Majumdar Jennifer R, Assel Melissa J, Lang Stephanie A, Vickers Andrew J, Afonso Anoushka M
Departments of Anesthesiology and Critical Care Medicine, New York, NY, USA.
Epidemiology and Biostatistics, New York, NY, USA.
Asia Pac J Oncol Nurs. 2022 Mar 12;9(7):100047. doi: 10.1016/j.apjon.2022.02.009. eCollection 2022 Jul.
We reviewed internal data and the current literature to update our enhanced recovery protocol (ERP) for patients undergoing a total breast mastectomy. Following implementation, the protocol was audited by chart review and compliance reminders were sent through email.
Our primary research aim was to examine the protocol compliance following the update. Our secondary aims were to examine the association between the change in protocol and the rates of postoperative nausea and vomiting (PONV) and hematoma formation requiring reoperation.
We retrospectively obtained data extracted from the electronic medical record. To test for a difference in outcomes before versus after implementation of the protocol we used multivariable logistic regression with the primary comparisons excluding a ± one-month window and secondary comparisons excluding a ± three-month window from the date of implementation.
Our cohort included 5853 unique patients. Total intravenous anesthesia (TIVA) compliance increased by 17%-52% ( < 0.001) and the use of intraoperative ketorolac dropped from 44% to nearly no utilization (0.7%; < 0.001). The rate of reoperation due to bleeding decreased from 3.6% to 2.6% after implementation with the adjusted decrease being 1.0% (bootstrap 95% CI, 0.11%, 1.9%; = 0.053) excluding a ± 1 month window and 1.2% (bootstrap 95% CI, 0.24%, 2.0%; = 0.028) excluding a ± 3-month window. The rate of rescue antiemetics dropped by 6.4% (95% CI, 3.9%, 9.0%).
We were able to improve compliance for nearly all components of the protocol which translated to a meaningful change in an important patient outcome.
我们回顾了内部数据和当前文献，以更新我们针对接受全乳切除术患者的强化康复方案（ERP）。实施后，通过病历审查对该方案进行了审核，并通过电子邮件发送了合规提醒。
我们的主要研究目的是检查更新后的方案依从性。次要目的是检查方案变化与术后恶心呕吐（PONV）发生率以及需要再次手术的血肿形成之间的关联。
我们回顾性地获取了从电子病历中提取的数据。为了测试方案实施前后结果的差异，我们使用了多变量逻辑回归，主要比较排除了实施日期前后±1个月的窗口，次要比较排除了实施日期前后±3个月的窗口。
我们的队列包括5853名独特患者。全静脉麻醉（TIVA）的依从性提高了17% - 52%（<0.001），术中酮咯酸的使用从44%降至几乎不使用（0.7%；<0.001）。实施后，因出血导致的再次手术率从3.6%降至2.6%，排除±1个月窗口时调整后的降低率为1.0%（自助法95%CI，0.11%，1.9%；P = 0.053），排除±3个月窗口时为1.2%（自助法95%CI，0.24%，2.0%；P = 0.028）。抢救性止吐药的使用率下降了6.4%（95%CI，3.9%，9.0%）。
我们能够提高该方案几乎所有组成部分的依从性，这转化为重要患者结局的有意义变化。
