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

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.

Development and Impact of an Institutional Enhanced Recovery Program on Opioid Use, Length of Stay, and Hospital Costs Within an Academic Medical Center

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Robert H. Thiele ◽  
Bethany M. Sarosiek ◽  
Susan C. Modesitt ◽  
Timothy L. McMurry ◽  
Mohamed Tiouririne ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Costs ◽  
Opioid Use ◽  
Enhanced Recovery Program ◽  
Academic Medical ◽  
Recovery Program

scholarly journals Implementation of enhanced recovery program after surgery (ERAS) in patients undergoing pancreatectomy: a controlled before and after study

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S700-S701
Author(s):  
J. Perinel ◽  
A. Duclos ◽  
T. Dagonneau ◽  
C. Payet ◽  
Y. Bouffard ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery Program ◽  
Before And After ◽  
Recovery Program ◽  
Before And After Study

scholarly journals Sustainability of an Enhanced Recovery Program for Pancreaticoduodenectomy with Pancreaticogastrostomy

2018 ◽  
Vol 108 (1) ◽  
pp. 17-22 ◽  
Author(s):  
C. Williamsson ◽  
T. Karlsson ◽  
M. Westrin ◽  
D. Ansari ◽  
R. Andersson ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Positive Outcome ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Adherence Rate ◽  
Strict Adherence ◽  
Abdominal Drain ◽  
Enhanced Recovery Program ◽  
Recovery Program

Background: Enhanced recovery program for pancreaticoduodenectomy have become standard care. Little is known about adherence rates and sustainability of the program, especially when pancreaticogastrostomy is used in reconstruction. The aim of this study was, therefore, to evaluate adherence rates and continued outcome, after implementation of an enhanced recovery program. Methods: Consecutive patients undergoing pancreaticoduodenectomy at the Department of Surgery, Skåne University Hospital, Lund, Sweden were followed, after implementation of enhanced recovery program, October 2012. In April 2015, some items in the enhanced recovery program were modified, namely earlier removal of nasogastric tubes and abdominal drain. The patients were analyzed in three groups, the implementation group (control) and two post-implementation groups; intermediate and modified group. Sustainability was assessed according to length of stay and adherence rate. Results: In total, 160 patients were identified. The overall protocol adherence rate increased from 65% to 72%, p = 0.035. While the pre- and intraoperative protocol items were fulfilled to more than >90%, the postoperative were lower, but increasing over time; 48%, 50%, and 58%, p = 0.033. Postoperative complications and hospital length of stay did not change significantly. Conclusion: The positive outcome of an enhanced recovery program for pancreaticoduodenectomy was reasonably well sustained. Compliance with the protocol has increased, but strict adherence remains a challenge, especially with the postoperative items.

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