Wide Variation in Perioperative Care in Anatomical Lung Resections in the Netherlands: A National Survey

Meyenfeldt, Erik M. von; Betue, Carlijn T.I. de; Berg, Rosaline van den; Thiel, E.; Schreurs, Wilhelmina H.; Marres, Geertruid M H

doi:10.1053/j.semtcvs.2020.05.015

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…In a Dutch national survey, it was the implementation of the preoperative care elements of ERAS that was most problematic with poor implementation of fasting protocols and carbohydrate loading [15]. In another study, patients admitted for thoracic surgery had a median fast for fluids of 8 h and for solids of 16 h [16].…”

Section: Preoperative Hydration and Fastingmentioning

confidence: 99%

Modern fluid management in thoracic surgery

Batchelor

2023

Current Opinion in Anaesthesiology

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Purpose of review To provide an approach to perioperative fluid management for lung resection patients that incorporates the entire patient pathway in the context of international guidelines on enhanced recovery after surgery (ERAS). Recent findings The concern with intraoperative fluid management is that giving too little or too much fluid is associated with worse outcomes after lung resection. However, it has not emerged as a key care element in thoracic ERAS programs probably due to the influence of other ERAS elements. Carbohydrate loading 2 h before surgery and the allowance of water until just prior to induction ensures the patient is both well hydrated and metabolically normal when they enter the operating room. Consequently, maintaining a euvolemic state during anesthesia can be achieved without goal-directed fluid therapy despite the recommendations of some guidelines. Intravenous fluids can be safely stopped in the immediate postoperative period. Summary The goal of perioperative euvolemia can be achieved with the ongoing evolution and application of ERAS principles. A focus on the pre and postoperative phases of fluid management and a pragmatic approach to intraoperative fluid management negates the need for goal-directed fluid therapy in most cases.

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Section: Preoperative Hydration and Fastingmentioning

confidence: 99%

Modern fluid management in thoracic surgery

Batchelor

2023

Current Opinion in Anaesthesiology

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“…Interestingly, wide variations are reported in literature reagarding the extent to which ERAS guidelines are implemented in clinical practice ( 6 - 8 ). As such, a Dutch national survey assessing 23 topics of the 45 recommendations demonstrated that 20 of the 43 responding surgical centers had an ERAS/ESTS score (defined as the amount of compliance) between 65% and 86% of the maximum score, indicating an intermediately high to high compliance in only half of centers ( 6 ).…”

Section: “Key Care Elements” Approach To Postoperative Eras Pathwaysmentioning

confidence: 99%

“…Interestingly, wide variations are reported in literature reagarding the extent to which ERAS guidelines are implemented in clinical practice (6)(7)(8). As such, a Dutch national survey assessing 23 topics of the 45 recommendations demonstrated that 20 of the 43 responding surgical centers had an ERAS/ESTS score (defined as the amount of compliance) between 65% and 86% of the maximum score, indicating an intermediately high to high compliance in only half of centers (6). Not only does this survey show a large variation in perioperative care, it is important to notice that this percentage does not reflect a proper representation of the actual care delivered to the individual patient.…”

mentioning

confidence: 99%

Thinking outside the “Enhanced Recovery After Surgery” box: would a more progressive, patient-tailored approach in chest tube management be next?

Laven¹,

Franssen²,

Daemen³

et al. 2023

J Thorac Dis

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“…In absence of a Dutch clinical guideline on perioperative care in patients with lung resection, practice variation exists for these patients. 12 This variation in perioperative care is associated with variation in clinical outcomes, for example, length of stay and complications. 3 4 Due to the mandatory registration in the Dutch national lung surgery audit, reliable national data are available regarding the number of anatomical lung resections per year (over 2200), length of stay (4–8 days) and complications (30%) in the Netherlands.…”

Section: Introductionmentioning

confidence: 99%

Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation

et al. 2022

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ObjectivesThis study aims to elucidate determinants for succesful implementation of the Enhanced Recovery After Thoracic Surgery (ERATS) protocol for perioperative care for surgical lung cancer patients in the Netherlands.SettingLung cancer operations are performed in both academic and regional hospitals, either by cardiothoracic or general thoracic surgeons. Limiting the impact of these operations by optimising and standardising perioperative care with the ERATS protocol is thought to enable reduction in length of stay, complications and costs.ParticipantsA broad spectrum of stakeholders in perioperative care for patients with lung resection participated in this study, ranging from patient representatives, healthcare professionals to an insurance company representative.InterventionsSemistructured interviews (N=14) were conducted with the stakeholders (N=18). The interviews were conducted one on one by telephone and two times, face to face, in small groups. Verbatim transcriptions of these interviews were coded for the purpose of thematic analysis.Outcome measuresDeterminants for successful implementation of the ERATS protocol in the Netherlands.ResultsSeveral determinants correspond with previous publications: having a multidisciplinary team, leadership from a senior clinician and support from an ERAS-coordinator as facilitators; lack of feedback on performance and absence of management support as barriers. Our study underscores the potential detrimental effect of inconsistent communication, the lack of support in the transition from hospital to home and the barrier posed by lack of accessible audit data.ConclusionsBased on a structured problem analysis among a wide selection of stakeholders, this study provides a solid basis for choosing adequate implementation strategies to introduce the ERATS protocol in the Netherlands. Emphasis on consistent and sufficient communication, support in the transition from hospital to home and adequate audit and feedback data, in addition to established implementation strategies for ERAS-type programmes, will enable a tailored approach to implementation of ERATS in the Dutch context.

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Wide Variation in Perioperative Care in Anatomical Lung Resections in the Netherlands: A National Survey

Cited by 10 publications

References 14 publications

Modern fluid management in thoracic surgery

Modern fluid management in thoracic surgery

Thinking outside the “Enhanced Recovery After Surgery” box: would a more progressive, patient-tailored approach in chest tube management be next?

Implementing an enhanced recovery after thoracic surgery programme in the Netherlands: a qualitative study investigating facilitators and barriers for implementation

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