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Turley N, Kogut K, Burian B, Moyal-Smith R, Etheridge J, Sonnay Y, Berry W, Merry A, Hannenberg A, Haynes AB, Dias RD, Hagen K, Molina G, Spruce L, Williams C, Brindle ME. Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol. ANNALS OF SURGERY OPEN 2024; 5:e436. [PMID: 38911631 PMCID: PMC11191993 DOI: 10.1097/as9.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objectives The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. Background The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. Methods A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Data analysis Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. Setting The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. Anticipated impact We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.
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Affiliation(s)
- Nathan Turley
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Karolina Kogut
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Barbara Burian
- NASA, Ames Research Center, Moffett Field, California, USA
| | - Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - James Etheridge
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - William Berry
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alan Merry
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Alexander Hannenberg
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alex B. Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas Austin, Austin, TX
| | - Roger D. Dias
- STRATUS Center for Medical Simulation, Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Kathryn Hagen
- Department of Anaesthesia and Peri-operative Medicine, Te Toka Tumai|Auckland City Hospital, Te Whātua Ora|Health New Zealand, New Zealand
| | - George Molina
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa Spruce
- Sr. Director, Evidence-based Perioperative Practice at AORN, Denver, CO
| | | | - Mary E. Brindle
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
- Professor of Surgery and Community Health Sciences, Cumming School of Medicine University of Calgary, Pediatric General Surgeon, Alberta Children’s Hospital, Calgary, AB
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Pagano E, Pellegrino L, Robella M, Castiglione A, Brunetti F, Giacometti L, Rolfo M, Rizzo A, Palmisano S, Meineri M, Bachini I, Morino M, Allaix ME, Mellano A, Massucco P, Bellomo P, Polastri R, Ciccone G, Borghi F. Implementation of an enhanced recovery after surgery protocol for colorectal cancer in a regional hospital network supported by audit and feedback: a stepped wedge, cluster randomised trial. BMJ Qual Saf 2024; 33:363-374. [PMID: 38423752 PMCID: PMC11103294 DOI: 10.1136/bmjqs-2023-016594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are known to potentially improve the management and outcomes of patients undergoing colorectal surgery, with limited evidence of their implementation in hospital networks and in a large population. We aimed to assess the impact of the implementation of an ERAS protocol in colorectal cancer surgery in the entire region of Piemonte, Italy, supported by an audit and feedback (A&F) intervention. METHODS A large, stepped wedge, cluster randomised trial enrolled patients scheduled for elective surgery at 29 general surgery units (clusters). At baseline (first 3 months), standard care was continued in all units. Thereafter, four groups of clusters began to adopt the ERAS protocol successively. By the end of the study, each cluster had a period in which standard care was maintained (control) and a period in which the protocol was applied (experimental). ERAS implementation was supported by initial training and A&F initiatives. The primary endpoint was length of stay (LOS) without outliers (>94th percentile), and the secondary endpoints were outliers for LOS, postoperative medical and surgical complications, quality of recovery and compliance with ERAS items. RESULTS Of 2626 randomised patients, 2397 were included in the LOS analysis (1060 in the control period and 1337 in the experimental period). The mean LOS without outliers was 8.5 days during the control period (SD 3.9) and 7.5 (SD 3.5) during the experimental one. The adjusted difference between the two periods was a reduction of -0.58 days (95% CI -1.07, -0.09; p=0.021). The compliance with ERAS items increased from 52.4% to 67.3% (estimated absolute difference +13%; 95% CI 11.4%, 14.7%). No difference in the occurrence of complications was evidenced (OR 1.22; 95% CI 0.89, 1.68). CONCLUSION Implementation of the ERAS protocol for colorectal cancer, supported by A&F approach, led to a substantial improvement in compliance and a reduction in LOS, without meaningful effects on complications. Trial registration number NCT04037787.
