Table 2. Adherence to the ERP.
| ERP component | Assessment of adherence | Result n (%) |
n patients | |
|---|---|---|---|---|
| 1 | Preadmission counselling | ERP consultation | 83 (86.5) | 96 |
| 2 | Preoperative optimization | n.a. | n.a. | 96 |
| 3 | Preoperative bowel preparation | No mechanical bowel preparation in colonic surgery | 60 (98.4) | 611 |
| 4 | Preoperative fasting | n.a. | n.a. | 96 |
| Carbohydrate loading | Yes | 67 (69.8) | 96 | |
| 5 | Pre-anesthetic medication | No sedative or anxiolytic premedication | 88 (91.7) | 96 |
| 6 | Thromboprophylaxis | Yes | 95 (99.0) | 96 |
| 7 | Antimicrobial prophylaxis | Yes | 96 (100) | 96 |
| 8 | Standard anesthesia protocol | n.a. | ||
| 9 | PONV prophylaxis | In patients with PONV risk ≥ 20% | 89 (94.7) | 942 |
| 10 | Laparoscopy and modifications of surgical access | Planned laparoscopic operation | 81 (84.4) | 96 |
| 11 | Nasogastric tubes | No NGT after reversal of anesthesia | 92 (95.8) | 96 |
| 12 | Preventing intraoperative hypothermia | Yes | 84 (87.5) | 96 |
| 13 | Perioperative fluid management | Stop intravenous fluids ≤ POD 3 (provided removal of PCEA/PCIA)
|
52 (54.7) 37 (63.8)* |
953 58 |
| 14 | Drain peritoneal cavity | No abdominal drain in colonic surgery | 50 (82.0) | 611 |
| 15 | Urinary catheter | Removal urinary catheter per protocol: laparoscopic colon POD 1, open colon or rectum POD 3 (only after PCEA removal)
|
69 (77.5) 50 (87.7)* |
893,4,5 57 |
| 16 | Ileus prevention | n.a. | n.a. | 96 |
| 17 | Multimodal opioid sparing postop analgesia8 | PCEA in patients without coagulation disorders for whom open surgery was planned | 8 (88.9) | 96 |
| 18 | Early nutrition | Oral food POD 1 | 79 (84.9) | 937 |
| Oral food POD 2 | 83 (89.2) | 933,7 | ||
| Oral food POD 3 | 82 (90.1) | 913,7 | ||
| 19 | Postoperative glycemic control | Glucose day profile in patients with diabetes | 19 (95.0) | 208 |
| 20 | Early mobilization | Out of bed POD 1 | 78 (83.9) | 937 |
| Out of bed POD 2 | 87 (93.6) | 933,7 | ||
| Out of bed POD 3 | 90 (98.9) | 913,7 | ||
| Overall adherence, mean (± SD) | 87.9% (± 10.8) | |||
CD: Clavien-Dindo severity grade; ERP: enhanced recovery program; n: number; n.a.: adherence was not assessed; NGT: nasogastric tube; PCEA: patient controlled epidural analgesia; PCIA: patient controlled intravenous analgesia; POCs: postoperative complications; POD: postoperative day; PONV: postoperative nausea and vomiting; SD: standard deviation; excluded from the analysis:
1rectal surgery (n = 35),
2missing data (n = 2),
3deceased patient (n = 1),
4no urinary catheter (n = 3),
5permanent catheter (n = 3),
6open surgery planned (n = 15) in patients with coagulation disorders (n = 6),
7ICU admission on the POD considered,
8no diabetes (n = 76); 8all patients received paracetamol, restrictive use of NSAIDs due to age and comorbidities;
*this subgroup is not included in the calculation of the overall adherence