Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study - 12/10/21
Doi : 10.1016/j.jclinane.2021.110378
Andres Zorrilla-Vaca a, b, ⁎ 
, Alexander B. Stone b, Javier Ripolles-Melchor c, Ane Abad-Motos c, Jose M. Ramirez-Rodriguez d, Patricia Galan-Menendez e, Gabriel E. Mena a, Michael C. Grant f
The Spanish Perioperative Audit and Research Network (RedGERM)
, Alexander B. Stone b, Javier Ripolles-Melchor c, Ane Abad-Motos c, Jose M. Ramirez-Rodriguez d, Patricia Galan-Menendez e, Gabriel E. Mena a, Michael C. Grant fThe Spanish Perioperative Audit and Research Network (RedGERM)
Power Investigators Group (including all Researchers participating in POWER Study)
Cristina Garcia-Perez 1, Eva Higuera-Míguelez 1, José M. Marcos-Vidal 1, María Merino-García 1, Ana B. Rubio-López 1, María E. Pascual-Diez 1, Francisco J. García-Miguel 2, Luis R. Cabezudo-Sanjose 3, Ruth Martínez-Díaz 3, Sara Alegría-Rebollo 3, José L. González-Rodríguez 4, María S. Vega-Cruz 4, Gema Martínez-Ragüés 4, Manuel A. Gómez-Ríos 5, Eva Mosquera-Rodríguez 5, Sara Del-Río-Regueira 5, Domingo Bustos-García 6, María P. Sánchez-Conde 6, Antonio Rodríguez-Calvo 6, María A. Hernández-Valero 6, María Angoso-Clavijo 7, Luis M. González-Fernández 7, Miguel A. Bravo-Riaño 8, María V. Arnes-Muñoz 8, José R. Perez-Valdivieso 9, Marta Martin-Vizcaino 9, Susana Hernandez-Garcia 9, Francisco J. Yoldi-Murillo 9, Miguel Salvador-Bravo 9, Manuela Rubial-Alvarez 9, Fabiola Oteiza-Martinez 10, Enrique Balen-Rivera 10, José A. Garcia-Erce 11, Ana Zugasti-Murillo 12, María E. Petrina-Jáuregui 12, Filadelfo Bustos-Molina 13, Daniel Paz-Martín 13, Bárbara Vázquez-Vicente 13, Lourdes González-López 13, Conrado Mínguez-Marín 13, Susana Diz-Jueguen 14, Jaime Seoane-Antelo 14, Julio Ballinas-Miranda 14, Ester Carrera-Dacosta 14, Erica Barreiro-Domínguez 14, Alexandra Piñeiro-Teijeiro 14, Raquel Sanchez-Santos 14, Marina Varela-Duran 15, Pilar Diaz-Parada 15, Aránzazu Calero-Lillo 16, Manuel Ángel López-Lara 16, Salvador Muñoz-Collado 16, Juan Valverde-Sintas 16, Silvia Aznar-Puig 16, Daniel Troyano-Escribano 16, Sandra Marmaña-Mezquita 17, Jesús Fernanz-Antón 17, Lucia Catot-Alemany 18, Jaume Balust 19, Marta Ubré 19, Carlos Ferrando-Ortolá 19, Graciela Martínez-Pallí 19, Ainitze Ibarzabal 20, Antonio M. Lacy 20, Rubén Sánchez-Martín 21, Karina Martins-Cruz 21, Paula Pérez-Jiménez 21, Rubén Casans-Francés 22, Javier Longás 22, José M. Ramírez Rodríguez 23, Ana Mugarra-Llopis 24, Cristina Crisan 24, Estefanía Gracia-Ferrándiz 24, Esther Romero-Vargas 24, Marina Soro-Domingo 24, Rita Rodríguez-Jiménez 25, Blanca Prada-Martin 25, Henar Muñoz-Hernández 25, José I. Gómez Herrera 25, Sara Cocho-Crespo 25, Sandra Fernández-Caballero 25, Miguel Flores-Crespo 25, Andrea Vázquez-Fernández 25, Carlo Brugiotti 26, Estefanía Ollé-Sese 26, Carla R. Houghton-Acuña 27, Marta López-Doucil 27, Ernesto A. Tarazona-López 28, Iván BEL-Marcobal 28, Sonia González-Cogollor 28, Manuel Llácer-Pérez 29, Alberto Arias-Romano 29, María C. Arrabal-Taborda 29, Mercedes Caballero-Domínguez 29, Rafael García-López 29, Julio Ontoria-Muriel 29, Antonio Vivó-Blasco 29, Francisco J. Blanco 30, Enrique DEL-Cojo-Peces 31, Jose M. Tena-Guerrero 31, Aitor Landaluce-Olavarria 32, Izaskun Badiola 32, Marta Calvo 32, Unai DE-Andres 32, Vicente Portugal-Porras 32, Bakarne Ugarte-Sierra 32, Ana Pedregosa-Sanz 33, Laura Perelló-Cerdà 33, Yobanys Rodríguez-Téllez 33, Joanna Grössl-Meleán 33, Xavier Viñas-Truñén 34, Enrique Alday-Muñoz 35, Elena