Evaluating Variation in Enhanced Recovery for Colorectal Surgery: A Report from the Surgical Care Outcomes Assessment Program.

AIM Robust data demonstrate that enhanced recovery protocols (ERPs) decrease length of stay, complications, and cost. However, little is known about reasons for variation in compliance with ERPs. Our purpose was to confirm the efficacy of ERPs in a regional network, and to determine factors that are associated with ERP delivery in diverse hospital settings. METHODS A prospective cohort of patients was created by recording all elective colorectal operations at hospitals in the Surgical Care Outcomes Assessment Program (SCOAP). Delivery of 12 ERP components is tracked at all sites, and factors associated with ERP component delivery and impact on outcomes were reported. RESULTS From 2016 to 2019, 9,274 elective colorectal operations were performed at 36 hospitals. Indications were 48% cancer, 23% diverticulitis, and 8% inflammatory bowel disease. Minimally invasive surgery was used in 71%. The proportion of cases with 6 or more ERP components received increased from 23% in 2016 to 50% in 2019. An increase in components was associated with a lower length of stay, fewer combined adverse events, and re-interventions. Further, increasing numbers of ERP components provided an incremental benefit to patients even when delivered in a low-volume center or by a low-volume surgeon, and regardless of patient presentation. CONCLUSION At SCOAP hospitals, delivery of increasing numbers of ERP components was associated with improved perioperative outcomes and decreased complications after elective colorectal surgery. The variation in delivery of these evidence-based components in subsets of our cohort indicates an important opportunity for quality improvement initiatives.