Favorable effect of enhanced recovery programs on post-discharge mortality: a French nationwide study

Background

Enhanced recovery programs (ERPs) imply early discharge but few papers have assessed the effect of ERPs on post-discharge mortality (PDM).

Methods

A multicenter nationwide case control study based on administrative data was carried out between March and December 2019. Coding for every episode of care whether in the setting of ERP or not is mandatory for hospital funding (public or private). Twelve surgical specialties or procedures were included. The episodes of care coded with ERP were matched with those without ERP code for several factors such as the type of hospital (public or private), age, gender, month of discharge, and updated Charlson score. Ninety-day PDM was the main outcome.

Results

Of 420,031 patients in the database, 78,119 had an ERP code. Finally, 132,600 patients with 66,300 matched pairs were considered for the study. Overall, PDM was significantly reduced after ERPs: 0.075% vs 0.138% (p = 0.00042). Significant one-half and two-thirds reduction in PDM was observed respectively after hip arthroplasty (odds ratio 0.48 [95% CI 0.21–0.99]) and colectomy (odds ratio 0.36 [95% CI 0.16–0.74]).

Conclusion

The findings, based on a large database and a rigorous matching, strongly suggest that ERPs reduce PDM particularly after colectomy and hip arthroplasty. This is likely due to better post-operative care in ERPs.

Medico-economic impact of enhanced rehabilitation after surgery: an exhaustive, nation-wide claims study

Background

Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program.

Methods

Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates.

Results

The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million).

Conclusions

Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07379-z.

Effects of a training program in medical hypnosis on burnout in anesthesiologists and other healthcare providers: A survey study

OBJECTIVE

To determine whether the participation to a medical hypnosis training program reduces the levels of burnout in healthcare providers.

DESIGN

Survey study.

SETTINGS

Study conducted from 2014 to 2018 using the MBI-HSS questionnaire assessing three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA).

PARTICIPANTS

Healthcare providers in particular anesthesiologists participating to a one-year medical hypnosis training program.

INTERVENTION

All participants were asked to fill the MBI-HSS on the first day before the training program had begun, then on the last day of the program once the entire training was completed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The EE, DP and PA scores and their grade (high, average and low) were compared before and after training and between physicians and caregivers.

RESULTS

In total, 1850 persons participated to the training sessions, with 1366 participants enrolled before the first session (74%) and 1407 (76%) after the fourth. On the 1366 persons enrolled before training, 1139 (83%) completed the survey and on the 1407 enrolled after training, 1194 (85%) completed the survey. The scores were significantly smaller after training for EE and DP and significantly greater for PA. Before training, EE was significantly greater in physicians than in caregivers as well as DP, with no difference for PA. After training, DP was significantly greater in physicians than in caregivers and PA was smaller, with no difference for EE. Before training, there was high rates of burnout in both healthcare providers but there was a significant trend to smaller rates of burnout after training.

CONCLUSIONS

This study shows that healthcare providers who participated to a medical hypnosis training program presented improvements in the three dimensions of burnout. Further study is required to investigate and recommend this type of continuous medical education to improve professional satisfaction and wellbeing in healthcare providers.

Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study

Introduction

This observational study was designed to assess the use of spinal anesthesia with chloroprocaine in the context of ambulatory surgery.

Methods

A prospective, multicenter, observational study was carried out among 33 private or public centers between May 2014 and January 2015 and adult patients, scheduled for a short ambulatory surgery under spinal anesthesia with chloroprocaine. The primary outcomes were anesthetic effectiveness, defined as performance of the whole surgical procedure without any additional anesthetic agent, and the time to achieve eligibility for hospital discharge. Secondary outcomes were the effect of chloroprocaine on motor and sensory blocks, patients’ satisfaction, and the use of analgesics in the first 24 h after surgery.

Results

Among the 615 enrolled patients, 56% were male, the mean age was 47.2 ± 15.2 years, and most patients had an ASA (American Society of Anesthesiologists) status of 1 (63.7%). Main surgical procedures performed were orthopedic (62.6%) and gynecologic (16.1%), and the mean duration of surgery was 26.7 ± 16.7 min. The overall anesthetic success rate was 93.8% (95% CI [91.5%; 95.6%]) for the 580 patients with available data for primary criteria. The failure rate was lower than 7% for all surgical procedures, except for gynecologic surgery (14.8%; 95% CI [8.1%; 23.9%]). The average times of eligibility for hospital discharge and effective discharge were 252.7 ± 82.7 min and 313.8 ± 109.9 min, respectively. The time of eligibility for hospital discharge is defined as the recovery of the patient’s normal clinical parameters and the time of effective discharge is defined as the time for the patient to leave the hospital after surgery. Eligibility for patient’s discharge was achieved more rapidly in private than public hospitals (236.3 ± 77.2 min vs. 280.9 ± 80.7 min, respectively, p < 0.001).

Conclusions

This study showed positive results on the effectiveness of chloroprocaine as a short-duration anesthetic and could be used to reduce the time to achieve eligibility for hospital discharge.

Trial Registration

ClinicalTrials.gov identifier, NCT02152293. Registered on May 6, 2014. Date of enrollment of the first participant in the trial May 7, 2014.

Hypnosis versus diazepam for embryo transfer: a randomized controlled study

Levitas et al. (2006) showed in a cohort study that hypnosis during embryo transfer (ET) increased pregnancy ratio by 76%. In order to evaluate hypnosis during ET in a general population, the authors performed a randomized prospective controlled study comparing diazepam (usual premedication) administered before ET plus muscle relaxation versus hypnosis plus placebo in 94 patients. Additionally, the authors studied anxiety pre and post ET. Anxiety scores were not different in the two groups before and after ET. No difference in pregnancy and birth ratio was found in the two groups. Hypnosis during ET is as effective as diazepam in terms of pregnancy ratio and anxiolytic effects, but with fewer side effects and should be routinely available.