Evaluation of the effectiveness of an enhanced recovery after surgery program using data from the National Surgical Quality Improvement Program
Evaluation of the effectiveness of an enhanced recovery after surgery program using data from the National Surgical Quality Improvement Program
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DOI：
10.1503/cjs.003518
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发表时间：
2019-06-01
影响因子：
2.5
通讯作者：
Auer, Rebecca C.
中科院分区：
文献类型：
--
作者：
Gresham, Louise M.;Sadiq, Manahil;Auer, Rebecca C.
背景资料：在实施旨在降低术后并发症发生率和住院时间的术后增强恢复（ERAS）方面存在障碍，因为围手术期护理是多种多样的，多学科团队的依从性对成功至关重要。本项目的目的是评估国家外科质量改进计划（NSQIP）数据库的有效性，作为一种工具，为正在进行的评估结果与ERAS和ERAS作为一种质量改进策略，在医院wide.Methods：成人患者谁接受了择期结直肠手术在渥太华医院2010年3月至2015年9月。从NSQIP数据库中提取有关人口统计学特征、功能状态、医学背景、手术细节和住院时间（LOS）的信息。我们比较了ERAS前后的结果（LOS、术后并发症、急诊非计划回访和30天死亡率）。结果：我们分析了609例患者的数据（318例[52.2%]结肠切除，291例[47.8%]直肠切除; ERAS前190例[31.2%]，ERAS后419例[68.8%]）。ERAS术后5天内出院的患者明显多于术前（43.5% v. 29.1%，p < 0.05），10天以上的LOS也减少（23.7% v. 24.9%，p < 0.001）。在接受开放手术的患者中，ERAS的实施与术后并发症的绝对减少12%和手术部位感染的显著减少相关（p = 0.04）。引入ERAS程序监测标准化围手术期护理有助于数据-（b）以一种驱动的方法指导实践准则的实施，并建立电子逆向拍卖系统协议和数据收集程序的可持续性。
Background: Barriers exist in implementing enhanced recovery after surgery (ERAS), which aims to decrease postoperative complication rates and length of stay, because perioperative care is varied and compliance from a multidisciplinary team is critical to success. The objectives of this project were to evaluate the effectiveness of the National Surgical Quality Improvement Program (NSQIP) database as a tool for the ongoing assessment of outcomes associated with ERAS and to evaluate ERAS as a quality-improvement strategy at a hospital-wide level.Methods: Adult patients who underwent an elective colorectal procedure at The Ottawa Hospital between March 2010 and September 2015 were included. Information on demographic characteristics, functional status, medical background, procedure details and hospital length of stay (LOS) was abstracted from the NSQIP database. We compared data on outcomes (LOS, postoperative complications, unplanned return visits to the emergency department and 30-day mortality) before and after ERAS.Results: We analyzed data for 609 patients (318 [52.2%] colon resection, 291 [47.8%] rectal resection; 190 [31.2%] before ERAS, 419 [68.8%] after ERAS). Significantly more patients were discharged within 5 days of surgery after ERAS than before (43.5% v. 29.1%, p < 0.05), and LOS more than 10 days was also reduced (23.7% v. 24.9%, p < 0.001). Implementation of ERAS was associated with an absolute reduction of 12% in postoperative complications and a significant reduction in surgical site infections among patients who underwent open procedures (p = 0.04).Conclusion: The introduction of an ERAS program for monitoring standardized perioperative care facilitates a data-driven approach to guide implementation of practice guidelines and establish the sustainability of ERAS protocols and data collection processes.