Bermejo-Marcos 36, Pedro A. Alonso-Casado 36, Francisco A. Gimeno-Calvo 36, Ana Rodriguez-Sánchez 36, Carmen Montes-López 36, Laura Álvarez-Llano 37, María J. FAS-Vicent 38, Juan M. Ortega-Monzó 38, Gustavo Flores-Flores 39, José L. Tristancho 39, Sandra Marmaña-Mezquita 40, Montserrat Bayo-Sans 40, María C. Deiros-Garcia 40, Jesús Fernanz-Antón 40, María L. GIL-Gómez 40, Lourdes Parra 40, Vanesa Tejedor-DE-LA-Fuente 40, Carlos Jericó-Alba 41, Núria Borrell-Brau 42, David Camacho-Martín 42, Jose L. Ortiz-DE-Zarate 43, Daniel López-Ruiz 44, Vicens Rodriguez-Bustamante 44, M. Martinez-Vilalta 45, Daniel Amoros-Ruiz 46, Marc Sadurni-Sarda 46, Fernando A.L.C.A.L.D.E. Matas 47, Hernán Giordano 47, Jose M. Perez Peña 48, Luis Olmedilla-Arnal 48, Pilar Benito-SAZ 48, Elena López-GIL 48, Adela Ruiz-Ortega 48, Sara Zapatero-García 48, Emilio DEL-Valle-García 49, Víctor Soria-Aledo 50, Carmen V. Pérez-Guarinos 50, Enrique Pellicer-Franco 50, Graciela Valero-Navarro 50, Mónica Mengual-Ballester 50, José Andrés García-Marín 50, Manuel Romero-Simó 51, Ibán Caravaca-García 51, Teresa Blasco-Segura 51, Carlos F. Campo-Betancourth 51, Rafael David Costa-Navarro 51, Laura Jordá-Sanz 52, María I. DE-Miguel-Cabrera 52, José M. España-Pamplona 52, Silvia GIL-Trujillo 53, Francisco J. Redondo-Calvo 53, Víctor Baladrón-Gónzalez 53, Remedios Moreno-Ballesteros 53, José L. Muñoz-Rodes 54, Elena Miranda 54, Marta Roselló-Chornet 55, Lourdes Alós-Zaragoza 55, Juan Catalá-Bauset 55, María A. Pallardo-López 55, Noemí Almenara-Almenara 55, Lorena Muñoz-Devesa 55, Benito Alcaide-Pardo 56, Pablo Gimeno-Fernández 57, José L. Gómez-Agraz 57, Carla Iglesias-Morales 57, Paola B. Ordoñez-Enireb 57, Ana M. Ríos-Villalba 57, Joselvy Rodríguez-Pinto 57, Sergio Sánchez-Cortés 57, María J. Montoya-Tabares 58, Vicente Ruiz 58, Francisco González-Sánchez 58, Víctor Soriano-Giménez 58, José M. Muñoz-Camarena 59, Jorge Benavides-Buleje 59, Juan C. Estupiñán-Jiménez 60, Irene Portero-Larragueta 60, David Alias 61, María J. Alberola-Estellés 62, Óscar Díaz-Cambronero 62, María S. Matoses-Jaén 62, María D. Ruiz-Boluda 63, Carlos Maristany-Bienert 64, José A. Pardo-López 64, Álvaro Ramiro-Ruiz 65, Pablo García 65, Arantza Martínez-DE-Guereñu 65, Belinda Montalbán 65, Claudia Olea 65, David Benguría 65, Javier Silva 65, Adriana Calderón 65, Jordi Escoll-Rufino 66, Carlos Cerdan-Santacruz 66, José E. Sierra-Grañón 66, María Rufas-Acín 66, Nuria Mestres-Petit 66, Ingrid C. Penagos-Saavedra 67, Cristina Moreno-Castilla 68, Jordi Riera-RIU 69, Ana Cuellar-Martínez 70, R.C. González-Álvarez 70, Míriam Sánchez-Merchante 71, Santiago García-DEL-Valle-Y-Manzano 71, Sara García-Zamorano 71, Natalia Gijón-Herreros 71, Patricia Robles-Ángel 71, Margarita Logroño-Ejea 72, Rodrigo Sanllorente-Sebastian 73, Maria C. Villalain-Perez 73, Mihaela Siclama-Stroe 73, Judith Benítez-Villar 73, Alberto Sánchez-Campos 74, Alberto Martínez-Ruiz 74, Patricia Alonso-Carnicero 75, Francisco J. DE-LA-Torre-González 76, Carolina Naranjo-Checa 76, Fernando Pereira-Pérez 76, Elena Ruiz-Ucar 76, Alfredo Rivera 76, Cristina GIL-Lapetra 77, Enrique Roca-Castillo 78, María L. Mariscal-Flores 78, Mario Morales-Cayuela 78, Irene Alonso-Ramos 78, Virginia Jiménez-Carneros 79, Lucas Casalduero-Garcia 79, Javier Jimenez-Miramón 79, L. José 79, Eva M. Nogués-Ramia 80, Yolanda Sosa-Quesada 80, Alonso Gómez 80, Laura M. Martínez-Meco-Ortiz 81, Mercedes Cabellos-Olivares 81, José R. Rodríguez-Fraile 81, María Labalde-Martínez 82, Ramos-Rodríguez 