Evaluation of the effectiveness of an enhanced recovery after surgery program using data from the National Surgical Quality Improvement Program

• Published in: Canadian Journal of Surgery Vol. 62; no. 3; pp. 175 - 181
• Main Authors: Gresham, Louise M, Sadiq, Manahil, Gresham, Gillian, McGrath, Maureen, Lacelle, Kiley, Szeto, Michael, Trickett, John, Schramm, David, Pearsall, Emily, McKenzie, Marg, McLeod, Robin, Auer, Rebecca C
• Format: Journal Article
• Language: English
• Published: Ottawa Joule Inc 01.06.2019; CMA Impact, Inc
• Subjects: Best practice; Colorectal surgery; Data collection; Effectiveness; Evaluation; Hospitals; Management; Medical care quality; Mortality; Outcome and process assessment (Medical care); Patient outcomes; Patients; Postoperative care; Postoperative complications; Quality; Quality control; Quality improvement; Recovery (Medical); Statistical analysis; Studies; Success; Surgeons; Surgical outcomes; Sustainable development; Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.003518

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. Contexte : Il y a des obstacles au deploiement du programme de retablissement postoperatoire rapide ERAS (enhanced recovery after surgery), qui vise a reduire les taux de complications postoperatoires et a abreger les sejours hospitaliers, parce que les soins perioperatoires sont tres diversifies et que l'observance des equipes multidisciplinaires est cruciale a sa reussite. Les objectifs de ce projet etaient d'evaluer l'efficacite de la base de donnees NSQIP (National Surgical Quality Improvement Program) comme outil de controle continu des resultats du programme ERAS et pour evaluer ce dernier a titre de strategie d'amelioration de la qualite des soins dans les hopitaux. Methodes : Les patients adultes qui ont subi une intervention colorectale non urgente a l'Hopital d'Ottawa entre mars 2010 et septembre 2015 ont ete inclus. Les donnees demographiques, le statut fonctionnel, les antecedents medicaux, les details de l'intervention et la duree du sejour hospitalier (DSH) ont ete extraits de la base de donnees NSQIP. Nous avons compare la DSH, les complications post operatoires, les retours non planifies aux urgences et la mortalite a 30 j avant et apres le deploiement du programme ERAS. Resultats : Nous avons analyse les donnees sur 609 patients (318 [52,2 %] resection du colon, 291 [47,8 %] resection rectale; 190 [31,2 %] avant le deploiement du programme ERAS, 419 [68,8 %] apres). Un nombre significativement plus eleve de patients ont recu leur conge dans les 5 jours suivant leur chirurgie apres le deploiement du programme ERAS qu'avant (43,5 % c. 29,1 %, p < 0,05) et le nombre de DSH superieurs a 10 jours a aussi diminue (23,7 % c. 24,9 %, p < 0,001). Le deploiement du programme ERAS a ete associe a une reduction absolue de 12 % des complications postoperatoires et a une reduction significative des infections du site operatoire chez les patients soumis a une chirurgie ouverte (p = 0,04). Conclusion : L'instauration d'un programme ERAS pour la surveillance des soins peri operatoires standardises facilite une approche axee sur les donnees pour orienter l'application des lignes directrices de pratique et assurer la viabilite des protocoles ERAS et des processus de collecte de donnees.