scholarly journals Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hakim Harkouk ◽  
Perrine Capmas ◽  
Nawal Derridj ◽  
Anissa Belbachir ◽  
Lionelle Nkam ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Application Rate ◽  
University Hospitals ◽  
Top Down ◽  
Enhanced Recovery Programme ◽  
Massive Open Online Course ◽  
Application Rates ◽  
Control Intervention ◽  
Before And After ◽  
Total Knee

Abstract Background Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP). Methods A retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure. Results 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together. Conclusion ERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.

scholarly journals Evolution of enhanced recovery program in French university hospitals: a before-after retrospective survey

2020 ◽  
Author(s):  
Hakim Harkouk ◽  
Perrine Capmas ◽  
Nawal Derridj ◽  
Anissa Belbachir ◽  
Lionelle Nkam ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Elective Surgery ◽  
Application Rate ◽  
University Hospitals ◽  
Massive Open Online Course ◽  
Enhanced Recovery Program ◽  
Control Intervention ◽  
Before And After ◽  
Recovery Program

Abstract Background: Enhanced recovery program (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris.Methods: a retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy, and hysterectomy) in 17 hospitals including 29 surgical departments. For each elective surgery, data were collected in one control intervention (Total hip arthroplasty (THA), gastrectomy and ovariectomy).To favour development of ERP strategy, in 2016, institutional mobilization developed with one day meeting of information, development of a Massive Open Online Course on ERP, diffusion of national update on ERP by Haute Autorité de Santé and inclusion in a regional professional partnership program. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. 70 % application rate reflects application of ERP procedure.Results: 1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The length of stay (LOS, mean (SD)) is reduced by 1.6 day for TKA (2015: 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but increases of 0.5 day for THA (2015: 8.2 (4.1) versus 8.7 (15.5) in 2017; p=0.011). LOS is stable for colectomy and hysterectomy as in their control groups (i.e. gastrectomy and ovariectomy). Incidence of severe complications after surgery is unchanged in all type of surgical models except in THA patients (11.1% in 2015 and 1.5% in 2017, p=0.029). For TKA and hysterectomy respectively applied items of ERP (i.e: >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. All centres progressed in ERP between 2015 and 2017 for TKA (7/7 centres) and hysterectomy (6/6 centres). The LOS was negatively correlated with ERP items application when data collected in 2015 and 2017 were analyzed together.Conclusion: ERP application improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals

Quantification of Reduction in Hydraulic Conductivity and Skid Resistance Caused by Fog Seal in Low-Volume Roads

2017 ◽  
Vol 2657 (1) ◽  
pp. 99-108 ◽  
Author(s):  
Readul Mohammad Islam ◽  
Shams Arafat ◽  
Nazimuddin M. Wasiuddin
Keyword(s):  
Hydraulic Conductivity ◽  
Low Cost ◽  
Surface Friction ◽  
Application Rate ◽  
Application Rates ◽  
Low Volume Roads ◽  
Before And After ◽  
Road Type ◽  
Rate Of Recovery ◽  
Low Volume

Fog seal increases pavement life and postpones major rehabilitation. The reduction of permeability caused by fog sealing will reduce moisture-induced damage, but this benefit comes with a temporary loss of surface friction. However, quantifying the effectiveness of fog sealing by measuring permeability is a difficult task. Although fog seal may be a good low-cost maintenance option for low-volume roads, the rate of recovery of friction may be very slow because of less rubbing action between the fog-sealed surface and tires. Four low-volume parish roads in Caddo Parish, Louisiana, were selected for this study. Two emulsions, CSS-1H and E-Fog, with three application rates, were used to evaluate the reduction in hydraulic conductivity and to assess the characteristics of friction over time. Results showed that fog seal can be expected to be fully cured within 2.5 to 3.5 hours for an application rate of 0.2 to 0.4 gallons per square yard (gal/yd2). The same field cores were tested before and after fog sealing to quantify exactly the reduction in hydraulic conductivity. It was observed that fog seal has a significant potential to reduce hydraulic conductivity. Considering all four pavements and application rates of 0.1 to 0.22 gal/yd2, the average reduction in hydraulic conductivity was 38.5%. Reduction in hydraulic conductivity shows very slight sensitivity to the application rate. Irrespective of road type, emulsion, and application rate, fog seal causes a sudden drop in the International Friction Index parameter F60 by 20% to 40%. A fog-sealed surface does not return to the original level of friction after three months; however, the rate of recovery was the highest for the busiest of the observed Caddo Parish roads.

Challenges to the Orthopaedic Arthroplasty Enhanced Recovery Programme

2017 ◽  
Vol 27 (1-2) ◽  
pp. 15-20 ◽  
Author(s):  
HL Kerr ◽  
LA Armstrong ◽  
L Beard ◽  
D Teichmann ◽  
J Mutimer
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Medical Problems ◽  
Enhanced Recovery Programme ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

We performed a retrospective study of patients undergoing total knee and hip arthroplasty on an enhanced recovery programme, to identify pre- and postoperative factors contributing to an increased length of hospital stay. Of 109 patients, only 61 (56%) were ready for discharge on the fifth postoperative day. The three most common reasons for delays were oozing wounds, postoperative medical problems and failure to reach physiotherapy goals.

scholarly journals Risk Factors of Opioid use Associated with an Enhanced-Recovery Programme after Total Knee Arthroplasty

2021 ◽  
Author(s):  
Guorui Cao ◽  
Fuxing Pei
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Protective Factor ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Enhanced Recovery Programme ◽  
Total Knee

Abstract Background: The relationship between total knee arthroplasty (TKA) and postoperative opioid use is poorly studied. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA.Methods: We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Multivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were recorded and compared.Results: The prevalence of opioid use after primary TKA was 23.0%. Significant risk factor were more operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and protective factor was tranexamic acid use (OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05).Conclusion: Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use. Reducing operative time and application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

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