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Affiliation(s)
- Eva Pagano
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Pellegrino
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Manuela Robella
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesco Brunetti
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lisa Giacometti
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Alessio Rizzo
- General Surgery and Oncology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Sarah Palmisano
- Anaesthesia and Intensive Care Unit, S Croce and Carle Cuneo Hospital Districts, Cuneo, Italy
| | - Maurizio Meineri
- Anaesthesia and Intensive Care Unit, S Croce and Carle Cuneo Hospital Districts, Cuneo, Italy
| | - Ilaria Bachini
- Clinical Nutrition and Dietetics Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Mario Morino
- Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Ettore Allaix
- Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alfredo Mellano
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
| | - Paolo Massucco
- General Surgery and Oncology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Paola Bellomo
- General Surgery, Presidio Sanitario Gradenigo, Torino, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Ponderano, Biella, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Felice Borghi
- Surgical Oncology Department, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Torino, Italy
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Blair WO, Ellis MA, Fada M, Wiggins AA, Wolfe RC, Patel GP, Brockhaus KK, Droege M, Ebbitt LM, Kramer B, Likar E, Petrucci K, Shah S, Taylor J, Bingham P, Krabacher S, Moon JH, Rogoz M, Jean-Jacques E, Cleary RK, Eke R, Findley R, Parrish RH. Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework. Healthcare (Basel) 2023; 11:3060. [PMID: 38063628 PMCID: PMC10706554 DOI: 10.3390/healthcare11233060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. METHODS AND MATERIALS Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. RESULTS POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. CONCLUSIONS Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals.
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Affiliation(s)
- William Olin Blair
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Mary Allison Ellis
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Maria Fada
- Heritage School of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA;
| | - Austin Allen Wiggins
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachel C. Wolfe
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO 63110, USA;
| | - Gourang P. Patel
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Kara K. Brockhaus
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Molly Droege
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Laura M. Ebbitt
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Brian Kramer
- Department of Pharmacy Services, OhioHealth/Grant Medical Center, Columbus, OH 43215, USA;
| | - Eric Likar
- Department of Pharmacy Services, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Kerilyn Petrucci
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Sapna Shah
- Department of Pharmacy Services, Beaumont Hospital—Troy, Troy, MI 48085, USA;
| | - Jerusha Taylor
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Paula Bingham
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Samuel Krabacher
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Jin Hyung Moon
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Monica Rogoz
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Edson Jean-Jacques
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Robert K. Cleary
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Ransome Eke
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachelle Findley
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Richard H. Parrish
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
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Principles of enhanced recovery in gastrointestinal surgery. Langenbecks Arch Surg 2022; 407:2619-2627. [PMID: 35861873 DOI: 10.1007/s00423-022-02602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To reduce the impact of surgery-related stress, enhanced recovery after surgery (ERAS) pathways have been developed since over 15 years with subsequent improved postoperative outcome. This multimodal and evidence-based perioperative approach has spread to all fields of gastrointestinal surgery, from esophagus, stomach, duodenum and pancreas, liver, small intestine and colon, and rectum, as well as for other specialties like vascular and cardia surgeries or neurosurgery, among others. PURPOSE The aim of this state-of-the-art article is to assess current state of evidence on perioperative management specifically in gastrointestinal surgery, with a focus on surgery-related aspects, outcome benefit, and future directions. CONCLUSION The surgical team must promote continuous improvement of the patient's ERAS compliance to ensure optimal perioperative care. Everyday clinical practice should be performed according to latest evidence-based medicine and challenging surgical dogma. Moreover, the surgeon must lead and support a multidisciplinary and collaborative teamwork tailored to patient's need especially with anesthetists and nursing staff.
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Schwenk W, Lang I, Huhn M. [Structured Implementation of a Fast-Track Program - How Does it Work?]. Zentralbl Chir 2021; 146:249-259. [PMID: 33782931 DOI: 10.1055/a-1385-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany. Neither scientific evidence nor reimbursement regulations explain this lack of fast-track acceptance. It seems however that a structured process of change from traditional perioperative medicine to evidence based fast-track therapy is missing in Germany. In other countries, structured programs for fast-track or ERAS implementation have been successful in many hospitals. This article describes structured fast-track implementation divided into three consecutive steps: organisational preparation, clinical implementation and continuous examination of fast-track adherence, functional recovery, morbidity and postoperative length of hospital stay. Due to its complex nature, fast-track implementation should be guided by external fast-track experts.
