Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes
| Autor: | Sarah Glaze, Xiaoming Wang, Leah Gramlich, S.P. Bisch, Pamela Chu, T. Wells, Gregg Nelson, Jill Nation, J. Sabourin, Nguyen Xuan Thanh, Prafull Ghatage, Valerie Capstick, Peter Faris, Helen Steed, Dat T. Tran |
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| Rok vydání: | 2018 |
| Předmět: |
Program evaluation
medicine.medical_specialty Genital Neoplasms Female MEDLINE Audit Gynecologic oncology Patient Readmission Perioperative Care 03 medical and health sciences 0302 clinical medicine Gynecologic Surgical Procedures Postoperative Complications Audit system Cost Savings Medicine Humans Enhanced recovery after surgery Aged Medical Audit 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology Cytoreduction Surgical Procedures After discharge Length of Stay Middle Aged Debulking Patient Discharge Oncology 030220 oncology & carcinogenesis Emergency medicine Practice Guidelines as Topic Female Guideline Adherence business Program Evaluation |
| Zdroj: | Gynecologic oncology. 151(1) |
| ISSN: | 1095-6859 |
| Popis: | Enhanced recovery pathways have been shown to reduce length of stay without increasing readmission or complications in numerous areas of surgery. Uptake of gynecologic oncology ERAS guidelines has been limited. We describe the effect of ERAS guideline implementation in gynecologic oncology on length of stay, patient outcomes, and economic impact for a province-wide single-payer system.We compared pre- and post-guideline implementation outcomes in consecutive staging and debulking patients at two centers that provide the majority of surgical gynecologic oncology care in Alberta, Canada between March 2016 and April 2017. Clinical outcomes and compliance were obtained using the ERAS Interactive Audit System. Patients were followed until 30 days after discharge. Negative binomial regression was employed to adjust for patient characteristics.We assessed 152 pre-ERAS and 367 post-ERAS implementation patients. Mean compliance with ERAS care elements increased from 56% to 77.0% after implementation (p 0.0001). Median length of stay for all surgeries decreased from 4.0 days to 3.0 days post-ERAS (p 0.0001), which translated to an adjusted LOS decrease of 31.4% (95% CI = [21.7% - 39.9%], p 0.0001). In medium/high complexity surgery median LOS was reduced by 2.0 days (p = 0.0005). Complications prior to discharge decreased from 53.3% to 36.2% post-ERAS (p = 0.0003). There was no significant difference in readmission (p = 0.6159), complications up to 30 days (p = 0.6274), or mortality (p = 0.3618) between the cohorts. The net cost savings per patient was $956 (95%CI: $162 to $1636).Systematic implementation of ERAS gynecologic oncology guidelines across a healthcare system improves patient outcomes and saves resources. |
| Databáze: | OpenAIRE |
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