R. Chandra1, A. Abbas1, L. Wood1, W. Oslock1, A.A. Harsono1, G.C. Hernandez-Marquez1, R. Hollis1, D. Chu1 1University Of Alabama at Birmingham, Division Of Gastrointestinal Surgery, Birmingham, Alabama, USA
Introduction:
Enhanced Recovery Programs (ERPs) accelerate surgical recovery but require patient activation to engage in the pre- and post-operative phases. Patient activation is defined by a patient’s knowledge, skills, motivation, and confidence to take an active part in their healthcare. The association between patient activation and adherence to ERP components remains unexplored. Therefore, the aim of this study was to assess the association of patient activation with ERP adherence among patients undergoing colorectal surgery.
Methods:
A retrospective cohort study utilizing single-institution ACS-NSQIP data from July 2021 to August 2023 was conducted for patients undergoing elective colorectal surgery with patient activation measures. Patient activation was measured using the 10-item Patient Activation Measure (PAM-10) survey by Insignia Health. High PAM was defined as a score greater than 55.1. The primary outcome was ERP adherent care (defined as >70% ERP components completed). Secondary outcomes were rates of individual ERP components. Bivariate analysis was conducted using Pearson chi-square tests for categorical data and Kruskal-Wallis Rank Sum tests for continuous data. Multivariable logistic regression was performed for the adjusted model analysis. All statistical tests were performed at an alpha level of 0.05 using SAS 9.4.
Results:
Overall, 223 patients were included with 32% receiving ERP adherent care and 74% having high PAM. The median age was 59.8 years, and BMI was 27.3 kg/m2. Most patients were white (n=135, 70%), female (n=102, 53%), and undergoing a laparoscopic approach (n=75, 43%), with partial colectomy the most common procedure (n=80, 42%), with no significant differences in patient-level between the high PAM and low PAM groups. Compared to patients in the low PAM group, patients in the high PAM group were more likely to receive the following individual ERP components: DVT prophylaxis, pain block, and normal body temperature. However, these results did not reach statistical significance (all p-value >0.05). Further, on multivariable analysis, there was no significant difference in achieving overall ERP adherent care based on PAM (OR:0.92, 95%CI: 0.47-1.83, p=0.82).
Conclusion:
In this study, both patients with high and low PAM were unlikely to receive overall ERP adherent care. However, early signals suggest that patients with high PAM may be more likely to receive individual ERP components. Larger studies are needed to understand this association to inform better interventions to improve ERP care.