.
•Qualitative research suggests that institutional factors may be influencing adherence with Enhanced Recovery Protocols.•This multicenter study demonstrated that anesthesiology leadership, multidisciplinary meetings, and program duration are facilitators to ERP adherence.•The number of anesthesiologists and case volume were potential barriers to adherence with ERP guidelines.•Self-declared ERAS institutions should tailor quality improvement initiatives to specific program-level factors, particularly in settings with high case volume and large anesthesia staff sizes.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2021.110378</identifier><identifier>PMID: 34144497</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Anesthesia ; Anesthesiology ; Auditing procedures ; Colorectal Surgery ; Confidentiality ; Enhanced recovery after surgery ; Guideline adherence ; Humans ; Leadership ; Medical personnel ; Meetings ; Multicenter Studies as Topic ; Patient education ; Perioperative care ; Perioperative medicine ; Postoperative period ; Quality control ; Quality improvement ; Recovery (Medical) ; Regression analysis ; Spain ; Surgeons ; Teams</subject><ispartof>Journal of clinical anesthesia, 2021-11, Vol.74, p.110378-110378, Article 110378</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><rights>2021. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-4840637a2d353f8f0b1faadc65035d4f8eee9b2eadf93381c7858f91cb4d1ef53</citedby><cites>FETCH-LOGICAL-c396t-4840637a2d353f8f0b1faadc65035d4f8eee9b2eadf93381c7858f91cb4d1ef53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2580914075?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27926,27927,45997,64387,64389,64391,72471</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34144497$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ripolles-Melchor, Javier</creatorcontrib><creatorcontrib>Marcos-Vidal, José M.</creatorcontrib><creatorcontrib>Perez-Valdivieso, José R.</creatorcontrib><creatorcontrib>Hernandez-Garcia, Susana</creatorcontrib><creatorcontrib>Salvador-Bravo, Miguel</creatorcontrib><creatorcontrib>Oteiza-Martinez, Fabiola</creatorcontrib><creatorcontrib>Garcia-Erce, José A.</creatorcontrib><creatorcontrib>Vázquez-Vicente, Bárbara</creatorcontrib><creatorcontrib>González-López, Lourdes</creatorcontrib><creatorcontrib>Barreiro-Domínguez, Erica</creatorcontrib><creatorcontrib>Piñeiro-Teijeiro, Alexandra</creatorcontrib><creatorcontrib>Varela-Duran, Marina</creatorcontrib><creatorcontrib>Calero-Lillo, Aránzazu</creatorcontrib><creatorcontrib>Ferrando-Ortolá, Carlos</creatorcontrib><creatorcontrib>Ramírez Rodríguez, José M.</creatorcontrib><creatorcontrib>Crisan, Cristina</creatorcontrib><creatorcontrib>Rodríguez-Jiménez, Rita</creatorcontrib><creatorcontrib>Fernández-Caballero, Sandra</creatorcontrib><creatorcontrib>Flores-Crespo, Miguel</creatorcontrib><creatorcontrib>Brugiotti, Carlo</creatorcontrib><creatorcontrib>López-Doucil, Marta</creatorcontrib><creatorcontrib>BEL-Marcobal, Iván</creatorcontrib><creatorcontrib>González-Cogollor, Sonia</creatorcontrib><creatorcontrib>Caballero-Domínguez, Mercedes</creatorcontrib><creatorcontrib>Vivó-Blasco, Antonio</creatorcontrib><creatorcontrib>Calvo, Marta</creatorcontrib><creatorcontrib>Gimeno-Calvo, Francisco A.</creatorcontrib><creatorcontrib>Tejedor-DE-LA-Fuente, Vanesa</creatorcontrib><creatorcontrib>Matas, Fernando A.L.C.A.L.D.E.</creatorcontrib><creatorcontrib>Benito-SAZ, Pilar</creatorcontrib><creatorcontrib>Pellicer-Franco, Enrique</creatorcontrib><creatorcontrib>Romero-Simó, Manuel</creatorcontrib><creatorcontrib>Blasco-Segura, Teresa</creatorcontrib><creatorcontrib>Jordá-Sanz, Laura</creatorcontrib><creatorcontrib>DE-Miguel-Cabrera, María I.