Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK.
Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, UK; Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
Br J Anaesth. 2022 Jul;129(1):114-126. doi: 10.1016/j.bja.2022.03.021. Epub 2022 May 12.
Enhanced recovery pathways are associated with improved postoperative outcomes. However, as enhanced recovery pathways have become more complex and varied, compliance has reduced. The 'DrEaMing' bundle re-prioritises early postoperative delivery of drinking, eating, and mobilising. We investigated relationships between DrEaMing compliance, postoperative hospital length of stay (LOS), and complications in a prospective multicentre major surgical cohort.
We interrogated the UK Perioperative Quality Improvement Programme dataset. Analyses were conducted in four stages. In an exploratory cohort, we identified independent predictors of DrEaMing. We quantified the association between delivery of DrEaMing (and its component variables) and prolonged LOS in a homogenous colorectal subgroup and assessed generalisability in multispecialty patients. Finally, LOS and complications were compared across hospitals, stratified by DrEaMing compliance.
The exploratory cohort comprised 22 218 records, the colorectal subgroup 7230, and the multispecialty subgroup 5713. DrEaMing compliance was 59% (13 112 patients), 60% (4341 patients), and 60% (3421), respectively, but varied substantially between hospitals. Delivery of DrEaMing predicted reduced odds of prolonged LOS in colorectal (odds ratio 0.51 [0.43-0.59], P<0.001) and multispecialty cohorts (odds ratio 0.47 [0.41-0.53], P<0.001). At the hospital level, complications were not the primary determinant of LOS after colorectal surgery, but consistent delivery of DrEaMing was associated with significantly shorter LOS.
Delivery of bundled and unbundled DrEaMing was associated with substantial reductions in postoperative LOS, independent of the effects of confounder variables. Consistency of process delivery, and not complications, predicted shorter hospital-level length of stay. DrEaMing may be adopted by perioperative health systems as a quality metric to support improved patient outcomes and reduced hospital length of stay.
强化康复路径与改善术后结果相关。然而，随着强化康复路径变得更加复杂和多样化，其依从性降低。“DrEaMing”方案重新优先考虑术后早期饮水、进食和活动。我们在一个前瞻性多中心大手术队列中研究了 DrEaMing 依从性、术后住院时间（LOS）和并发症之间的关系。
我们查询了英国围手术期质量改进计划数据集。分析分四个阶段进行。在探索性队列中，我们确定了 DrEaMing 的独立预测因素。我们量化了在同质结直肠亚组中提供 DrEaMing（及其组成变量）与延长 LOS 之间的关联，并评估了多专业患者的普遍性。最后，根据 DrEaMing 依从性对医院进行分层，比较 LOS 和并发症。
探索性队列包括 22218 份记录、7230 份结直肠亚组和 5713 份多专业亚组。DrEaMing 的依从性分别为 59%（13112 例）、60%（4341 例）和 60%（3421 例），但医院之间差异很大。在结直肠（比值比 0.51 [0.43-0.59]，P<0.001）和多专业队列（比值比 0.47 [0.41-0.53]，P<0.001）中，提供 DrEaMing 预测了 LOS 延长的可能性降低。在医院层面，结直肠手术后 LOS 的主要决定因素不是并发症，而是 DrEaMing 的一致提供与 LOS 显著缩短相关。
捆绑和非捆绑 DrEaMing 的提供与术后 LOS 的显著减少相关，独立于混杂变量的影响。流程提供的一致性，而不是并发症，预测了医院层面的住院时间缩短。DrEaMing 可被围手术期卫生系统采用作为质量指标，以支持改善患者结局和缩短住院时间。
