Basile Pache1,2, David Martin1, Valérie Addor1, Nicolas Demartines1, Martin Hübner3. 1. Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland. 2. Department of Gynecology, Lausanne University Hospital CHUV, Pierre Decker 2, University of Lausanne (UNIL), Lausanne, 1011, Switzerland. 3. Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland. martin.hubner@chuv.ch.
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet. METHODS: Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15-20). RESULTS: Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables "urinary catheter removal" (16.4%) and "mobilization on day 1" (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria. CONCLUSION: EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset.
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet. METHODS: Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15-20). RESULTS: Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables "urinary catheter removal" (16.4%) and "mobilization on day 1" (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria. CONCLUSION: EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset.
Authors: Matthew T McMillan; Valentina Allegrini; Horacio J Asbun; Chad G Ball; Claudio Bassi; Joal D Beane; Stephen W Behrman; Adam C Berger; Mark Bloomston; Mark P Callery; John D Christein; Euan Dickson; Elijah Dixon; Jeffrey A Drebin; Carlos Fernandez-Del Castillo; William E Fisher; Zhi Ven Fong; Ericka Haverick; Robert H Hollis; Michael G House; Steven J Hughes; Nigel B Jamieson; Tara S Kent; Stacy J Kowalsky; John W Kunstman; Giuseppe Malleo; Amy L McElhany; Ronald R Salem; Kevin C Soares; Michael H Sprys; Vicente Valero; Ammara A Watkins; Christopher L Wolfgang; Amer H Zureikat; Charles M Vollmer Journal: Ann Surg Date: 2017-05 Impact factor: 12.969