J C Simpson1, S R Moonesinghe2, M P W Grocott3, M Kuper4, A McMeeking5, C M Oliver2, M J Galsworthy2, M G Mythen6. 1. The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK. 2. The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK. 3. The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK Anaesthesia and Critical Care Research Unit, University Hospitals Southampton; Integrative Physiology and Critical Illness Group, University of Southampton and University Hospital Southampton, University of Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK. 4. Homerton Hospital, Homerton Row, London, UK. 5. National Cancer Action Team, NHS, London, UK. 6. The Surgical Outcomes Research Centre (SOuRCe), University College London Hospitals NIHR Biomedical Research Centre, London, UK m.mythen@ucl.ac.uk.
Abstract
BACKGROUND: The UK Department of Health Enhanced Recovery Partnership Programme collected data on 24 513 surgical patients in the UK from 2009-2012. Enhanced Recovery is an approach to major elective surgery aimed at minimizing perioperative stress for the patient. Previous studies have shown Enhanced Recovery to be associated with reduced hospital length of stay and perioperative morbidity. METHODS: In this national clinical audit, National Health Service hospitals in the UK were invited to submit patient-level data. The data regarding length of stay and compliance with each element of Enhanced Recovery protocols for colorectal, orthopaedic, urological and gynaecological surgery patients were analysed. The relationship between Enhanced Recovery protocol compliance and length of stay was measured. RESULTS: From 16 267 patients from 61 hospital trusts, three out of four surgical specialties showed Enhanced Recovery, compliance being weakly associated with shorter length of stay (correlation coefficients -0.18, -0.14, -0.25 in colorectal, orthopaedics and gynaecology respectively). At a cut-off of 80% compliance, good compliance was associated with two, one and three day reductions in median length of stay respectively in colorectal, orthopaedic and urological surgeries, with no saving in gynaecology. CONCLUSIONS: This study is the largest assessment of the relationship between Enhanced Recovery protocol compliance and outcome in four surgical specialties. The data suggest that higher compliance with an Enhanced Recovery protocol has a weak association with shorter length of stay. This suggests that changes in process, resulting from highly protocolised pathways, may be as important in reducing perioperative length of stay as any individual element of Enhanced Recovery protocols in isolation.
BACKGROUND: The UK Department of Health Enhanced Recovery Partnership Programme collected data on 24 513 surgical patients in the UK from 2009-2012. Enhanced Recovery is an approach to major elective surgery aimed at minimizing perioperative stress for the patient. Previous studies have shown Enhanced Recovery to be associated with reduced hospital length of stay and perioperative morbidity. METHODS: In this national clinical audit, National Health Service hospitals in the UK were invited to submit patient-level data. The data regarding length of stay and compliance with each element of Enhanced Recovery protocols for colorectal, orthopaedic, urological and gynaecological surgery patients were analysed. The relationship between Enhanced Recovery protocol compliance and length of stay was measured. RESULTS: From 16 267 patients from 61 hospital trusts, three out of four surgical specialties showed Enhanced Recovery, compliance being weakly associated with shorter length of stay (correlation coefficients -0.18, -0.14, -0.25 in colorectal, orthopaedics and gynaecology respectively). At a cut-off of 80% compliance, good compliance was associated with two, one and three day reductions in median length of stay respectively in colorectal, orthopaedic and urological surgeries, with no saving in gynaecology. CONCLUSIONS: This study is the largest assessment of the relationship between Enhanced Recovery protocol compliance and outcome in four surgical specialties. The data suggest that higher compliance with an Enhanced Recovery protocol has a weak association with shorter length of stay. This suggests that changes in process, resulting from highly protocolised pathways, may be as important in reducing perioperative length of stay as any individual element of Enhanced Recovery protocols in isolation.
Authors: Joseph C Carmichael; Deborah S Keller; Gabriele Baldini; Liliana Bordeianou; Eric Weiss; Lawrence Lee; Marylise Boutros; James McClane; Scott R Steele; Liane S Feldman Journal: Surg Endosc Date: 2017-08-03 Impact factor: 4.584
Authors: Gregg Nelson; Lawrence N Kiyang; Ellen T Crumley; Anderson Chuck; Thanh Nguyen; Peter Faris; Tracy Wasylak; Carlota Basualdo-Hammond; Susan McKay; Olle Ljungqvist; Leah M Gramlich Journal: World J Surg Date: 2016-05 Impact factor: 3.352
Authors: Nicolò Pecorelli; Olivia Hershorn; Gabriele Baldini; Julio F Fiore; Barry L Stein; A Sender Liberman; Patrick Charlebois; Franco Carli; Liane S Feldman Journal: Surg Endosc Date: 2016-08-18 Impact factor: 4.584