Compliance with enhanced recovery programmes in elective colorectal surgery

Area of Science:

• Surgical Outcomes
• Evidence-Based Medicine
• Healthcare Implementation Science

Background:

• Enhanced Recovery After Surgery (ERAS) protocols face challenges in real-world implementation outside controlled clinical trials.
• This study audited ERAS protocol compliance in colorectal surgery patients and compared it to a prior clinical trial cohort.

Purpose of the Study:

• To evaluate compliance with an ERAS protocol in a non-trial setting.
• To compare ERAS protocol adherence between a clinical trial and a subsequent audit.
• To assess the impact of differing compliance levels on patient outcomes.

Main Methods:

• A case-note review of 100 consecutive colorectal surgery patients was conducted for the audit.
• Compliance data from the audit group was compared with data from 95 patients in a previous clinical trial.
• Key ERAS components assessed included preoperative carbohydrate loading, incision type, fluid/diet reintroduction, and postoperative analgesia.

Main Results:

• The audit group showed significantly lower compliance with preoperative oral carbohydrate loading, early fluid/diet reintroduction, and non-opiate postoperative analgesia compared to the trial group.
• While transverse incision use was also lower in the audit group, non-opiate analgesia use did not correlate with increased opiate use.
• No significant differences were observed in length of hospital stay, septic morbidity, or 30-day mortality between the audit and trial groups.

Conclusions:

• Adherence to certain ERAS protocol elements is reduced when implemented outside a clinical trial setting.
• Despite lower compliance in some areas, the ERAS protocol's impact on key patient outcomes remained largely consistent between the trial and audit phases.