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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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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).

Author information

Author notes

  1. Ruben van Zelm and Ellen Coeckelberghs contributed equally

Authors and Affiliations

  1. Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium

    Ruben van Zelm, Ellen Coeckelberghs, Walter Sermeus, Deborah Seys, Massimiliano Panella & Kris Vanhaecht

  2. European Pathway Association, Leuven, Belgium

    Ruben van Zelm, Ellen Coeckelberghs, Walter Sermeus, Massimiliano Panella & Kris Vanhaecht

  3. Q-Consult zorg, Utrecht, The Netherlands

    Ruben van Zelm

  4. Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium

    Anthony De Buck van Overstraeten

  5. Department of General, Abdominal, and Oncological Surgery, Klinikum Skt George, Leipzig, Germany

    Arved Weimann

  6. Department of Translational Medicine, University of Eastern Piemonte (UPO), Novara, Italy

    Massimiliano Panella

  7. Department of Quality Management, University Hospitals Leuven, Leuven, Belgium

    Kris Vanhaecht

Authors
  1. Ruben van Zelm
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Corresponding author

Correspondence to Ruben van Zelm.

Ethics declarations

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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van Zelm, R., Coeckelberghs, E., Sermeus, W. et al. Variation in care for surgical patients with colorectal cancer: protocol adherence in 12 European hospitals. Int J Colorectal Dis 32, 1471–1478 (2017). https://doi.org/10.1007/s00384-017-2863-z

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  • DOI: https://doi.org/10.1007/s00384-017-2863-z

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