154 Chapter 7 Compliance with the ERAS protocol Patients in the intervention group had a significantly higher compliance of 10% (76.4%) than patients in the control group (66.4%) (p = 0.003) (Table 3). This was mainly due to improved compliance with the early intake of solid foods on day 1 (92%; p<0.001) and start with early mobilization on day 1 (41%; p<0.001). These two elements were also significantly higher from day 2 to day 7 after surgery. After adjusting for confounding factors in multivariate linear regression analysis, the improvement in compliance was similar (Table 4). The analysis identified an academic hospital, high Karnofsky score, poor physical health score, and high disability score as being significant confounders. It is worth mentioning that patient compliance was 16% higher in teaching hospitals than in academic hospitals. A comparative sub analysis reported that the patient populations of both type of hospital are significantly different (Table S3), however none of these variables were significant confounders. Secondary outcomes The median hospital stay was 5 days for patients in both groups. Complications were not reported to be significantly different: 23.5% in the control group and 26.4% in the intervention group. The intervention group demonstrated a noteworthy reduction in reported pain by day 7, as evidenced by a VAS score of 2.5 compared to 3.3 in the control group (p=0.021). The other postoperative outcomes were also comparable between groups (Table 5). The PROMs quality of life, disabilities and satisfaction were similar in both groups (Table 6). Patients from teaching hospitals had significant better postoperative outcomes; a hospital stay of 4 days vs 6 days (p<0.001), complications 16% vs 34%, and reinterventions 3% vs 14%. (p=0.018). The activities of both groups are presented in figure 4. Although not statistically significant, preoperative activity did increase by 946 daily steps with the use of the ERAS app (8491 compared to 7545; p=0.106). Postoperative activity in both groups was comparable. However, the intervention group became increasingly active in the last few days of their activity follow-up.
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