83, Beatriz Nacarino-Alcorta 84, Raquel Fernández-García 84, Borja DE-LA-Quintana-Gordon 84, Justyna Drewniak 85, Fátima Senra-L 85, Pablo Galindo-Jara 86, Ana B. Gallardo-Herrera 86, Cesar García-Llorente 86, Laura Colao-García 86, Luz-Divina Rellan-Álvarez 87, Miguel Miro-Murillo 87, Sahely-CLARET Flores-Risco 87, Jordi Serrat-Puyol 88, Adrian Medina-Gallardo 89, Yuhami Mitsahid-Curbelo-Peña 89, Orenzana 90, Ane Abad-Motos 91, Alfredo Abad-Gurumeta 91, Norma Aracil-Escoda 91, Eugenio Martínez-Hurtado 91, Beatriz Nozal-Mateo 91, Elena Sáez-Ruiz 91, Rut Salvachua-Fernández 91, Javier Ripollés-Melchor 91, María L. DE-Fuenmayor-Valera 92, Elena Sánchez 93, Begoña Toribio 93, Antonio Navarro-Sánchez 94, José López-Fernández 94, Dácil Montesdeoca-Cabrera 94, Francisco J. Alcalá-Serrano 94, Azahara Sancho-DE-Avila 95, Sofia Diaz-Carrasco 95, Almudena Martín-Martín 95, Alejandro Suarez-DE-LA-Rica 95, Rafael UÑA-Orejón 95, Emilio Maseda 95, Guillermo Tejón-Pérez 96, María V. Alfaro-Martínez 96, Marta Alonso-Fernández 96, María A. Álvarez-Cebrián 96, María J. Álvarez-DEL-Vayo-Rodríguez 96, Mariana Carrillo-Rivas 96, María Fernández-Rodríguez 96, Sonia Trabanco-Morán 96, José L. Rábago-Morán 96, Javier Martínez-Ubieto 97, Ana M. Pascual-Bellosta 97, Sonia M. Ortega-Lucea 97, Maria P. Santero-Ramirez 97, Maria V. Duque-Mallen 97, Cristian Aragon-Benedi 97, Andrea Vallejo-Tarrat 98, Carmen Colillas-Calvet 98, Maria J. Laso 98, Javier Martinez-Cabañero 98, Javier Hernández-Salván 99, Beatriz Ledesma-Muñoz 99, Carolina Ochoa-Osorio 99, Máximo Sanz-García 99, Begoña Herrero-Garrote 99, Alma Blázquez-Martin 100, Manuel Díez-Alonso 100, Pilar Hernández-Juara 100, José M. Muguerza-Huguet 100, Macarena Barbero-Mielgo 101, Belén SAN-Antonio-SAN-Román 101, Laura Alonso-Aguilar 101, Viktoria Molnar 101, María C. Delgado-Naviero 102, Encarnación Meléndez-Leal 102, Virginia Cavero-García 103, África Fernández-Sánchez 103, Daniela A. Cubek-Quevedo 103, Rocío D.Í.E.Z. Munar 103, Francisco J. Blázquez-Fernández-DE-LA Pradilla 103, Ana B. Serrano 104, Alberto Balvís 104, Alberto Berruezo 104, Elena Esparza 104, Inés D.E.L.A. HOZ 104, Ana Palavicini 104, Lucia Pereira 104, Ximena Vega 104, Judith Villahoz 104, Gema Villanueva 104, José I. Alonso-Fernández 105, César Aldecoa 105, Clara Bolaño-Pérez 105, Teresa Villán-González 105, Astrid Batalla 106, G. Azparren 106, M. Basttita 106, M. Felipe 106, L. Cueva 106, Marta Gine 106, A.M. Gómez-Caro 106, I. India 106, S. Piñol 106, Neus Esteve-Pérez 107, Carlos Mora-Fernández 107, Ana Ferrer-Robles 107, Juan J. Segura-Sampedro 108, Natalia Alonso-Hernández 108, Angels Camps-Cervantes 109, Ivette Chocrón-DA-Prat 109, Carolina C. Coronado-Silva 109, Héctor Duque-Santos 109, Elena Esclapez-Sempere 109, Patricia Galan-Menéndez 109, Silvia Matarín-Olmo 109, M.P. Tormos-Pérez 109, Laura Villarino-Villa 109, Héctor Bergés-Gutiérrez 110, Miguel Aisa-Gasca 110, Verónica Arbona-Camillero 110, José D. Bautista-González 110, Francisco J. Carballido-Pascual 110, Mercedes Gutiérrez-Moreno 110, Ana Muñoz-Durán 110, Jesús Cañete-Gómez 111, Esther Cáceres-Fabrega 111, José M. Lorente-Herce 111, Octavio Mulet-Zayas 111, Rocío Gómez-Pérez 112, Cristina Monje-Salazar 112, Luis Lobato-Bancalero 112, Carmelo Torres-Moreno 112, Elena Sanchez-Cárdenas 112, Juan J. Daza-González 112, Teresa Sanchez-Viguera 112, Antonio DEL-Fresno-Asensio 112, Laura Bermudez-Román 113, José L. Jover-Pinillos 114, Francisco J. Orts-Micó 115, Coral Cózar-Lozano 116, Olga Blasco-Delgado 116, Andrea Nonnemacher-SAN-Julián 116, José A. Pérez 116, Laura D.U.R.Á.N. Cruces 117, Pablo Renedo-Corcóstegui 118
