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Uptake of enhanced recovery practices by SAGES members: a survey

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Abstract

Background

The SAGES Surgical Multimodal Accelerated Recovery Trajectory (SMART) Enhanced Recovery Task Force aims to increase awareness and provide tools for members to successfully implement enhanced recovery pathways (ERPs) to improve clinical outcomes and patient satisfaction. An initial step was to survey SAGES member on their knowledge, use, and impediments to enhanced recovery.

Methods

An online survey designed by SMART committee members to define SAGES member’s awareness and use of enhanced recovery principles and practice was emailed to all SAGES members. Reminders were sent 2 and 3 weeks later, encouraging completion of the survey. The web-based survey included 48 questions and took an estimated 20 min to complete.

Results

A total of 229 members completed the survey. Respondents were primarily general/MIS surgeons (82.6%) working in an urban location (85.5%), with a bell-shaped age distribution (median 35–44). Almost half regularly used some elements of ERPs (48.7%), but 30% were unfamiliar with the concept. Wide variety in the specific ERP elements used and discharge criteria were reported. The majority had to create and implement their own plan (70.4%). Roadblocks to implementation were inconsistencies with partners/covering physicians (56.3%), nursing education (46.6%), and resources (34.7%). When implemented, members saw improvements in length of stay (88%), patient satisfaction (54.7%), postoperative pain (53.3%), time to return of bowel function (52.7%), and readmissions (16.7%). A need for education and standardization was especially seen in preoperative care, with 74.4% fasting patients from midnight the night before surgery. Wide variations were also reported in pain management practices. An overwhelming majority (89%) reported that having a protocol endorsed by a national organization, such as SAGES, would help with implementation.

Conclusions

From this survey of SAGES members, there is a need for education, tools, and standardized protocols to increase awareness, support implementation, and encourage wider utilization of ERP. The overwhelming majority stated having a protocol endorsed by a national organization, such as SAGES, would facilitate implementation.

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Acknowledgements

The authors acknowledge the SAGES SMART Task Force members: Liane Feldman, Chair, Conor Delaney, Co-Chair, Gina Adrales, Rajesh Aggarwal, Thomas Aloia, Diana Diesen, Justin Dimick, Courtney Doyle, Lorenzo Ferri, Julio Fiore Jr., Gerald Fried, Pascal Fuchshuber, Alexis Grucela, Matthew Hutter, Edmundo Inga-Zapata, Rohan Joseph, Deborah Keller, Lawrence Lee, Anne Lidor, Sumeet Mittal, Charles Paget III, Benjamin Poulose, Patrick Reardon, Michele Riordon, Anthony Senagore, Vadim Sherman, Julie Thacker, Tonia Young-Fadok.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, 3500 Gaston Street, R-1013, Dallas, TX, 75204, USA

    Deborah S. Keller

  2. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Conor P. Delaney

  3. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Anthony J. Senagore

  4. Department of Surgery, McGill University, Montreal, QC, Canada

    Liane S. Feldman

Authors
  1. Deborah S. Keller
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  2. Conor P. Delaney
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  3. Anthony J. Senagore
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  4. Liane S. Feldman
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Consortia

on Behalf of the SAGES SMART Task Force

  • Liane Feldman
  • , Conor Delaney
  • , Gina Adrales
  • , Rajesh Aggarwal
  • , Thomas Aloia
  • , Diana Diesen
  • , Justin Dimick
  • , Courtney Doyle
  • , Lorenzo Ferri
  • , Julio Fiore Jr.
  • , Gerald Fried
  • , Pascal Fuchshuber
  • , Alexis Grucela
  • , Matthew Hutter
  • , Edmundo Inga-Zapata
  • , Rohan Joseph
  • , Deborah Keller
  • , Lawrence Lee
  • , Anne Lidor
  • , Sumeet Mittal
  • , Charles Paget III
  • , Benjamin Poulose
  • , Patrick Reardon
  • , Michele Riordon
  • , Anthony Senagore
  • , Vadim Sherman
  • , Julie Thacker
  •  & Tonia Young-Fadok

Corresponding author

Correspondence to Deborah S. Keller.

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Disclosures

Dr. Keller, Dr. Delaney, Dr. Senagore, and Dr. Feldman have no conflicts of interest or financial ties to disclose.

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Keller, D.S., Delaney, C.P., Senagore, A.J. et al. Uptake of enhanced recovery practices by SAGES members: a survey. Surg Endosc 31, 3519–3526 (2017). https://doi.org/10.1007/s00464-016-5378-8

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  • DOI: https://doi.org/10.1007/s00464-016-5378-8

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