Active and passive compliance in an enhanced recovery programme.

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Enhanced Recovery After Surgery (ERAS)

Background:

• Enhanced Recovery After Surgery (ERAS) is established in colorectal surgery, reducing length of stay (LOS) and morbidity.
• Uncertainty exists regarding which ERAS elements are essential for achieving benefits.
• ERAS elements may influence or reflect patient recovery, impacting outcomes.

Purpose of the Study:

• To investigate the association between ERAS protocol compliance and short-term surgical outcomes.
• To introduce and evaluate the concept of 'active compliance' versus 'passive compliance' in ERAS.

Main Methods:

• Prospective database analysis of 614 patients undergoing colorectal surgery within an ERAS program.
• Classification of ERAS elements into 'active' (patient participation required) and 'passive' (intervention delivered to patient).
• Analysis of short-term surgical outcomes in relation to ERAS protocol compliance.

Main Results:

• Higher compliance observed for passive ERAS elements compared to active elements.
• Poor active compliance, but not passive compliance, significantly associated with major morbidity.
• Active compliance was a stronger predictor of major morbidity and LOS than passive compliance.

Conclusions:

• Poor active compliance may serve as an early surrogate marker for post-operative morbidity.
• This highlights the clinical relevance of patient engagement in ERAS for timely diagnosis and intervention.
• Further independent validation of these findings is warranted.