Does adherence to perioperative enhanced recovery pathway elements influence patient-reported recovery following colorectal resection?

  • Nicolò Pecorelli
  • Saba Balvardi
  • A. Sender Liberman
  • Patrick Charlebois
  • Barry Stein
  • Franco Carli
  • Liane S. Feldman
  • Julio F. FioreJr.Email author
2018 SAGES Oral



Patient-reported outcome measures (PROMs) are pivotal to promote patient-centered perioperative care. Adherence to enhanced recovery programs (ERPs) is associated with improved clinical outcomes (i.e., morbidity, length of stay), but the impact of adherence on PROMs is uncertain. The objective of this study was to evaluate the extent to which adherence to an ERP for colorectal surgery is associated with postoperative recovery as assessed using PROMs.

Methods and procedures

100 patients were included [median age 63 (IQR 50–71) years, 81 laparoscopic, 37 rectal surgery]. Overall adherence to the ERP and adherence to specific ERP elements were analyzed. Adjusted linear regression was used to evaluate the association of adherence with PROMs assessing early recovery [Abdominal surgery impact scale (ASIS) and Multidimensional fatigue inventory (MFI) on POD2] and late recovery (Duke Activity Status Index, RAND-36 Physical and Mental Summary Scores, Life-Space Mobility Assessment at 4 weeks after surgery). Missing data were addressed using multiple imputations.


Median adherence to the ERP was 80% (16/20 elements, IQR 70–90%). Overall adherence was associated with ASIS scores on POD2 (4% increase per additional element, 95% CI 1–8%; p = 0.018). When specific ERP elements were analyzed, ASIS scores were associated with adherence to PONV prophylaxis (34% increase, 95% CI 5–63%; p = 0.023) and early solid food diet (20% increase, 95% CI 5–35%; p = 0.009). MFI General fatigue and MFI Mental fatigue scores on POD2 were associated with adherence to PONV prophylaxis (36% decrease, 95% CI − 64 to − 8%, p = 0.014 and 22% decrease, 95% CI − 44 to − 8%, p = 0.042). Overall adherence and adherence to specific elements were not associated with PROMs at 4 weeks after surgery.


Our findings suggest that, from the perspective of patients, adherence to an ERP for colorectal surgery impacts early, but not late postoperative recovery. This result may reflect the lack of PROMs able to validly measure postoperative recovery beyond hospital discharge.


Patient-reported outcome measures Postoperative recovery Enhanced recovery Outcome and process assessment (Health Care) Colorectal surgery 


Compliance with ethical standards


The Steinberg-Bernstein Centre for Minimally Invasive Surgery (McGill University Health Centre, Montreal, Canada) is supported by an unrestricted educational Grant from Medtronic. Nicolò Pecorelli, Saba Balvardi, A. Sender Liberman, Patrick Charlebois, Barry Stein, Franco Carli, Liane S. Feldman, Julio F. Fiore Jr have no conflicts of interests or financial ties to disclose.

Supplementary material

464_2019_6684_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nicolò Pecorelli
    • 1
    • 4
  • Saba Balvardi
    • 1
  • A. Sender Liberman
    • 2
  • Patrick Charlebois
    • 2
  • Barry Stein
    • 2
  • Franco Carli
    • 3
  • Liane S. Feldman
    • 1
    • 2
  • Julio F. FioreJr.
    • 1
    • 2
    Email author
  1. 1.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill University Health CentreMontrealCanada
  2. 2.Department of SurgeryMcGill University Health CentreMontrealCanada
  3. 3.Department of AnesthesiaMcGill University Health CentreMontrealCanada
  4. 4.Division of Pancreatic Surgery, Pancreas Translational & Clinical Research CenterSan Raffaele Scientific InstituteMilanItaly

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