Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery

Thiele, Robert H.; Rea, Kathleen; Turrentine, Florence E.; Friel, Charles M.; Hassinger, Taryn E.; Goudreau, Bernadette J.; Umapathi, Bindu A.; Krön, Irving L.; Sawyer, Robert G.; Hedrick, Traci L.; McMurry, Timothy L.

doi:10.1016/j.jamcollsurg.2014.12.042

Cited by 365 publications

(255 citation statements)

References 78 publications

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“…Traditionally, patients with gastric resection followed by anastomosis have received excessive volume of intravenous infusion for several days 14 . In bariatric surgery, this excessive volume is prescribed because of the fear of rhabdomyolysis 15 .…”

Section: Discussionmentioning

confidence: 99%

Cuidados perioperatórios em cirurgia bariátrica no contexto do projeto ACERTO: realidade e o imaginário de cirurgiões em um hospital de Cuiabá

De-Marchi

De-Souza

Salomão

et al. 2017

Rev. Col. Bras. Cir.

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RESUMO Objetivo: verificar o grau de conhecimento entre cirurgiões, sobre as recomendações do Projeto ACERTO em cirurgia bariátrica, correlacionando o "imaginário", sobre suas prescrições, e a "realidade", através de dados de prontuários de seus pacientes. Métodos: estudo observacional longitudinal prospectivo comparativo entre o "imaginário" dos cirurgiões, obtido através de respostas de questionário sobre condutas recomendadas pelo ACERTO e a análise de dados clínicos "reais" encontrados em prontuários de pacientes submetidos à cirurgia bariátrica. Foram analisados: jejum pré-operatório, realimentação precoce, hidratação venosa perioperatória, antibioticoprofilaxia, uso de sondas e drenos, analgesia e profilaxia de náuseas e vômitos. Foram confrontadas as respostas de sete cirurgiões e dados de 200 prontuários médicos. Resultados: todos os cirurgiões entrevistados conheciam o Projeto ACERTO. Cinco (72%) responderam que seguiam o protocolo completamente. O tempo mediano de jejum pré-operatório foi maior do que o relatado pelos cirurgiões (p<0,05). Os pacientes receberam realimentação precoce em 96,5% dos casos. O volume mediano de fluidos prescritos nas primeiras 24 horas foi 4000ml, condizente com a entrevista. Em relação à antibioticoprofilaxia, uso de sondas e drenos, analgesia e prevenção de náuseas e vômitos, não houve diferença entre o respondido e o constatado nos prontuários. Conclusão: o Projeto ACERTO era bem praticado entre os cirurgiões pesquisados, havendo boa correlação entre o "imaginário" e "realidade" dos cuidados perioperatórios prescritos em pacientes submetidos à cirurgia bariátrica.

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Section: Discussionmentioning

confidence: 99%

Cuidados perioperatórios em cirurgia bariátrica no contexto do projeto ACERTO: realidade e o imaginário de cirurgiões em um hospital de Cuiabá

De-Marchi

De-Souza

Salomão

et al. 2017

Rev. Col. Bras. Cir.

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“…Standardized quality improvement efforts such as Enhanced Recovery (ER) protocols with colorectal surgery have been reported to be associated with improved patient satisfaction, decreased length of hospital stay, reduced complication rate, and reduced costs [19,20]. These evidence-based pathways provide the opportunity to standardize any number of aspects of patient care.…”

Section: Discussionmentioning

confidence: 99%

“…as [19][20][21][22][23][24][25] % for open repairs [7,8]. Other reasons for unplanned 30-day readmission following VIHR are ileus or obstruction, bleeding, pulmonary issues, and venous thromboembolism (VTE) [1].…”

mentioning

confidence: 99%

Ventral and incisional hernia: the cost of comorbidities and complications

et al. 2016

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ASA Class ≥ 3, Wound Class > 1, open abdominal wound, and postoperative complications significantly increase costs. Although the hospital encounter represents the majority of the cost associated with VIHR, additional costs are incurred during the 90-day postoperative period. An appreciation of global costs is essential in developing alternative payment models for hernia in order to provide the greatest value in hernia care.

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“…One procedure showed a reduction in lactate at various time points during and after major abdominal surgery, and the other showed reduced length of stay and hospital costs when PVI was used to guide intraoperative fluid management as part of an Enhanced Recovery After Surgery protocol. 76,77 In both instances, the PVI-guided group received less overall fluid than the control. Recently, PVI has been expanded beyond fluid responsiveness and has been used to predict both hypotension after induction of anesthesia and the hemodynamic impact of positive end-expiratory pressure.…”

Section: 6470-72mentioning

confidence: 97%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery

Cited by 365 publications

References 78 publications

Cuidados perioperatórios em cirurgia bariátrica no contexto do projeto ACERTO: realidade e o imaginário de cirurgiões em um hospital de Cuiabá

Cuidados perioperatórios em cirurgia bariátrica no contexto do projeto ACERTO: realidade e o imaginário de cirurgiões em um hospital de Cuiabá

Ventral and incisional hernia: the cost of comorbidities and complications

Advances in photoplethysmography: beyond arterial oxygen saturation

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