1 Dept of Anesthesiology, Complejo Asistencial Universitario de León, Spain
2 Dept of Anesthesiology, Complejo Asistencial de Segovia, Spain
3 Dep. General Surgery, Complejo Asistencial de Zamora, Spain
4 Dep. Anestesia and Critical Care, Complejo Asistencial de Zamora, Spain
5 Dept of Anaesthesiology and Perioperative Medicine, Complejo Asistencial de A Coruña, Spain
6 Dep. Anestehesiology, Complejo Asistencial Universitario de Salamanca, Spain
7 Dep. Surgery, Complejo Asistencial Universitario de Salamanca, Spain
8 Dep. Nursery, Complejo Asistencial Universitario de Salamanca, Spain
9 Dep. Anaesthesiology, Complejo Hospitalario de Navarra, Pamplona, Spain
10 Dep. Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
11 Director Blood and Tissue Bank of Navarra, Complejo Hospitalario de Navarra, Pamplona, Spain
12 Nutrition and Endocrinology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
13 Dep. Anesthesiology, Complejo Hospitalario de Toledo, Spain
14 Dep. General Surgery, Complejo Hospitalario y Universitario de Pontevedra, Spain
15 Dep Anestesia and Critical Care, Complejo Hospitalario y Universitario de Pontevedra, Spain
16 Dep. Colorectal Surgery, Fundación Hospital del Espíritu Santo; Santa Coloma de Gramanet, Spain
17 Dep. Anesthesia and Critical Care, Hospital 2 de Mayo, Barcelona, Spain
18 Dep.General and Digestive Surgery, Hospital 2 de Mayo, Barcelona, Spain
19 Dep. Anesthesiology, Hospital Clínic Universitat de Barcelona, Spain
20 Dep. General and Digestive Surgery, Hospital Clínic Universitat de Barcelona, Spain
21 Dep. Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
22 Dep. Anesthesiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza
23 Manuela ELIA Dep.General and Digestive Surgery, Hospital Clínico Universitario Lozano Blesa, Zaragoza
24 Dep. Anesthesiology, Hospital Clínico Universitario de Valencia, Spain
25 Dep. Anesthesiology, Hospital Clínico de Valladolid, Spain
26 Dep.General Surgery, Hospital Comarcal de Inca, Spain
27 Dep. Anesthesiology, Hospital Comarcal de Laredo, Spain
28 Dep. Anesthesiology, Hospital Comarcal de Vinaroz, Spain
29 Dep. Anesthesiology, Hospital Costa del Sol, Marbella, Spain
30 Dep. Surgery, Hospital de Alzira, Spain
31 Dep. Anesthesiology, Hospital Don Benito-Villanueva de la Serena, Spain
32 Dep. Surgery, Hospital de Galdacano-Usansolo, Spain
33 Dep. Anesthesiology, Hospital de Igualada, Spain
34 Dep. Surgery, Hospital de Igualada, Spain
35 Dep. Anesthesiology, Hospital de La Princesa, Madrid, Spain
36 Dep. Surgery, Hospital de La Princesa, Madrid, Spain
37 Dep. Surgery, Hospital de Manacor, Spain
38 Dep. Anesthesiology, Hospital de Manises, Spain
39 Dep. Anesthesiology, Hospital de Mérida, Spain
40 Dep. Anesthesiology, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain
41 Dep. Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain
42 Dep. Nursery, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain
43 Dep. Surgery, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Spain
44 Dep. Anesthesiology, Hospital de Viladecans, Spain
45 Dep. Surgery, Hospital de Viladecans, Spain
46 Dep. Anesthesiology, Hospital del Mar, Barcelona, Spain
47 Dep.General Surgery, Hospital General Mateu Orfilia, Menorca, Spain
48 Dep. Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
49 Dep. General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
