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Compliance Assessment to Enhanced Recovery Protocols: A Three-Tier Donabedian Framework-Based Approach.

Monish Karunakaran^1,2, Emmanuel Melloul³, Hans D de Boer⁴

¹Department of Surgical Gastroenterology, HPB Surgery and Organ Transplantation, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India.

World Journal of Surgery

|July 9, 2026

Summary

This summary is machine-generated.

Enhanced recovery pathways in hepato-pancreato-biliary (HPB) surgery show benefits despite adherence challenges. Understanding compliance data is key to optimizing these perioperative care bundles for better patient outcomes.

Keywords:

compliance enhanced recovery pathways outcomes quality

Related Experiment Videos

Area of Science:

Perioperative Medicine
Surgical Outcomes
Healthcare Management

Background:

Enhanced recovery pathways (ERPs) are evidence-based perioperative care bundles proven to reduce hospitalization, morbidity, and costs.
Implementation of ERPs in hepato-pancreato-biliary (HPB) surgery faces challenges due to procedural complexity and difficulties in measuring adherence.
Despite low protocol compliance, ERPs may achieve intended outcomes through partial adoption of key elements or system-level effects.

Purpose of the Study:

To investigate the paradox of ERP effectiveness in HPB surgery despite adherence challenges.
To highlight the critical role of data availability and accurate adherence measurement in understanding ERP performance.
To differentiate between pathway failure, poor implementation, and justified deviations in HPB surgery outcomes.

Main Methods:

Review of existing literature on ERP implementation and outcomes in HPB surgery.
Analysis of factors influencing adherence measurement and interpretation.
Exploration of system-level factors potentially impacting ERP effectiveness.

Main Results:

ERPs can yield positive outcomes in HPB surgery even with suboptimal adherence.
Incomplete adherence measurement and system-level factors complicate outcome attribution.
Data gaps hinder the precise evaluation of ERP success or failure.

Conclusions:

Reliable data and accurate adherence metrics are essential for evaluating ERPs in HPB surgery.
Understanding adherence is crucial for refining ERPs and improving patient care.
Further research is needed to elucidate the mechanisms behind ERP success in complex surgical settings.