</creatorcontrib><creatorcontrib>Moreno-Ballesteros, Remedios</creatorcontrib><creatorcontrib>Roselló-Chornet, Marta</creatorcontrib><creatorcontrib>Almenara-Almenara, Noemí</creatorcontrib><creatorcontrib>Gómez-Agraz, José L.</creatorcontrib><creatorcontrib>Sánchez-Cortés, Sergio</creatorcontrib><creatorcontrib>Ruiz, Vicente</creatorcontrib><creatorcontrib>Soriano-Giménez, Víctor</creatorcontrib><creatorcontrib>Muñoz-Camarena, José M.</creatorcontrib><creatorcontrib>Benavides-Buleje, Jorge</creatorcontrib><creatorcontrib>Portero-Larragueta, Irene</creatorcontrib><creatorcontrib>Alias, David</creatorcontrib><creatorcontrib>Ruiz-Boluda, María D.</creatorcontrib><creatorcontrib>García, Pablo</creatorcontrib><creatorcontrib>Silva, Javier</creatorcontrib><creatorcontrib>Cerdan-Santacruz, Carlos</creatorcontrib><creatorcontrib>Mestres-Petit, Nuria</creatorcontrib><creatorcontrib>Moreno-Castilla, Cristina</creatorcontrib><creatorcontrib>Robles-Ángel, Patricia</creatorcontrib><creatorcontrib>Martínez-Ruiz, Alberto</creatorcontrib><creatorcontrib>Ruiz-Ucar, Elena</creatorcontrib><creatorcontrib>GIL-Lapetra, Cristina</creatorcontrib><creatorcontrib>Mariscal-Flores, María L.</creatorcontrib><creatorcontrib>Alonso-Ramos, Irene</creatorcontrib><creatorcontrib>Jiménez-Carneros, Virginia</creatorcontrib><creatorcontrib>José, L.</creatorcontrib><creatorcontrib>Nogués-Ramia, Eva M.</creatorcontrib><creatorcontrib>Gómez, Alonso</creatorcontrib><creatorcontrib>Rodríguez-Fraile, José R.</creatorcontrib><creatorcontrib>DE-LA-Quintana-Gordon, Borja</creatorcontrib><creatorcontrib>Senra-L, Fátima</creatorcontrib><creatorcontrib>Galindo-Jara, Pablo</creatorcontrib><creatorcontrib>Serrat-Puyol, Jordi</creatorcontrib><creatorcontrib>Abad-Motos, Ane</creatorcontrib><creatorcontrib>Abad-Gurumeta, Alfredo</creatorcontrib><creatorcontrib>Ripollés-Melchor, Javier</creatorcontrib><creatorcontrib>DE-Fuenmayor-Valera, María L.</creatorcontrib><creatorcontrib>López-Fernández, José</creatorcontrib><creatorcontrib>Martín-Martín, Almudena</creatorcontrib><creatorcontrib>Suarez-DE-LA-Rica, Alejandro</creatorcontrib><creatorcontrib>UÑA-Orejón, Rafael</creatorcontrib><creatorcontrib>Álvarez-DEL-Vayo-Rodríguez, María J.</creatorcontrib><creatorcontrib>Fernández-Rodríguez, María</creatorcontrib><creatorcontrib>Rábago-Morán, José L.</creatorcontrib><creatorcontrib>Duque-Mallen, Maria V.</creatorcontrib><creatorcontrib>Martinez-Cabañero, Javier</creatorcontrib><creatorcontrib>Hernández-Salván, Javier</creatorcontrib><creatorcontrib>Ledesma-Muñoz, Beatriz</creatorcontrib><creatorcontrib>Berruezo, Alberto</creatorcontrib><creatorcontrib>Vega, Ximena</creatorcontrib><creatorcontrib>Villahoz, Judith</creatorcontrib><creatorcontrib>Aldecoa, César</creatorcontrib><creatorcontrib>Bolaño-Pérez, Clara</creatorcontrib><creatorcontrib>Villán-González, Teresa</creatorcontrib><creatorcontrib>Cueva, L.</creatorcontrib><creatorcontrib>Gine, Marta</creatorcontrib><creatorcontrib>India, I.</creatorcontrib><creatorcontrib>Esteve-Pérez, Neus</creatorcontrib><creatorcontrib>Matarín-Olmo, Silvia</creatorcontrib><creatorcontrib>Tormos-Pérez, M.P.</creatorcontrib><creatorcontrib>Villarino-Villa, Laura</creatorcontrib><creatorcontrib>Lorente-Herce, José M.</creatorcontrib><creatorcontrib>Monje-Salazar, Cristina</creatorcontrib><creatorcontrib>Orts-Micó, Francisco J.</creatorcontrib><creatorcontrib>Cruces, Laura D.U.R.Á.N.</creatorcontrib><creatorcontrib>Renedo-Corcóstegui, Pablo</creatorcontrib><creatorcontrib>Power Investigators Group (including all Researchers participating in POWER Study)</creatorcontrib><title>Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>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.
