A Provincial Assessment of the Barriers and Utilization of Enhanced Recovery After Colorectal Surgery

Jeremy E Springer; Aristithes G Doumouras; Sara Lethbridge; Shawn Forbes; Cagla Eskicioglu

doi:10.1016/j.jss.2018.10.047

A Provincial Assessment of the Barriers and Utilization of Enhanced Recovery After Colorectal Surgery

J Surg Res. 2019 Mar:235:521-528. doi: 10.1016/j.jss.2018.10.047. Epub 2018 Nov 26.

Authors

Jeremy E Springer¹, Aristithes G Doumouras¹, Sara Lethbridge¹, Shawn Forbes¹, Cagla Eskicioglu²

Affiliations

¹ Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
² Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: eskicio@mcmaster.ca.

PMID: 30691838
DOI: 10.1016/j.jss.2018.10.047

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols after colorectal surgery use several perioperative, intraoperative and postoperative interventions that decrease morbidity, length of stay, and improve patient satisfaction. ERAS is increasingly being considered standard of care; however, uptake of formalized protocols remains low. The objective is to characterize the provincial rates of ERAS utilization after colorectal surgery and identify barriers and limitations to ERAS implementation.

Methods: A total of 797 general surgeons were identified through the College of Physicians and Surgeons of Ontario. A survey identifying demographics, rates of ERAS utilization, and barriers to implementation was distributed. Logistic regression determined the effects of demographic and hospital covariates on ERAS utilization.

Results: A total of 235 general surgeons representing 84 Ontario hospitals participated (response rate 29.5%). Surgeons working in academic or large community hospitals represented the majority of the cohort (30.5% and 47.2%, respectively). Multivariable analysis showed no significant effect of surgeon demographics, years in practice, or training details on ERAS protocol utilization; however, practicing in small community hospitals (compared with large and academic hospitals) was significantly associated with not using ERAS protocols (odds ratio, 0.02; 95% confidence interval, 0-0.3; P = 0.005). Over 50% of respondents used ERAS principles but did not have a formal protocol. Barriers to implementing ERAS protocols included patient variability, lack of institutional and nursing support, and poor communication with the care team.

Conclusions: Small community hospitals are less likely to use formal ERAS protocols; however, most Ontario surgeons are using ERAS principles after colorectal surgery. Barriers to ERAS implementation are broad and the present study has provided a pragmatic solution to change.

Keywords: Colorectal surgery; ERAS; Fast-track surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Clinical Protocols*
Colorectal Surgery*
Female
Humans
Male
Middle Aged
Postoperative Care*
Surgeons / statistics & numerical data*
Surveys and Questionnaires