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Affiliation(s)
- Wolfgang Schwenk
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
| | - Ina Lang
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
| | - Marion Huhn
- Klinik für Allgemein- und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Deutschland
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Levy N, Selwyn DA, Lobo DN. Turning 'waiting lists' for elective surgery into 'preparation lists'. Br J Anaesth 2021; 126:1-5. [PMID: 32900503 DOI: 10.1016/j.bja.2020.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nicholas Levy
- Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Bury St. Edmunds, UK
| | - David A Selwyn
- Centre for Perioperative Care (CPOC), Churchill House, London, UK; Department of Critical Care, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield, UK
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
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Lode L, Oma E, Henriksen NA, Jensen KK. Enhanced recovery after abdominal wall reconstruction: a systematic review and meta-analysis. Surg Endosc 2020; 35:514-523. [PMID: 32974781 DOI: 10.1007/s00464-020-07995-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) are evidence-based protocols associated with improved patient outcomes. The use of ERAS pathways is well documented in various surgical specialties. The aim of this systematic review and meta-analysis was to examine the efficacy of ERAS protocols in patients undergoing abdominal wall reconstruction (AWR). METHODS This systematic review and meta-analysis were reported according to PRISMA and MOOSE guidelines. The databases PubMed, EMBASE, CINAHL, Web of Science and Cochrane Library were searched for original studies comparing ERAS with standard care in patients undergoing AWR. The primary outcome was length of stay (LOS) and secondary outcomes were readmission and surgical site infection (SSI) and/or surgical site occurrences (SSO). RESULTS Five studies were included in the meta-analysis. All were retrospective cohort studies including 453 patients treated according to ERAS protocols, and 494 patients treated according to standard care. The meta-analysis demonstrated that patients undergoing AWR managed with ERAS had a mean 0.89 days reduction in LOS compared with patients treated with standard care (95% CI - 1.70 to - 0.07 days, p = 0.03). There was no statistically significant difference in readmission rate (OR 1.00, 95% CI 0.53 to 1.87, p = 1.00) or SSI/SSO (OR 1.19, 95% CI 0.67 to 2.11, p = 0.56) between groups. CONCLUSIONS The use of ERAS in patients undergoing AWR was found to significantly reduce LOS without increasing the readmission rate or SSI/SSO. Based on the existing literature, ERAS protocols should be implemented for patients undergoing AWR.
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Affiliation(s)
- Lise Lode
- Department of Surgery, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Erling Oma
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nadia A Henriksen
- Department of Surgery, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
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Hawasli AH, Ray WZ, Goad MA, Frank TL, Ellis ER, Schmidt M, Lamartina P. Project management for developing a spine "enhanced recovery after surgery" program in a large university-affiliated hospital. J Neurosurg Sci 2020; 64:206-212. [DOI: 10.23736/s0390-5616.19.04669-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Associations Between Perioperative Crystalloid Volume and Adverse Outcomes in Five Surgical Populations. J Surg Res 2020; 251:26-32. [PMID: 32109743 DOI: 10.1016/j.jss.2019.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Optimal administration of fluids is an important part of enhanced recovery after surgery (ERAS) protocols. We sought to examine the relationship between perioperative crystalloid volume and adverse outcomes in five common types of surgical procedures with ERAS fluid guidelines in place where large randomized controlled trials have not been conducted: breast reconstruction, bariatric, major urologic, gynoncologic, and head and neck oncologic procedures. METHODS This retrospective cohort study included patients who had undergone any one of the aforementioned procedures within any facility in a large multihospital alliance (Premier, Inc, Charlotte, NC) between 2008 and 2014. We used multivariable generalized additive models to examine relationships between the total crystalloid volume (TCV) on the day of surgery and a composite adverse outcome of prolonged (>75th percentile) hospital or intensive care unit stay or in-hospital mortality. Models were constructed separately within each surgical category and adjusted for demographic, clinical, and hospital characteristics. Informed consent requirements were waived because deidentified data were used. RESULTS We identified 83,685 patients within 312 US hospitals undergoing breast reconstruction (n = 8738), bariatric surgery (n = 8067), major urologic surgery (n = 28,654), gynoncologic surgery (n = 34,559), and head/neck oncology surgery (n = 3667). There was significant patient-independent variation in TCV. Probabilities of adverse outcomes increased at a TCV below 3 L and above 6 L for all types of surgeries except bariatric surgery, where larger volumes were associated with progressively better outcomes. CONCLUSIONS AND RELEVANCE Relationships between TCV and adverse outcomes were generally J shaped with higher volumes (>6 L) associated with increased risk. As per current ERAS guidelines, it is important to avoid excessive crystalloid volume in most surgical procedures except for bariatric surgery.