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.
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.
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.
•Qualitative research suggests that institutional factors may be influencing adherence with Enhanced Recovery Protocols.•This multicenter study demonstrated that anesthesiology leadership, multidisciplinary meetings, and program duration are facilitators to ERP adherence.•The number of anesthesiologists and case volume were potential barriers to adherence with ERP guidelines.•Self-declared ERAS institutions should tailor quality improvement initiatives to specific program-level factors, particularly in settings with high case volume and large anesthesia staff sizes.</description><subject>Anesthesia</subject><subject>Anesthesiology</subject><subject>Auditing procedures</subject><subject>Colorectal Surgery</subject><subject>Confidentiality</subject><subject>Enhanced recovery after surgery</subject><subject>Guideline adherence</subject><subject>Humans</subject><subject>Leadership</subject><subject>Medical personnel</subject><subject>Meetings</subject><subject>Multicenter Studies as Topic</subject><subject>Patient education</subject><subject>Perioperative care</subject><subject>Perioperative medicine</subject><subject>Postoperative period</subject><subject>Quality control</subject><subject>Quality improvement</subject><subject>Recovery (Medical)</subject><subject>Regression 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D.U.R.Á.N.</creator><creator>Renedo-Corcóstegui, Pablo</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study</title><author>Ripolles-Melchor, Javier ; Marcos-Vidal, José M. ; Perez-Valdivieso, José R. ; Hernandez-Garcia, Susana ; Salvador-Bravo, Miguel ; Oteiza-Martinez, Fabiola ; Garcia-Erce, José A. ; Vázquez-Vicente, Bárbara ; González-López, Lourdes ; Barreiro-Domínguez, Erica ; Piñeiro-Teijeiro, Alexandra ; Varela-Duran, Marina ; Calero-Lillo, Aránzazu ; Ferrando-Ortolá, Carlos ; Ramírez Rodríguez, José M. ; Crisan, Cristina ; Rodríguez-Jiménez, Rita ; Fernández-Caballero, Sandra ; Flores-Crespo, Miguel ; Brugiotti, Carlo ; López-Doucil, Marta ; BEL-Marcobal, Iván ; González-Cogollor, Sonia ; Caballero-Domínguez, Mercedes ; Vivó-Blasco, Antonio ; Calvo, Marta ; Gimeno-Calvo, Francisco A. ; Tejedor-DE-LA-Fuente, Vanesa ; Matas, Fernando A.L.C.A.L.D.E. ; Benito-SAZ, Pilar ; Pellicer-Franco, Enrique ; Romero-Simó, Manuel ; Blasco-Segura, Teresa ; Jordá-Sanz, Laura ; DE-Miguel-Cabrera, María I. ; Moreno-Ballesteros, Remedios ; Roselló-Chornet, Marta ; Almenara-Almenara, Noemí ; Gómez-Agraz, José L. ; Sánchez-Cortés, Sergio ; Ruiz, Vicente ; Soriano-Giménez, Víctor ; Muñoz-Camarena, José M. ; Benavides-Buleje, Jorge ; Portero-Larragueta, Irene ; Alias, David ; Ruiz-Boluda, María D. ; García, Pablo ; Silva, Javier ; Cerdan-Santacruz, Carlos ; Mestres-Petit, Nuria ; Moreno-Castilla, Cristina ; Robles-Ángel, Patricia ; Martínez-Ruiz, Alberto ; Ruiz-Ucar, Elena ; GIL-Lapetra, Cristina ; Mariscal-Flores, María L. ; Alonso-Ramos, Irene ; Jiménez-Carneros, Virginia ; José, L. ; Nogués-Ramia, Eva M. ; Gómez, Alonso ; Rodríguez-Fraile, José R. ; DE-LA-Quintana-Gordon, Borja ; Senra-L, Fátima ; Galindo-Jara, Pablo ; Serrat-Puyol, Jordi ; Abad-Motos, Ane ; Abad-Gurumeta, Alfredo ; Ripollés-Melchor, Javier ; DE-Fuenmayor-Valera, María L. ; López-Fernández, José ; Martín-Martín, Almudena ; Suarez-DE-LA-Rica, Alejandro ; UÑA-Orejón, Rafael ; Álvarez-DEL-Vayo-Rodríguez, María J. ; Fernández-Rodríguez, María ; Rábago-Morán, José L. ; Duque-Mallen, Maria V. ; Martinez-Cabañero, Javier ; Hernández-Salván, Javier ; Ledesma-Muñoz, Beatriz ; Berruezo, Alberto ; Vega, Ximena ; Villahoz, Judith ; Aldecoa, César ; Bolaño-Pérez, Clara ; Villán-González, Teresa ; Cueva, L. ; Gine, Marta ; India, I. ; Esteve-Pérez, Neus ; Matarín-Olmo, Silvia ; Tormos-Pérez, M.P. ; Villarino-Villa, Laura ; Lorente-Herce, José M. ; Monje-Salazar, Cristina ; Orts-Micó, Francisco J. ; Cruces, Laura D.U.R.Á.N. ; Renedo-Corcóstegui, Pablo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-4840637a2d353f8f0b1faadc65035d4f8eee9b2eadf93381c7858f91cb4d1ef53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anesthesia</topic><topic>Anesthesiology</topic><topic>Auditing procedures</topic><topic>Colorectal Surgery</topic><topic>Confidentiality</topic><topic>Enhanced recovery after 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J.</creatorcontrib><creatorcontrib>Cruces, Laura D.U.R.Á.N.</creatorcontrib><creatorcontrib>Renedo-Corcóstegui, Pablo</creatorcontrib><creatorcontrib>Power Investigators Group (including all Researchers participating in POWER Study)</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni 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(DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ripolles-Melchor, Javier</au><au>Marcos-Vidal, José M.</au><au>Perez-Valdivieso, José R.</au><au>Hernandez-Garcia, Susana</au><au>Salvador-Bravo, Miguel</au><au>Oteiza-Martinez, Fabiola</au><au>Garcia-Erce, José A.</au><au>Vázquez-Vicente, Bárbara</au><au>González-López, Lourdes</au><au>Barreiro-Domínguez, Erica</au><au>Piñeiro-Teijeiro, Alexandra</au><au>Varela-Duran, Marina</au><au>Calero-Lillo, Aránzazu</au><au>Ferrando-Ortolá, Carlos</au><au>Ramírez Rodríguez, José M.</au><au>Crisan, Cristina</au><au>Rodríguez-Jiménez, Rita</au><au>Fernández-Caballero, Sandra</au><au>Flores-Crespo, Miguel</au><au>Brugiotti, Carlo</au><au>López-Doucil, Marta</au><au>BEL-Marcobal, Iván</au><au>González-Cogollor, Sonia</au><au>Caballero-Domínguez, Mercedes</au><au>Vivó-Blasco, Antonio</au><au>Calvo, Marta</au><au>Gimeno-Calvo, Francisco A.</au><au>Tejedor-DE-LA-Fuente, Vanesa</au><au>Matas, Fernando A.L.C.A.L.D.E.</au><au>Benito-SAZ, Pilar</au><au>Pellicer-Franco, Enrique</au><au>Romero-Simó, Manuel</au><au>Blasco-Segura, Teresa</au><au>Jordá-Sanz, Laura</au><au>DE-Miguel-Cabrera, María I.</au><au>Moreno-Ballesteros, Remedios</au><au>Roselló-Chornet, Marta</au><au>Almenara-Almenara, Noemí</au><au>Gómez-Agraz, José L.</au><au>Sánchez-Cortés, Sergio</au><au>Ruiz, Vicente</au><au>Soriano-Giménez, Víctor</au><au>Muñoz-Camarena, José M.</au><au>Benavides-Buleje, Jorge</au><au>Portero-Larragueta, Irene</au><au>Alias, David</au><au>Ruiz-Boluda, María D.</au><au>García, Pablo</au><au>Silva, Javier</au><au>Cerdan-Santacruz, Carlos</au><au>Mestres-Petit, Nuria</au><au>Moreno-Castilla, Cristina</au><au>Robles-Ángel, Patricia</au><au>Martínez-Ruiz, Alberto</au><au>Ruiz-Ucar, Elena</au><au>GIL-Lapetra, Cristina</au><au>Mariscal-Flores, María L.</au><au>Alonso-Ramos, Irene</au><au>Jiménez-Carneros, Virginia</au><au>José, L.