Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery

Grant, Michael C.; Hanna, Andrew; Benson, Andrew R.; Hobson, Deborah B.; Wu, Christopher L.; Yuan, Christina T.; Rosen, Michael A.; Wick, Elizabeth C.

doi:10.1016/j.jamcollsurg.2017.12.010

Cited by 26 publications

(18 citation statements)

References 18 publications

(16 reference statements)

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“…The key challenge is the ERAS pathway itself, with the operative team's compliance with the protocols rather than the surgical approach as the main determinant of good outcomes. 4 In this paper we provide a first full description of our ERAS protocol tailored for lumbar microdiscectomy and demonstrate its association with short operation time, less blood loss, lower pain scores, shorter length of hospital stay, and lower cost.…”

Section: Discussionmentioning

confidence: 97%

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Kılıç¹,

Demirbilek

Naderi

2019

Neurosurgical Focus

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OBJECTIVEEnhanced recovery after surgery (ERAS) is a multimodal approach that aims to improve perioperative surgical outcomes. The aim of this study was to evaluate the benefits of ERAS in terms of cost-effectiveness and postoperative outcomes in single-level lumbar microdiscectomy.METHODSThis study was a single-center retrospective comparing costs and outcomes before and after implementation of the ERAS pathway. Data were collected from the electronic medical records of patients who had undergone single-level lumbar microdiscectomy during 2 time periods—during the 2 years preceding implementation of the ERAS pathway (pre-ERAS group) and after implementation of the ERAS pathway (ERAS group). Each group consisted of 60 patients with an American Society of Anesthesiologists (ASA) Physical Status Classification of class 1. Patients were excluded if their physical status was classified as ASA class II–V or if they were younger than 18 years or older than 65.Groups were compared in terms of age, sex, body mass index (BMI), perioperative hemodynamics, operation time, intraoperative blood loss, intraoperative fluid administration, intraoperative opioid administration, time to first oral intake, time to first mobilization, postoperative nausea and vomiting (PONV), difference between preoperative and postoperative visual analog scale (VAS) scores, postoperative analgesic requirements, length of hospital stay, and cost of anesthesia.RESULTSThe ERAS and pre-ERAS groups were comparable with respect to age, sex, and BMI. Operation time, intraoperative blood loss, intraoperative opioid administration, and intraoperative fluid administration were all less in the ERAS group. First oral intake and first mobilization were earlier in the ERAS group. The incidence of PONV was less in the ERAS group. Postoperative analgesic requirements and postoperative VAS scores were significantly less in the ERAS group. The length of hospital stay was found to be shorter in the ERAS group. The ERAS approach was found to be cost-effective.CONCLUSIONSERAS had clinical and economic benefits and is associated with improved outcomes in lumbar microdiscectomy.

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Section: Discussionmentioning

confidence: 97%

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Kılıç¹,

Demirbilek

Naderi

2019

Neurosurgical Focus

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“…Therefore, effective anti-infection measures and enhanced postoperative rehabilitation after PPH for hemorrhoids are particularly important for wound healing and recovery and improving the quality of life of patients [ 6 ]. At present, Western medicine mainly focuses on symptomatic treatment in the treatment of complications after hemorrhoid surgery, and there is a lack of specific treatments that can significantly promote the recovery of complications after hemorrhoid surgery [ 7 ]. Chinese herbal fumigation is one of the more unique external treatment methods, which combines thermal effects and drugs on the treatment site to promote lymphatic reflux, improve blood circulation, relieve muscle spasm, and thus play a role in reducing pain and edema and promoting healing [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Zeng

Lin

2021

Evidence-Based Complementary and Alternative Medicine

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Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients’ postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient’s wound healing and hospital stay, while improving the patient’s anal function and reducing postoperative complications, and is worthy of clinical promotion and application.

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“…Furthermore, in some studies, individual SSI and/or compliance data were provided to the staff, while in other studies, overall data or both individual and overall data were made available. At Note: * only studies reporting both baseline and cohort SSI rates the same time, while measures that aimed to trigger changes in organizational culture varied as well, they mostly focused on building groups such as multidisciplinary teams [36,39,48,53,55,72], multidisciplinary task forces [63], steering committees [34], and dedicated operating room teams [45]. For instance, teams were formed to develop bundles of clinical measures, promote implementation, or monitor compliance.…”

Section: Discussionmentioning

confidence: 99%

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

Tomsic

Heinze

Chaberny

et al. 2020

BMC Health Serv Res

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Background: Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions. Methods: Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions. Results: Forty studies were included. Implementation interventions used most frequently ("top five") were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3-5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant.

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Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery

Abstract: Dedicated operating room teams led to increased centrality among anesthesia providers, which in turn not only increased compliance, but also improved several clinical outcomes.

Cited by 26 publications

References 18 publications

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Does an enhanced recovery after surgery protocol change costs and outcomes of single-level lumbar microdiscectomy?

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

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