van Zelm Ruben, Coeckelberghs Ellen, Sermeus Walter, De Buck van Overstraeten Anthony, Weimann Arved, Seys Deborah, Panella Massimiliano, Vanhaecht Kris
Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.
European Pathway Association, Leuven, Belgium.
Int J Colorectal Dis. 2017 Oct;32(10):1471-1478. doi: 10.1007/s00384-017-2863-z. Epub 2017 Jul 17.
Surgical care for patients with colorectal cancer has become increasingly standardized. The Enhanced Recovery After Surgery (ERAS) protocol is a widely accepted structured care method to improve postoperative outcomes of patients after surgery. Despite growing evidence of effectiveness, adherence to the protocol remains challenging in practice. This study was designed to assess the adherence rate in daily practice and examine the relationship between the importance of interventions and adherence rate.
This international observational, cross-sectional multicenter study was performed in 12 hospitals in four European countries. Patients were included from January 1, 2014. Data was retrospectively collected from the patient record by the local study coordinator.
A total of 230 patients were included in the study. Protocol adherence was analyzed for both the individual interventions and on patient level. The interventions with the highest adherence were antibiotic prophylaxis (95%), thromboprophylaxis (87%), and measuring body weight at admission (87%). Interventions with the lowest adherence were early mobilization-walking and sitting (9 and 6%, respectively). The adherence ranged between 16 and 75%, with an average of 44%.
Our results show that the average protocol adherence in clinical practice is 44%. The variation on patient and hospital level is considerable. Only in one patient the adherence rate was >70%. In total, 30% of patients received 50% or more of the key interventions. A solid implementation strategy seems to be needed to improve the uptake of the ERAS pathway. The importance-performance matrix can help in prioritizing the areas for improvement.
结直肠癌患者的外科护理已日益标准化。术后加速康复（ERAS）方案是一种广泛接受的结构化护理方法，用于改善术后患者的预后。尽管有效性证据越来越多，但在实践中遵循该方案仍具有挑战性。本研究旨在评估日常实践中的遵循率，并探讨干预措施的重要性与遵循率之间的关系。
这项国际观察性横断面多中心研究在四个欧洲国家的12家医院进行。从2014年1月1日起纳入患者。当地研究协调员从患者记录中回顾性收集数据。
共有230名患者纳入研究。对个体干预措施和患者层面的方案遵循情况进行了分析。遵循率最高的干预措施是抗生素预防（95%）、血栓预防（87%）和入院时测量体重（87%）。遵循率最低的干预措施是早期活动——行走和坐立（分别为9%和6%）。遵循率在16%至75%之间，平均为44%。
我们的结果表明，临床实践中方案的平均遵循率为44%。患者和医院层面的差异相当大。只有一名患者的遵循率>70%。总体而言，30%的患者接受了50%或更多的关键干预措施。似乎需要一个坚实的实施策略来提高ERAS路径的采用率。重要性-绩效矩阵有助于确定改进领域的优先级。
