Adherence to Enhanced Recovery Protocols in NSQIP and Association With Colectomy Outcomes

Objective: To evaluate the effect of protocol adherence on length of stay (LOS) and recovery-specific outcomes after colectomy. Background: Enhanced recovery protocols (ERPs) may decrease postoperative morbidity and LOS; however, the effect of overall protocol adherence remains unclear. Methods: Using American College of Surgeons' National Surgical Quality Improvement Program colectomy data (July 2014–December 2015) and 13 novel ERP variables, propensity scores were constructed for low (0–5), moderate (6–9), and high adherence (10–13 components). Prolonged LOS (>75th percentile, uncomplicated cases) was modeled with multivariable logistic regression with robust standard errors, adjusted for hospital-level clustering and propensity score. Secondary recovery-specific outcomes were modeled with negative binomial regression. Subgroup analysis was conducted on uncomplicated cases. Results: Among 8139 elective colectomies at 113 hospitals, LOS increased with decreasing adherence (4.3 days [SD 3.3] high adherence vs 7.8 [SD 6.8] low adherence; P

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