ACERTO Project - 15 years changing perioperative care in Brazil

Abstract

The ACERTO project is a multimodal perioperative care protocol. Implemented in 2005, the project in the last 15 years has disseminated the idea of a modern perioperative care protocol, based on evidence and with interdisciplinary team work. Dozens of published studies, using the protocol, have shown benefits such as reduced hospital stay, postoperative complications and hospital costs. Disseminated in Brazil, the project is supported by the Brazilian College of Surgeons and the Brazilian Society of Parenteral and Enteral Nutrition, among others. This article compiles publications by the authors who belong to the CNPq research group “Acerto em Nutrição e Cirurgia”, refers to the experience of other national authors in various surgical specialties, and finally outlines the evolution of the ACERTO project in the timeline.

Cost-Effectiveness of the Use of Acerto Protocol in Major Digestive Surgery

“…For the purposes of calculating the average cost of hospitalization at the surgical clinics of the HUJM, we used the following data: (1) product output report by sector issued by the MV 2000 inventory control system; (2) laboratory and image examination report issued by the MV 2000 exam billing system; (3) authorizations for hospital admission (AIH) movement report -reduced files and rejected AIH issued by the DataSUS/Tabwin system; (4) personnel data sheet for public employees provided by the HUJM human resources unit; (5) personnel data from the servants of the single legal regime (RJU) provided by the HUJM expense settlement and payment unit; (6) work schedule available on the HUJM website; (7) information on the number of equipment in the operating room provided by the head of that unit; (8) data of the clinical engineering contract, as well as footage of the HUJM hospital areas made available by the logistics and infrastructure division; and (9) information on accommodation costs obtained by the hospital accommodation indicators monitoring panel and made available by the hospital accommodation unit. We thus obtained the value of R$1,442.86 for the daily cost of a patient operated on our infirmary.…”

“…In Brazil, the ACERTO (Aceleração da Recuperação Total Pós-Operatória - Postoperative Enhanced Total Recovery) multimodal protocol was launched in 2005 and was reported first in 2006 1 . A guideline for the implementation of the ACERTO project was published in 2017 7 after various articles assured the reduction of important end points such as postoperative length of stay (LOS), postoperative complications, and mortality when compared with traditional care 1 , 4 , 6 .…”

Perioperative Care in Digestive Surgery: The Eras and Acerto Protocols - Brazilian College of Digestive Surgery Position Paper

“…This evidence-based guideline for perioperative care was named ERAS (Enhanced Recovery After Surgery) protocol 9 , 31 , 34 , 35 , 40 , 43 , 56 . In 2005, a Brazilian multimodal protocol of perioperative care was initiated in a university hospital and first published in 2006 5 , 17 , 18 , 19 , 54 ( Figure 1 ).…”

“…Perioperative nutrition plays an important role in enhanced recovery protocols especially by improving the nutritional condition of the patient before and after surgery as well as reducing the fasting period 8 , 18 , 25 , 32 , 36 . Multimodal analgesia, a cornerstone of these protocols, utilizes a combination of analgesic agents to minimize reliance on opioids, thereby reducing side effects and promoting quicker recovery 17 , 30 , 31 . Psychosocial elements, like patient education and psychological support, play a crucial role in minimizing perioperative stress and improving overall well-being 5 , 19 , 35 , 36 .…”

“…Supplements, often in the form of clear liquids, containing easily digestible carbohydrates (12% maltodextrin, 200-400 mL given two hours before induction of anesthesia), help to maintain metabolic function and mitigate the catabolic effects of prolonged fasting 22 , 61 . These supplements given two hours before surgery contribute to improved insulin sensitivity, reduce muscle protein breakdown, and provide a readily available energy source for the body 17 , 18 , 19 , 20 , 31 , 34 , 35 , 36 .…”