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Altman AD, Helpman L, McGee J, Samouëlian V, Auclair MH, Brar H, Nelson GS. Enhanced recovery after surgery: implementing a new standard of surgical care. CMAJ 2020; 191:E469-E475. [PMID: 31036609 DOI: 10.1503/cmaj.180635] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta.
| | - Limor Helpman
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Jacob McGee
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Vanessa Samouëlian
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Marie-Hélène Auclair
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Harinder Brar
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
| | - Gregg S Nelson
- Department of Obstetrics, Gynecology and Reproductive Sciences (Altman), University of Manitoba, Winnipeg, Man.; Division of Gynecologic Oncology (Helpman), McMaster University, Hamilton, Ont.; Division of Gynecologic Oncology (McGee), University of Western Ontario, London, Ont.; Division of Gynecologic Oncology (Auclair, Samouëlian), CHUM, Université de Montréal, Montréal, Que.; Division of Gynecologic Oncology (Brar), University of British Columbia, Vancouver, BC; Department of Gynecologic Oncology (Nelson), Tom Baker Cancer Centre, Calgary, Alta
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Beesoon S, Robert J, White J. Surgery Strategic Clinical Network: Improving quality, safety and access to surgical care in Alberta. CMAJ 2019; 191:S27-S29. [PMID: 31801760 DOI: 10.1503/cmaj.190590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sanjay Beesoon
- Surgery Strategic Clinical Network (Beesoon, Robert, White), Alberta Health Services; Faculty of Medicine and Dentistry (Beesoon, White), University of Alberta, Edmonton, Alta.
| | - Jill Robert
- Surgery Strategic Clinical Network (Beesoon, Robert, White), Alberta Health Services; Faculty of Medicine and Dentistry (Beesoon, White), University of Alberta, Edmonton, Alta
| | - Jonathan White
- Surgery Strategic Clinical Network (Beesoon, Robert, White), Alberta Health Services; Faculty of Medicine and Dentistry (Beesoon, White), University of Alberta, Edmonton, Alta
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Manns BJ, Wasylak T. Clinical networks: enablers of health system change. CMAJ 2019; 191:E1299-E1305. [PMID: 31767705 DOI: 10.1503/cmaj.190313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Braden J Manns
- Departments of Community Health Sciences (Manns) and Medicine (Manns), Cumming School of Medicine and O'Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta (Manns), Cumming School of Medicine, University of Calgary; Alberta Health Services Strategic Clinical Networks (Manns, Wasylak); Faculty of Nursing (Wasylak), University of Calgary, Calgary, Alta.
| | - Tracy Wasylak
- Departments of Community Health Sciences (Manns) and Medicine (Manns), Cumming School of Medicine and O'Brien Institute of Public Health and Libin Cardiovascular Institute of Alberta (Manns), Cumming School of Medicine, University of Calgary; Alberta Health Services Strategic Clinical Networks (Manns, Wasylak); Faculty of Nursing (Wasylak), University of Calgary, Calgary, Alta
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Kim MK, Kim JG, Lee G, Won DD, Lee YS, Kye BH, Kim J, Lee IK. Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients. Sci Rep 2019; 9:11998. [PMID: 31427651 PMCID: PMC6700146 DOI: 10.1038/s41598-019-48526-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninety-one, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra- and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes.
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Affiliation(s)
- Min Ki Kim
- Department of Surgery, Myongji Hospital, Goyang, Republic of Korea
| | - Jun-Gi Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gyeora Lee
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Daeyoun David Won
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Suk Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bong-Hyeon Kye
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Kyu Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Manns BJ, Strilchuk A, Mork M, Wasylak T. Alberta's Strategic Clinical Networks: A roadmap for the future. Healthc Manage Forum 2019; 32:313-322. [PMID: 31394938 DOI: 10.1177/0840470419867344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical networks are groups of clinicians, patients, operational leaders, and other stakeholders who work together to solve health challenges, translate evidence into practice, and improve health outcomes and clinical care. Networks enable health, community, and academic partners to align their efforts, address priority issues, and advance quality improvements, health innovation, and transformational change on a local and system-wide scale. Clinical networks have existed in some countries for nearly 20 years. Alberta first implemented clinical networks in 2012 in specific areas of health. There are now 16 Strategic Clinical Networks (SCNs) in Alberta, embedded within a province-wide health system. The SCNs have developed an action plan that builds on their experience and identifies common areas of focus. This article describes the SCNs, their impact to date, and the objectives, areas of focus, and processes Alberta's SCNs will use to improve health outcomes and health system performance over the next 5 years.
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Affiliation(s)
- Braden J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services Strategic Clinical NetworksTM, Alberta, Canada
| | - Allison Strilchuk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services Strategic Clinical Networks, Alberta, Canada
| | - Mikie Mork
- Alberta Health Services Strategic Clinical Networks, Alberta, Canada
| | - Tracy Wasylak
- Alberta Health Services Strategic Clinical Networks, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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