Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience
Implementation of Enhanced Recovery After Surgery (ERAS) Across a Provincial Healthcare System: The ERAS Alberta Colorectal Surgery Experience
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DOI：
10.1007/s00268-016-3472-7
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发表时间：
2016-05-01
影响因子：
2.6
通讯作者：
Gramlich, Leah M.
中科院分区：
文献类型：
--
作者：
Nelson, Gregg;Kiyang, Lawrence N.;Gramlich, Leah M.
手术后增强恢复（ERAS）结直肠指南的实施主要发生在世界各地的独立机构。我们在一个省的医疗系统中实施了该指南，我们的研究检查了该指南对整个医疗系统中患者结局[住院时间（LOS），并发症和出院后30天再入院]的影响。我们比较了连续择期结直肠患者实施指南前后的情况，18年每千日元，从2013年2月到2014年12月之间从六家阿尔伯塔医院。参与者被随访至出院后30天。我们采用汇总统计方法评估LOS和并发症，采用多元回归方法评估再入院率和估计费用影响，共分析了1333例患者（ERAS术前350例，术后983例）。其中55%为男性。ERAS前患者的总体指南依从性中位数为39%，ERAS后患者为60%。ERAS前的中位LOS为6天，而ERAS后患者的中位LOS为4.5天（p值< 0.0001）。比较ERAS前后患者，30天再入院的校正风险比（RR）为1.71，95% CI 1.09-2.68。从ERAS前到后，出现至少一种并发症的患者比例显着降低，比例差异= 11.7%，95%CI 2.5-21.0，p值：0.0139。净成本节省归因于指南的实施范围之间$2806和$5898 USD每patient.The研究结果表明，ERAS结直肠指南的实施在医疗保健系统内导致患者的结果改善，类似于那些在较小的独立实施。ERAS对稀缺的卫生系统资源产生了重大的有益影响。
Enhanced recovery after surgery (ERAS) colorectal guideline implementation has occurred primarily in standalone institutions worldwide. We implemented the guideline in a single provincial healthcare system, and our study examined the effect of the guideline on patient outcomes [length of stay (LOS), complications, and 30-day post-discharge readmissions] across a healthcare system.We compared pre- and post-guideline implementation in consecutive elective colorectal patients, a parts per thousand yen18 years, from six Alberta hospitals between February 2013 and December 2014. Participants were followed up to 30 days post discharge. We used summary statistics, to assess the LOS and complications, and multivariate regression methods to assess readmissions and to estimate cost impacts.A total of 1333 patients (350 pre- and 983 post-ERAS) were analysed. Of this number, 55 % were males. Median overall guideline compliance was 39 % in pre- and 60 % in post-ERAS patients. Median LOS was 6 days for pre-ERAS compared to 4.5 days in post-ERAS patients with the longest implementation (p value < 0.0001). Adjusted risk ratio (RR) was 1.71, 95 % CI 1.09-2.68 for 30-day readmission, comparing pre- to post-ERAS patients. The proportion of patients who developed at least one complication was significantly reduced, from pre- to post-ERAS, difference in proportions = 11.7 %, 95 % CI 2.5-21.0, p value: 0.0139. The net cost savings attributable to guideline implementation ranged between $2806 and $5898 USD per patient.The findings in our study have shown that ERAS colorectal guideline implementation within a healthcare system resulted in patient outcome improvements, similar to those obtained in smaller standalone implementations. There was a significant beneficial impact of ERAS on scarce health system resources.