Sauro K, Thomas A, Bakunda L, Smith C, Ibadin S, Kuzma T, Nelson G
Department of Surgery, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB, T2N 4Z6, Canada.
Department of Community Health Sciences & O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
BMC Surg. 2025 Aug 2;25(1):336. doi: 10.1186/s12893-025-03085-3.
The Enhanced Recovery After Surgery (ERAS) Interactive Audit System (EIAS) is a retrospective database containing information about the pre-, intra-, and post-operative components of surgical patient care. EIAS was created to allow centers that have adopted ERAS protocols to assess their performance. To have confidence in the data collected by EIAS, its completeness, accuracy and validity must be assessed. This study aims to assess the validity of the Alberta EIAS when compared to the gold standard measurement for patient data, the patient electronic medical record (EMR).
Four sites that implemented ERAS across Alberta were included, with 20 to 60 patient EMRs pulled from each site. Data on 12 pre-specified ERAS elements and three outcome variables was abstracted from patient EMRs and compared to the corresponding variables from EIAS. Validation criteria included (I) accuracy (agreement between EMR and EIAS) and (II) missingness (percent of data that was missing in patients EMR and EIAS). The estimates of accuracy were compared to estimates of accuracy from two other EIAS validation studies using meta-analysis.
A total of 113 patient charts were reviewed across four sites. The mean agreement between chart review and EIAS was 73.6% (standard deviation, SD = 14.5) with a mean sensitivity of 70.3 (SD = 32.8) and mean specificity of 50.1 (SD = 42.5). Agreement between chart review and EIAS was better among outcomes (agreement for re-operation was 93.7%) than it was for accuracy of documentation of the ERAS elements (mean agreement = 73.6%). Agreement varied by site (68.5% to 94.4%) and reviewer (68.0% to 96.6%). Across all 12 ERAS elements and three outcome variables, a mean of 11.4% of data were missing, with re-operation having the greatest proportion of missing data (15.9%) and termination of drains and early mobilization with the lowest proportion of missing data (9.7%). Estimates of accuracy were not different between studies (I = 56.4%, p = 0.101).
In Alberta, the accuracy and completeness of EIAS data is similar to that of Sweden and Switzerland, but is varied. This study found that data abstractors that are medically trained, and trained in standardized data abstraction are important determinants of generating high quality data, highlighting the need for adequate resources for data collection.
术后加速康复（ERAS）交互式审核系统（EIAS）是一个回顾性数据库，包含手术患者术前、术中和术后护理的相关信息。创建EIAS的目的是让采用ERAS方案的中心能够评估自身表现。为了对EIAS收集的数据有信心，必须评估其完整性、准确性和有效性。本研究旨在将艾伯塔省的EIAS与患者数据的金标准测量方法即患者电子病历（EMR）进行比较，以评估其有效性。
纳入了艾伯塔省实施ERAS的四个地点，每个地点抽取20至60份患者EMR。从患者EMR中提取了12个预先指定的ERAS要素和三个结果变量的数据，并与EIAS中的相应变量进行比较。验证标准包括（I）准确性（EMR与EIAS之间的一致性）和（II）缺失情况（患者EMR和EIAS中缺失数据的百分比）。使用荟萃分析将准确性估计值与另外两项EIAS验证研究的准确性估计值进行比较。
共审查了四个地点的113份患者病历。病历审查与EIAS之间的平均一致性为73.6%（标准差，SD = 14.5），平均敏感性为70.3（SD = 32.8），平均特异性为50.1（SD = 42.5）。病历审查与EIAS之间在结果方面的一致性（再次手术的一致性为93.7%）优于ERAS要素记录准确性方面的一致性（平均一致性 = 73.6%）。一致性因地点（68.5%至94.4%）和审查者（68.0%至96.6%）而异。在所有12个ERAS要素和三个结果变量中，平均有11.4%的数据缺失，再次手术的缺失数据比例最高（15.9%），引流管拔除和早期活动的缺失数据比例最低（9.7%）。各研究之间的准确性估计值没有差异（I = 56.4%，p = 0.101）。
在艾伯塔省，EIAS数据的准确性和完整性与瑞典和瑞士相似，但存在差异。本研究发现，经过医学培训且接受过标准化数据提取培训的数据提取人员是生成高质量数据的重要决定因素，这突出了数据收集需要充足资源的必要性。
