Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
Department of Gynecology, Lausanne University Hospital CHUV, Pierre Decker 2, University of Lausanne (UNIL), Lausanne, 1011, Switzerland.
World J Surg. 2021 Apr;45(4):940-945. doi: 10.1007/s00268-020-05926-z. Epub 2021 Jan 23.
Enhanced recovery after surgery (ERAS) pathways have considerably improved postoperative outcomes and are in use for various types of surgery. The prospective audit system (EIAS) could be a powerful tool for large-scale outcome research but its database has not been validated yet.
Swiss ERAS centers were invited to contribute to the validation of the Swiss chapter for colorectal surgery. A monitoring team performed on-site visits by the use of a standardized checklist. Validation criteria were (I) coverage (No. of operated patients within ERAS protocol; target threshold for validation: ≥ 80%), (II) missing data (8 predefined variables; target ≤ 10%), and (III) accuracy (2 predefined variables, target ≥ 80%). These criteria were assessed by comparing EIAS entries with the medical charts of a random sample of patients per center (range 15-20).
Out of 18 Swiss ERAS centers, 15 agreed to have onsite monitoring but 13 granted access to the final dataset. ERAS coverage was available in only 7 centers and varied between 76 and 100%. Overall missing data rate was 5.7% and concerned mainly the variables "urinary catheter removal" (16.4%) and "mobilization on day 1" (16%). Accuracy for the length of hospital stay and complications was overall 84.6%. Overall, 5 over 13 centers failed in the validation process for one or several criteria.
EIAS was validated in most Swiss ERAS centers. Potential patient selection and missing data remain sources of bias in non-validated centers. Therefore, simplified validation of other centers appears to be mandatory before large-scale use of the EIAS dataset.
术后加速康复（ERAS）方案显著改善了术后转归，目前已广泛应用于各类手术。前瞻性审核系统（EAS）是进行大规模结局研究的有力工具，但数据库尚未经过验证。
邀请瑞士 ERAS 中心参与验证瑞士结直肠外科章节。监测团队使用标准化清单进行现场访问。验证标准为：（I）覆盖率（符合 ERAS 方案的手术患者数量；验证目标阈值：≥80%），（II）缺失数据（8 个预定义变量；目标值≤10%）和（III）准确性（2 个预定义变量，目标值≥80%）。通过对每个中心的随机患者样本（范围为 15-20 例）的 EIAS 条目与医疗记录进行比较，评估这些标准。
在 18 家瑞士 ERAS 中心中，有 15 家同意进行现场监测，但只有 13 家同意提供最终数据集。仅 7 家中心提供 ERAS 覆盖率，范围为 76%-100%。总体缺失数据率为 5.7%，主要涉及“导尿管拔除”（16.4%）和“第 1 天开始活动”（16%）这两个变量。住院时间和并发症的准确性总体为 84.6%。共有 5 家中心中超过 13 家在一个或多个标准的验证过程中失败。
EAS 在大多数瑞士 ERAS 中心得到验证。在未经验证的中心，潜在的患者选择和缺失数据仍然是偏倚的来源。因此，在大规模使用 EAS 数据集之前，简化对其他中心的验证似乎是必要的。
