Enhanced Recovery after Elective Colorectal Surgery - Reasons for Non-Compliance with the Protocol.

Details

Serval ID
serval:BIB_B73C33AA8F7E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Enhanced Recovery after Elective Colorectal Surgery - Reasons for Non-Compliance with the Protocol.
Journal
Digestive surgery
Author(s)
Roulin D., Muradbegovic M., Addor V., Blanc C., Demartines N., Hübner M.
ISSN
1421-9883 (Electronic)
ISSN-L
0253-4886
Publication state
Published
Issued date
2017
Peer-reviewed
Oui
Volume
34
Number
3
Pages
220-226
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Enhanced recovery after surgery (ERAS) protocols for elective colorectal surgery reduce the intensity of postoperative complications, hospital stays and costs. Improvements in clinical outcome are directly proportional to the adherence to the recommended pathway (compliance). The aim of the present study was to analyze reasons for the non-compliance of colorectal surgeries with the ERAS protocol.
A consecutive cohort of patients undergoing elective colorectal surgery was prospectively analyzed with regards to the surgery's compliance with the ERAS protocol. The reason for every single protocol deviation was documented and the decision was categorized based on whether it was medically justified or not.
During the 8-month study period, 76 patients were included. The overall compliance with 22 ERAS items was 76% (96% in the preoperative, 82% in the perioperative, and 63% in the postoperative period). The decision to deviate from the clinical pathway was mainly a medical decision, while patients and nurses were responsible in 26 and 14% of the cases, respectively. However, reasons for non-compliance were medically justified in 78% of the study participants.
'Non-compliance' with the ERAS protocol was observed mostly in the postoperative period. Most deviations from the pathway were decided by doctors and in a majority of cases it appeared that they were due to a medical necessity rather than non-compliance. However, almost a quarter of deviations that were absolutely required are still amenable to improvement.

Keywords
Adult, Aged, Clinical Decision-Making, Clinical Protocols, Digestive System Surgical Procedures, Early Ambulation/standards, Elective Surgical Procedures, Female, Guideline Adherence, Humans, Male, Middle Aged, Postoperative Care/standards, Preoperative Care/standards, Prospective Studies, Colorectal surgery, Compliance, Enhanced recovery
Pubmed
Web of science
Create date
22/12/2016 12:29
Last modification date
12/05/2020 17:08
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