eP436 - Identifying Populations at Risk for Non-Adherence to ERAS Protocols in the Colorectal Surgical Setting

Sunday, June 2, 2024

1:57 PM – 2:02 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Samuel A. Younan, MD

Colorectal Research Fellow
Department of Colorectal Surgery at Vanderbilt University Medical Center
Vanderbilt University Medical Center
Brentwood, TN, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Michael Benjamin Hopkins, MD

Associate Professor of Surgery, Clinical Director Colon & Rectal Surgery
Vanderbilt University Medical Center
Vanderbilt University Medical Center
Nashville, Tennessee, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

Alexander Hawkins, MD, MPH

Associate Professor of Surgery
Vanderbilt University Medical Center
VIMC
Nashville, Tennessee, United States

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This individual has no financial relationships with ineligible companies.
Andrea Fa, MD

Resident Physician
Lsu
VUMC
New Orleans, LA, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.
PE

Parker Evans, MD

General Surgery Resident
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.
Aimal Khan, MD, FACS

Assistant Professor
Vanderbilt University Medical Center
Vanderbilt University Medical Center
NASHVILLE, TN, United States

Disclosure information not submitted.
FY

Fei Ye, PhD, MSPH

Professor of Biostatistics
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure information not submitted.

Purpose/Background: The efficacy of Enhanced Recovery After Surgery (ERAS) pathways has been extensively studied with results demonstrating significant improvements in post-operative outcomes. However, most studies have focused on in-hospital aspects of the ERAS pathway that are easier to control and track, neglecting pre-hospital components that are difficult to evaluate due to subjectivity and lack of patient reporting. This study utilizes institutional ERAS pathway compliance data to investigate factors that affect the rates of pre-hospital ERAS adherence. We hypothesize that pre-hospital ERAS adherence is associated with multiple social and demographic factors including smoking, insurance status, distance to hospital, and appointment type.Methods/Interventions: Adult patients enrolled in the ERAS pathway and undergoing elective colorectal surgery from 2018-2022 were identified at a tertiary care medical center. Data evaluating patient compliance within the ERAS pathway was collected via our institutional ERAS database. Patients with missing data on compliance were excluded from the analysis. We defined a patient as “adherent” if they completed ≥ 85% of the pre-hospital components of the ERAS pathway, which includes liquid intake within 4 hours of OR start, antibiotics, CHG wipes, discharge plan compliance, education compliance, increased pre-op activity, and mechanical bowel prep. Relevant demographic and social covariates were identified and analyzed. Multivariate logistic regression was performed to determine the association of risk factors with adherence.Results/Outcomes: 701 patients were identified and analyzed with complete adherence information. Of these, n=354 (50.5%) were found to be “adherent” and n=347 (49.5%) were “non-adherent” to pre-hospital ERAS protocols based on our described definition. No statistically significant impact on adherence was found regarding ASA, BMI, medical comorbidities (ESRD, COPD, CHF, Diabetes), clinic education, distance to VUMC, insurance type, or pre-op appointment type. Current smoking status was associated with ERAS non-adherence (OR 2.46; 95% CI 1.12 – 5.39; p=0.025).Conclusion/

Discussion: Our study illustrates that current smoking is the only demographic factor that serves as a predictor of poor pre-hospital ERAS compliance. Future analysis will be aimed at analyzing the impact of ERAS adherence rates on post-operative outcomes.