title: Enhanced Recovery after Elective Colorectal Surgery - Reasons for Non-Compliance with the Protocol.
abstract: OBJECTIVE
  Enhanced recovery after surgery (ERAS) protocols for elective colorectal surgery reduce the intensity of postoperative complications, hospital stays and costs. Improvements in clinical outcome are directly proportional to the adherence to the recommended pathway (compliance). The aim of the present study was to analyze reasons for the non-compliance of colorectal surgeries with the ERAS protocol.
  
  
  METHODS
  A consecutive cohort of patients undergoing elective colorectal surgery was prospectively analyzed with regards to the surgery's compliance with the ERAS protocol. The reason for every single protocol deviation was documented and the decision was categorized based on whether it was medically justified or not.
  
  
  RESULTS
  During the 8-month study period, 76 patients were included. The overall compliance with 22 ERAS items was 76% (96% in the preoperative, 82% in the perioperative, and 63% in the postoperative period). The decision to deviate from the clinical pathway was mainly a medical decision, while patients and nurses were responsible in 26 and 14% of the cases, respectively. However, reasons for non-compliance were medically justified in 78% of the study participants.
  
  
  CONCLUSIONS
  'Non-compliance' with the ERAS protocol was observed mostly in the postoperative period. Most deviations from the pathway were decided by doctors and in a majority of cases it appeared that they were due to a medical necessity rather than non-compliance. However, almost a quarter of deviations that were absolutely required are still amenable to improvement.
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Roulin
authors.forename: Mirza
authors.initials: M
authors.lastname: Muradbegovic
authors.forename: Valérie
authors.initials: V
authors.lastname: Addor
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures; D004434:Early Ambulation / Q000592:standards; D017558:Elective Surgical Procedures; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards*; D011300:Preoperative Care / Q000592:standards*; D011446:Prospective Studies
keywords: Colorectal surgery; Compliance; Enhanced recovery