50 Dep. Coloproctology, Hospital General Universitario José María Morales Messeguer, Murcia, Spain
51 Dep. General and Digestive Tract Surgery, Colorectal Surgery Unit, Hospital General Universitario de Alicante, Spain
52 Dep. Anesthesiology, Hospital General Universitario de Castellón, Spain
53 Dep. Anesthesiology, Hospital General Universitario de Ciudad Real, Spain
54 Dep. Anesthesiology, Hospital General Universitario de Elche, Spain
55 Dep. Anesthesiology, Hospital General Universitario de Valencia, Spain
56 Dep. Surgery, Hospital General de La Palma, Santa Cruz de Tenerife, Spain
57 Dep. Anesthesiology, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
58 Dep. Surgery, Hospital Rafael Méndez, Lorca, Spain
59 Dep. Surgery, Hospital Reina Sofía, Murcia, Spain
60 Dep. Anesthesiology, Hospital Rey Juan Carlos, Móstoles, Spain
61 Dep. Surgery, Hospital Rey Juan Carlos, Móstoles, Spain
62 Dep. Anesthesia and Critical Care, Perioperative Medicine Research Group, Hospital Universitari i Politécnic La Fe, Valencia, Spain
63 Dep. Anesthesia and Critical Care, Hospital Universitari i Politécnic La Fe, Valencia, Spain
64 Dep. Surgery, Hospital Universitari Mútua Terrassa, Spain
65 Dep. Anesthesiology, Hospital Universitario 12 de Octubre, Madrid, Spain
66 Dep. Surgery, Hospital Universitario Arnau de Vilanova, Lleida, Spain
67 Dep. Anesthesiology, Hospital Universitario Arnau de Vilanova, Lleida, Spain
68 Dep of Endocrinology & Nutrition, Hospital Universitario Arnau de Vilanova, Lleida, Spain
69 Dep of Nursing, Hospital Universitario Arnau de Vilanova, Lleida, Spain
70 Dep. Anesthesiology, Hospital Universitario Central de Asturias, Oviedo, Spain
71 Dep. Anesthesiology, Hospital Universitario Fundación Alcorcón, Spain
72 Dep. Anesthesiology, Hospital Universitario de Álava, Spain
73 Dep. Anesthesiology, Hospital Universitario de Burgos, Spain
74 Dep. Anesthesiology, Hospital Universitario de Cruces, Baracaldo, Spain
75 Dep. Surgery, Hospital Universitario de Cruces, Baracaldo, Spain
76 Dep. Surgery, Hospital Universitario de Fuenlabrada, Spain
77 Dep. Anesthesiology, Hospital Universitario de Fuenlabrada, Spain
78 Dep. Anesthesiology, Hospital Universitario de Getafe, Spain
79 Hospital Universitario de Getafe, Spain
80 Dep. Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Spain
81 Dep. Anesthesiology, Hospital Universitario de Guadalajara, Spain
82 Dep. Surgery, Hospital Universitario de Guadalajara, Spain
83 Dep. Surgery, Hospital Universitario de Guadalajara, Spain
84 Dep. Anesthesiology, Hospital Universitario de Móstoles, Spain
85 Hospital Universitario de Móstoles, Spain
86 Dep. Surgery, Hospital Universitario de Torrejón, Spain
87 Dep. Anesthesiology, Hospital Universitario de Torrejón, Spain
88 Dep. Anesthesiology, Hospital Universitario de Vic, Spain
89 Dep. Surgery, Hospital Universitario de Vic, Spain
90 Dep. Surgery, Hospital Universitario de Vic, Spain
91 Dep. Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
92 Dep. Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
93 Dep. Nursey, Hospital Universitario Infanta Leonor, Madrid, Spain
94 Dep. Surgery, Hospital Universitario Insular de Gran Canaria, Spain
95 Dep. Anesthesiology, Hospital Universitario La Paz, Madrid, Spain
96 Dep. Anesthesiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
97 Dep. Anesthesiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
98 Dep. Anesthesiology, Hospital Universitario ParcTaulí, Sabadell, Spain
99 Dep. Anesthesiology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
