Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium.
Department of Quality, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
Ann Surg. 2022 Nov 1;276(5):890-896. doi: 10.1097/SLA.0000000000005646. Epub 2022 Aug 2.
This multicenter study aimed to assess (1) the effect of an improvement collaborative on enhanced recovery after surgery (ERAS) protocol adherence after elective colectomy and (2) the association between adherence and patient outcomes.
ERAS pathways provide a framework to standardize care processes and improve postoperative outcomes in patients after colon surgery. Despite growing evidence of its effectiveness, adherence to these guidelines remains a challenge.
This prospective, multicenter collaborative was initiated throughout 11 hospitals in Flanders, Belgium. A structured audit tool was used to study patient outcomes and adherence to 12 ERAS components, defined by the collaborative. Three retrospective audits (based on patient record analysis) were conducted in 2017, 2019, and 2021, respectively.
Overall, 740 patients were included (45.4% female; mean±SD age, 71±12 years). The overall adherence increased from 42.8% in 2017 to 58.4% in 2019 and 69.2% in 2021. Compared with low adherence, length of stay was increasingly reduced by 1.3 days for medium [95% confidence interval (95% CI): -2.5; 0.0], 3.6 days for high (95% CI: -4.9; -2.2), and up to 4.4 days for very high adherence (95% CI: -6.1; -2.7). Corresponding odds ratios for postoperative complications were 0.62 (95% CI: 0.33; 1.17), 0.19 (95% CI: 0.09; 0.43), and 0.14 (95% CI: 0.05; 0.39), respectively. No increase in 30-day readmissions was observed.
A peer-constructed improvement collaborative effectively increases adherence to an ERAS protocol in individual hospitals. Across time, length of stay and postoperative complications decreased significantly, and a dose-response relationship was observed.
本多中心研究旨在评估（1）改进协作对择期结肠切除术患者术后加速康复（ERAS）方案依从性的影响，以及（2）依从性与患者结局之间的关联。
ERAS 路径为结肠手术后患者的护理流程标准化和改善术后结局提供了框架。尽管其有效性的证据不断增加，但对这些指南的依从仍然是一个挑战。
本前瞻性多中心协作在比利时弗拉芒地区的 11 家医院开展。使用结构化审核工具研究患者结局和 12 项 ERAS 组成部分的依从性，这些组成部分由协作定义。分别于 2017 年、2019 年和 2021 年进行了 3 次回顾性审核（基于患者病历分析）。
共纳入 740 例患者（45.4%为女性；平均年龄±标准差为 71±12 岁）。整体依从性从 2017 年的 42.8%增加到 2019 年的 58.4%和 2021 年的 69.2%。与低依从性相比，中依从性使住院时间减少 1.3 天[95%置信区间（95%CI）：-2.5；0.0]，高依从性减少 3.6 天[95%CI：-4.9；-2.2]，非常高依从性减少 4.4 天[95%CI：-6.1；-2.7]。术后并发症的相应比值比为 0.62（95%CI：0.33；1.17）、0.19（95%CI：0.09；0.43）和 0.14（95%CI：0.05；0.39）。未观察到 30 天再入院率增加。
由同行构建的改进协作可有效提高个体医院 ERAS 方案的依从性。随着时间的推移，住院时间和术后并发症显著减少，并且观察到剂量-反应关系。
