Active and passive compliance in an enhanced recovery programme.

Active and passive compliance in an enhanced recovery programme.

Thorn CC, White I, Burch J, Malietzis G, Kennedy R, Jenkins JT. Int J Colorectal Dis. 2016 Jul;31(7):1329-39. doi: 10.1007/s00384-016-2588-4. Epub 2016 Apr 26.

What is already known:
We know that outcomes improve with increasing compliance of (all) elements. And a large number of trials have attempted to discover which individual element is the most important, so far without success.

What this paper adds:
This is a really interesting paper, where the authors have attempted to split the ERAS elements into active and passive ones. Active elements require patient participation (e.g. mobilising for a set distance per day); and so are more difficult to achieve than passive elements that do not require patient participation (e.g. undergoing goal directed fluid therapy). The authors defined 6 elements as active ones and 10 as passive elements. Compliance of active elements demonstrated superior discrimination of major morbidity and prolonged length of stay (LoS) compared to the passive elements. Failure to comply with these active elements could therefore be used as an early indicator of either potential morbidity or prolonged LoS, allowing for timely intervention.

Chris Jones, Guildford. @chrisnjones