Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

“…Only 2 of 17 quantitative studies specified criteria of programme sustainability a priori, in both instances this was related to maintaining adherence only, 37 or adherence and outcomes, 37 at a level comparable to the early postimplementation period. The remaining quantitative studies reported adherence to pre, intra and postoperative ERAS elements (all or a combination of these) only (n/N = 3/15), 48,50,52 maintenance of outcomes only (n/N = 1/15), 43 or a combination of both adherence and outcomes (n/N = 11/15) 35,36,[38][39][40]42,44,45,47,49,51 as an indicator of sustainability. Similarly, the mixed methods grey literature evidence 53 reported a combination of both adherence and outcomes, without prespecifying what would determine success.…”

“…Of the 22 included studies, 12 (n/N = 4/4 qualitative, 8/17 quantitative, 0/1 mixed methods grey literature) reported determinants (i.e., barriers/ enablers) of sustainability. 33,34,36,37,41,44,[46][47][48][49][50]52 Determinants were reported using the Theoretical Domains Framework 55 to inform initial implementation but it was unclear whether this also guided their evaluation sustainability.…”

“…Resources were the most frequently identified determinant to sustainability of ERAS programmes (n/N = 9/12, 75%), 33,34,41,44,46,47,49,50,52 commonly resources such as investment in dedicated staff and infrastructure such as audit and reporting systems. This was followed equally by People involved 33,34,36,41,[47][48][49]52 and the Organisational setting 33,34,36,41,44,46,49,52 (n/N = 8/12, 67%). Determinants related to the External environment were least often identified (n/N = 3/12, 25%).…”

“…Strategies to support sustainability were reported by 17 of the included studies (n/N = 3/4 qualitative, 13/16 quantitative, 1/1 mixed methods grey literature). 33,[35][36][37][39][40][41][42][44][45][46][47][49][50][51][52][53] When categorised according to the EPOC Intervention Taxonomy 30 (Figure 3), these were most frequently related to Professional activities (n/ N = 16/17, 94%), 33,[35][36][37][39][40][41][42][44][45][46][47]49,[51][52][53] commonly education (n/ N = 12/16, 75%), 33,35,36,[39][40][41][42]45,46,[51][52][53] audit and feedback processes (n/N = 10/16, 63%), 33,37,…”

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

“…Certainly, implementation of ERAS protocols needs an initialgreat investment, but it is later associated with important costs reductions [46]. Successful implementation and adherence to ERAS protocols require a committed MDTand a powerful leadership to refine the protocol with the best and newest evidence-based literature [64]. Markar et al [13]showed that the knowledge and experience gained by the staff in the ERAS protocol is associated with a significant reduction in median LOS.Patients' engagementis also fundamentalto facilitate the compliance of ERAS protocols [63].Finally, continuous data evaluation with systematic audits is crucial to improve compliance and clinical outcomes [15,63] With the aim to optimize functional capacity prior to surgery, the concept ofprehabilitationemergedin recent years and is being considered as key component of ERAS programs.…”