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International Journal of Colorectal Disease

, Volume 32, Issue 10, pp 1471–1478 | Cite as

Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals

  • Ruben van ZelmEmail author
  • Ellen Coeckelberghs
  • Walter Sermeus
  • Anthony De Buck van Overstraeten
  • Arved Weimann
  • Deborah Seys
  • Massimiliano Panella
  • Kris Vanhaecht
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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%.

Conclusion

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.

Keywords

ERAS Colorectal surgery Care pathways Protocol adherence Importance-performance analysis 

Notes

Acknowledgements

Research made possible by an unconditional educational grant by Baxter SA, Baxter Belgium, Baxter France, Baxter Germany, and Baxter The Netherlands to the European Pathway Association. Baxter had no influence on the study. We would like to thank the teams in the participating hospitals for their commitment. The participating hospitals are as follows: Belgium: AZ Groeninge, Kortrijk (Dr. D. Devriendt/Mrs. K. Vandendriessche & Mrs. D. Verhelst), Institute Bordet, Brussels (Dr. G. Liberale), University Hospital Leuven (Dr. A. De Buck van Overstraeten/Mr. D. Michiels & Mr. K. Op de Beeck); France: American Hospital of Paris/Institute Hospitalier Franco-Britannique, Paris/Clinique Hartmann – Ambroise Parre, Paris (Dr. A. Toledano/Mr. P. Ihout); Germany: Kreisklinikum Ebersberg (Dr. D. Plecity), Städtischen Klinikum Frankfurt Höechst (Dr. M. Ferschke & Dr. J. Reusch), Klinikum St. Georg, Leipzig (Prof. Dr. A. Weimann/Dr. M. Braunert/Dr. M. Wobith); The Netherlands: Groene Hart Hospital, Gouda (Dr. L. Tseng/Mrs. J. Verkerk), Onze Lieve Vrouwe Hospital, Amsterdam (Mrs. H. Hiemstra), Wilhelmina Hospital Assen (Dr. W. Bleeker/Mrs. G. Boekeloo & Mrs. H. Bouwman).

Compliance with ethical standards

Ethical approval for this study was obtained with the ethical committee of the University Hospital Leuven (S57152 (ML11311)). Based on the study protocol, all hospitals provided written agreement of the local study coordinator and approval of the local ethical committee.

Funding

This study was funded with an unconditional educational grant by Baxter SA to the European Pathway Association. Baxter SA had no influence on the study.

Conflict of interest

AW has received lecturers’ honoraria from Baxter, B.Braun, Berlin-Chemie, Fresenius Gabi, Lilly, Medtronic, Nestlé, and Nutricia, and has received research grants from Baxter and Danone. The other authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Ruben van Zelm
    • 1
    • 2
    • 3
    Email author
  • Ellen Coeckelberghs
    • 1
    • 2
  • Walter Sermeus
    • 1
    • 2
  • Anthony De Buck van Overstraeten
    • 4
  • Arved Weimann
    • 5
  • Deborah Seys
    • 1
  • Massimiliano Panella
    • 1
    • 2
    • 6
  • Kris Vanhaecht
    • 1
    • 2
    • 7
  1. 1.Leuven Institute for Healthcare PolicyKU LeuvenLeuvenBelgium
  2. 2.European Pathway AssociationLeuvenBelgium
  3. 3.Q-Consult zorgUtrechtThe Netherlands
  4. 4.Department of Abdominal SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  5. 5.Department of General, Abdominal, and Oncological SurgeryKlinikum Skt GeorgeLeipzigGermany
  6. 6.Department of Translational MedicineUniversity of Eastern Piemonte (UPO)NovaraItaly
  7. 7.Department of Quality ManagementUniversity Hospitals LeuvenLeuvenBelgium

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