Richard Hu, Juan Mata, MD, Nicolo Pecorelli, MD, Pepa Kaneva, MSc, Lawrence Lee, MD, PhD, Barry L. Stein, MD, A. Sender Liberman, MD, Patrick Charlebois, MD, Julio Flavio Fiore Junior, PhD, Liane Feldman, MD. McGill University
Introduction: Enhanced recovery programs (ERP) are perioperative evidence-based care bundles that improve morbidity and length of stay in colorectal surgery patients. However, adherence to ERP elements in the postoperative period remains low and may negatively affect outcomes. Much data have focused on process measures to improve adherence, but little is known regarding patient factors that may contribute to low adherence. The aim of this study was to identify patient-reported barriers to adherence to an ERP for elective colorectal surgery.
Methods: A secondary analysis was performed with data obtained from a randomized trial designed to study the effect of a mobile application device on adherence in 2016-17 at a single university-affiliated specialist referral centre. Adult patients who underwent elective colorectal surgery were included. Target discharge day was postoperative day (POD) 3. Grounded theory methodology was used to identify and categorize patients’ self-reported barriers to achieving ERP milestones on POD 1 and 2 for mobilization (time spent out of bed), ambulation (number of hallway laps walked in a day), gum chewing, breathing exercises and intake of liquids, nutritional drink and solid food. Patients were visited by an evaluator daily assessing adherence to each ERP element. If a goal was not reached, the patients were asked to provide explanations, which were then compiled.
Results: In the original study, 97 patients were randomized, with data from 93 patients available on POD1 and 62 available on POD2 (due to early discharges). Elements with the highest adherence across POD1 and 2 were breathing exercises (90% and 90%), solid food intake (83% and 65% respectively) and liquid intake (81% and 65%), while lower adherence was seen for mobilization (46% and 35%), ambulation (59% and 50%), nutritional drink intake (44% and 35%) and gum chewing (63% and 47%). Barriers to mobilization included patient preference (e.g “prefer the comfort of bed”, “didn’t feel like doing it”), pain, fatigue and nausea/vomiting. Barriers to adherence with nutritional drink were patient preference and nausea/vomiting, as well as non-patient dependent factors such as medical restrictions (i.e NG insertion, medical order) and the nutritional drink not being supplied. Patient preference and nausea/vomiting were reported as the most common barriers for gum chewing.
Conclusion: Self-reported barriers to postoperative ERP elements were identified in colorectal surgery patients. “Patient preference” was a common reason for non- adherence. This suggests that strategies to maximize patient engagement may be helpful in improving postoperative adherence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93957
Program Number: P341
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster