Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

Abstract

IMPORTANCE Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. OBJECTIVE To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. INTERVENTIONS Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. MAIN OUTCOMES AND MEASURES Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. RESULTS A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort

Effect of integrated perioperative rehabilitation intervention under the fast-track surgery concept on stress and complications in patients undergoing craniocerebral injury surgery

“…FTS focuses on a multidisciplinary approach to problem solving and decision making through the implementation of an integrated medical and nursing approach, which brings together the strengths of each field and integrates them with a common goal, so that an integrated medical and nursing approach to rapid perioperative rehabilitation interventions is necessary to enable patients to recover after surgery (10,11). Domestic and international studies (12,13) have reported that integrated medical and nursing rehabilitation interventions based on the FTS concept have been used in thoracic surgery, spine surgery, orthopedics, and cancer patients with more extensive results making them safe, effective, and improving their prognosis. However, in China, reports on the application of integrated medical and nursing perioperative rehabilitation interventions under the FTS concept in the perioperative period of TBI are rare.…”

Does Size Matter? Opioid Use after Laparoscopy for Apical Pelvic Organ Prolapse Using an 8 mm versus 10—12 mm Accessory Port

“…Sutures were tied without strangulation of tissue but ensured the tip of the surgeon's fifth digit could not pass the fascia. Perioperative care was as per the Enhanced Recovery After Surgery protocols at our institution (15,16). This includes preoperative administration of 1000mg acetaminophen and 400mg ibuprofen 1-hour prior to surgery, as well as scheduled acetaminophen and non-steroidal anti-inflammatory administration post-operatively unless allergies or contraindications exist.…”

Perioperative medicine

“…28 Although the evidence of benefit is clear, GIRFT has observed reduced emphasis on delivery and development of ER pathways. 29,30 Additionally, there is unwarranted variation across surgical sub-specialties in enrolment to ER programmes, despite a high number of commonalities in pathways between specialties. 5 A simplified and generic enhanced recovery concept has been developed to improve early postoperative recovery by focusing on early drinking, eating, and mobilising (DREAMing).…”