</au><au>Nogués-Ramia, Eva M.</au><au>Gómez, Alonso</au><au>Rodríguez-Fraile, José R.</au><au>DE-LA-Quintana-Gordon, Borja</au><au>Senra-L, Fátima</au><au>Galindo-Jara, Pablo</au><au>Serrat-Puyol, Jordi</au><au>Abad-Motos, Ane</au><au>Abad-Gurumeta, Alfredo</au><au>Ripollés-Melchor, Javier</au><au>DE-Fuenmayor-Valera, María L.</au><au>López-Fernández, José</au><au>Martín-Martín, Almudena</au><au>Suarez-DE-LA-Rica, Alejandro</au><au>UÑA-Orejón, Rafael</au><au>Álvarez-DEL-Vayo-Rodríguez, María J.</au><au>Fernández-Rodríguez, María</au><au>Rábago-Morán, José L.</au><au>Duque-Mallen, Maria V.</au><au>Martinez-Cabañero, Javier</au><au>Hernández-Salván, Javier</au><au>Ledesma-Muñoz, Beatriz</au><au>Berruezo, Alberto</au><au>Vega, Ximena</au><au>Villahoz, Judith</au><au>Aldecoa, César</au><au>Bolaño-Pérez, Clara</au><au>Villán-González, Teresa</au><au>Cueva, L.</au><au>Gine, Marta</au><au>India, I.</au><au>Esteve-Pérez, Neus</au><au>Matarín-Olmo, Silvia</au><au>Tormos-Pérez, M.P.</au><au>Villarino-Villa, Laura</au><au>Lorente-Herce, José M.</au><au>Monje-Salazar, Cristina</au><au>Orts-Micó, Francisco J.</au><au>Cruces, Laura D.U.R.Á.N.</au><au>Renedo-Corcóstegui, Pablo</au><aucorp>Power Investigators Group (including all Researchers participating in POWER Study)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2021-11</date><risdate>2021</risdate><volume>74</volume><spage>110378</spage><epage>110378</epage><pages>110378-110378</pages><artnum>110378</artnum><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>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.
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.
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.
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.
•Qualitative research suggests that institutional factors may be influencing adherence with Enhanced Recovery Protocols.•This multicenter study demonstrated that anesthesiology leadership, multidisciplinary meetings, and program duration are facilitators to ERP adherence.•The number of anesthesiologists and case volume were potential barriers to adherence with ERP guidelines.•Self-declared ERAS institutions should tailor quality improvement initiatives to specific program-level factors, particularly in settings with high case volume and large anesthesia staff sizes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34144497</pmid><doi>10.1016/j.jclinane.2021.110378</doi><tpages>1</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0952-8180 |
| ispartof | Journal of clinical anesthesia, 2021-11, Vol.74, p.110378-110378, Article 110378 |
| issn | 0952-8180 1873-4529 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2543446986 |
| source | MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland |
| subjects | Anesthesia Anesthesiology Auditing procedures Colorectal Surgery Confidentiality Enhanced recovery after surgery Guideline adherence Humans Leadership Medical personnel Meetings Multicenter Studies as Topic Patient education Perioperative care Perioperative medicine Postoperative period Quality control Quality improvement Recovery (Medical) Regression analysis Spain Surgeons Teams |
| title | Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study |
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