Responses to 5 patient-reported outcome measure (PROM) assessment tools used to assess their perceptions on whether adherence to an early recovery program (ERP) following colorectal surgery was associated with improved postoperative outcomes suggest that patients perceive early, but not late, postoperative benefits of adherence to an ERP in this setting. This article was published in Surgical Endoscopy.1

Patients included in this study had been enrolled in a large randomized trial that previously demonstrated an association between adherence to an ERP following colorectal surgery and postsurgical recovery as assessed using traditional clinical end points; however, these measures did not evaluate patient assessments of recovery.2

In this study, assessments of patients’ adherence to the ERP were obtained from data collected within the randomized controlled trial. Postsurgical recovery from the perspective of patients was evaluated using 5 PROMs: the Abdominal Surgery Impact Scale (ASIS) and the Multidimensional Fatigue Inventory (MFI-20), which are designed to evaluate short-term recovery; and the RAND-36 Physical and Mental Summary Scores, the Duke Activity Status Index, and the Life-Space Mobility (LSM) Scale, which assess long-term recovery. 

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The self-reported recovery assessments were obtained from 100 adult patients undergoing colorectal resection at a university hospital in Canada. Median adherence to the ERP, a structured multimodal approach to surgical care was 80%. The only interventions significantly associated with improved PROMs scores were adherence to perioperative PONV prophylaxis (P =.023) and an early solid food diet (P =.009).  Adherence to specific ERP components was not associated with improved PROM scores measured at 4 weeks following surgery.

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“It is not clear whether these results reflect a lack of appropriate measures of recovery beyond hospital discharge, or if in fact ERPs have fewer advantages than expected. There remains a need for the development of recovery-specific PROMs with adequate measurement properties to enable patient-centered assessment of postoperative recovery,” the authors concluded.


1. Pecorelli N, Balvardi S, Liberman AS, et al. Does adherence to perioperative enhanced recovery pathway elements influence patient-reported recovery following colorectal resection? [published online January 30, 2019]. Surg Endosc. doi: 10.1007/s00464-019-06684-3

2. Fiore JF Jr, Castelino T, Pecorelli N, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery: a randomized controlled trial. Ann Surg. 2017;266(2):223-231.