100 Dep. Surgery, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
101 Dep. Anesthesiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
102 Dep. Anesthesiology, Hospital Universitario Puerta del Mar, Cádiz, Spain
103 Dep. Anesthesiology, Hospital Universitario Quirón Madrid, Spain
104 Dep. Anesthesiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
105 Dep. Anesthesiology, Hospital Universitario Río Hortega, Valladolid, Spain
106 Dep. Anesthesiology, Hospital Universitario Sant Pau, Barcelona, Spain
107 Dep. Anesthesiology, Hospital Universitario Son Espases, Spain
108 Dep. Surgery, Hospital Universitario Son Espases, Spain
109 Dep. Anesthesiology, Hospital Universitario Valld´Hebrón, Barcelona, Spain
110 Hospital Universitario Virgen Macarena, Sevilla, Spain
111 Dep. Surgery, Hospital Universitario Virgen de Valme, Sevilla, Spain
112 Dep. Surgery, Hospital Universitario Virgen de la Victoria, Málaga, Spain
113 Dep. Anesthesiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
114 Dep. Anesthesiology, Hospital Virgen de los Lirios de Alcoy, Spain
115 Dep. Surgery, Hospital Virgen de los Lirios de Alcoy, Spain
116 Dep. Surgery, Hospital Virgen del Puerto, Plasencia, Spain
117 Dep. Anesthesiology, Hospital Virgen del Puerto, Plasencia, Spain
118 Dep. Anesthesiology, OSI Alto Deba, Spain
a Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
b Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
c Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain
d Department of Surgery, Lozano Blesa Clinic University Hospital, Zaragoza, Spain
e Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
f Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, USA
⁎Corresponding author at: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 74 Francis St, Boston, MA, USA.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women's Hospital74 Francis StBostonMAUSA
Abstract |
Introduction |
Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.
Methods |
A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.
Results |
The median adherence to ERAS was 68.2% (IQR 59.1%–81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P < 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P < 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P < 0.01) were independently associated with greater adherence. Case volume (−2.38% per 4 cases weekly, 95%CI -3.03 to −1.74, P < 0.01) and number of anesthesia providers (−1.19% per 10 providers, 95%CI +2.23 to −8.18%, P < 0.01) were negatively associated with adherence.
Conclusion |
Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Qualitative research suggests that institutional factors may be influencing adherence with Enhanced Recovery Protocols. |
• | This multicenter study demonstrated that anesthesiology leadership, multidisciplinary meetings, and program duration are facilitators to ERP adherence. |
• | The number of anesthesiologists and case volume were potential barriers to adherence with ERP guidelines. |
• | Self-declared ERAS institutions should tailor quality improvement initiatives to specific program-level factors, particularly in settings with high case volume and large anesthesia staff sizes. |
Keywords : Guideline adherence, Enhanced recovery after surgery, Colorectal surgery, Anesthesiology, Perioperative medicine, Quality improvement
Plan
© 2021
Elsevier Inc. Tous droits réservés.
Vol 74
Article 110378- novembre 2021 Retour au numéro
Article précédent
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