From the Faculty of Medicine, University of British Columbia, Vancouver, BC (D’Souza, Choi, Wallace); the Interior Health Authority Quality, Risk, and Accreditation, Royal Inland Hospital, Kamloops, BC (Wootton, Wallace); and the Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC (Wallace).
Can J Surg. 2019 Feb 1;62(1):25-32. doi: 10.1503/cjs.015617.
Standardized care protocols offer the potential to reduce postoperative complication rates. The purpose of this study was to determine whether there was an additive benefit associated with the sequential implementation of the evidence-based surgical site infection bundle (SSIB) and enhanced recovery after surgery (ERAS) protocols for patients undergoing colorectal surgery in a community hospital.
Patients at a single institution who underwent elective colorectal surgery between Apr. 1, 2011, and Dec. 31, 2015, were identified by means of American College of Surgeons National Surgical Quality Improvement Program data. Patients were stratified into 3 groups according to the protocol implementation dates: pre-SSIB/pre-ERAS (control), post-SSIB/pre-ERAS and post-SSIB/post-ERAS. Primary outcomes assessed were length of stay and wound complication rates. We used inverse proportional weighting to control for possible differences between the groups.
There were 368 patients included: 94 in the control group, 95 in the post-SSIB/pre-ERAS group and 179 in the post-SSIB/post-ERAS group. In the adjusted analyses, mean length of stay (control group 7.6 d, post-SSIB/post-ERAS group 5.5 d, p = 0.04) and overall wound complication rates (14.7% and 6.5%, respectively, p = 0.049) were reduced after sequential implementation of the protocols.
Sequential implementation of quality-improvement initiatives yielded additive benefit for patients undergoing colorectal surgery in a community hospital, with a decrease in length of stay and wound complication rates. The amount of improvement attributable to either initiative is difficult to define as they were implemented sequentially. The improved outcomes were realized after the introduction of the ERAS protocol in adjusted analyses.
标准化护理方案有可能降低术后并发症发生率。本研究旨在确定在社区医院对行结直肠手术的患者连续实施基于循证的手术部位感染预防包(SSIB)和术后加速康复(ERAS)方案是否具有附加获益。
通过美国外科医师学会国家外科质量改进计划(ACS-NSQIP)数据,确定 2011 年 4 月 1 日至 2015 年 12 月 31 日期间在一家机构接受择期结直肠手术的患者。根据方案实施日期将患者分为 3 组:SSIB/ERAS 实施前(对照组)、SSIB 实施后/ERAS 实施前和 SSIB 实施后/ERAS 实施后。评估的主要结局是住院时间和伤口并发症发生率。我们使用倒数比例权重来控制组间可能存在的差异。
纳入 368 例患者:对照组 94 例,SSIB 实施后/ERAS 实施前组 95 例,SSIB 实施后/ERAS 实施后组 179 例。在调整分析中,与对照组相比,SSIB/ERAS 方案连续实施后,平均住院时间(对照组 7.6 d,SSIB/ERAS 实施后组 5.5 d,p = 0.04)和总伤口并发症发生率(分别为 14.7%和 6.5%,p = 0.049)降低。
在社区医院对行结直肠手术的患者连续实施质量改进措施可产生附加获益,住院时间和伤口并发症发生率降低。由于这两项措施是连续实施的,因此很难确定每项措施的改进程度。在调整分析中,引入 ERAS 方案后,结果得到了改善。