Abstract
BackgroundEnhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP).MethodsA 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.Results1321 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.ConclusionERP 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.
Highlights
Enhanced recovery programme (ERP) for surgical patients is an approach for perioperative multimodal management of the patient aiming at a rapid restoration of previous physical and mental capacities allowing the reduction of perioperative morbidity
A Canadian team, having deployed an ERP on colonic surgery in more than 2 years in 15 academic hospitals, concludes to the importance of a demand that emerges from the field and the need for the cohesion of the institution (McLeod et al 2015)
The incidence of complications within the first month 2017 was unchanged in all types of surgical models except in 137 THA patients (11.1% in 2015 versus 1.5% in 2017, p= 96 0.029)
Summary
Enhanced recovery programme (ERP) for surgical patients is an approach for perioperative multimodal management of the patient aiming at a rapid restoration of previous physical and mental capacities allowing the reduction of perioperative morbidity. Several authors point out the difficulties or failures of the method. These guidelines remain difficult to adopt essentially because they require the simultaneous and complex involvement of all members of the perioperative team (Kahokehr et al 2009). Enhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP)
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