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Huang T, Wang J, Chen Y, Ye Z, Fang Y, Xia Y. Knowledge, attitude and application towards fast track surgery among operating room paramedics: a cross-sectional study. BMC Health Serv Res 2022; 22:1401. [PMID: 36424590 PMCID: PMC9685959 DOI: 10.1186/s12913-022-08817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fast track surgery has shown its effectiveness to accelerate recovery and gained acceptance in many operations. However, data for paramedics using fast track surgery are limited in China. The aims of our study are to evaluate the knowledge, attitude and application status of fast track surgery in paramedics and to provide suggestions for the better application of fast track surgery. METHODS Two Hundred Ninety-one operating room paramedics were investigated by simple random sampling from October 20 to December 20, 2019 time. A self-reported questionnaire was used to collect data with five dimensions: demographic data, cognitive level, knowledge, attitude and application of fast track surgery. Data were analyzed using qualitative and quantitative methods. RESULTS 19.93% of participants never heard fast track surgery and only 3.32% of participants were very familiar with it. Gender (0.702, 95% CI 0.109-1.294), technical title (0.342, 95% CI 0.126-0.558) and awareness of the concept of fast track surgery (0.471, 95% CI 0.165-0.776) had a correlation with the knowledge level of paramedics towards fast track surgery. In terms of attitude towards fast track surgery, gender (- 1.944, 95% CI -3.830- -0.058), age (0.303, 95% CI 0.021-0.585) and knowledge score of fast track surgery (0.426, 95% CI 0.014-0.838) are related. Half of the paramedics believe the most difficult problem in the application of fast track surgery was the lack of multi-team communication and cooperation. CONCLUSION The knowledge of fast track surgery among paramedics in Wuhan is poor, and some paramedics have a negative attitude towards it. As the attitude is positively correlated with the knowledge, it is necessary to improve the knowledge level of fast track surgery among paramedics in Wuhan.
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Affiliation(s)
- Ting Huang
- grid.412632.00000 0004 1758 2270Renmin Hospital of Wuhan University, Wuhan, P. R. China
| | - Jingming Wang
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yuanyao Chen
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Zhen Ye
- grid.33199.310000 0004 0368 7223Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yiwei Fang
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Yuze Xia
- grid.33199.310000 0004 0368 7223Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
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Perioperative Care in Colorectal Cancer Surgery before a Structured Implementation Program of the ERAS Protocol in a Regional Network. The Piemonte EASY-NET Project. Healthcare (Basel) 2021; 10:healthcare10010072. [PMID: 35052236 PMCID: PMC8775376 DOI: 10.3390/healthcare10010072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 01/02/2023] Open
Abstract
Background: In 2019, the Enhanced Recovery After Surgery (ERAS) protocol for colorectal cancer surgery was adopted by a minority of hospitals in Piemonte (4.3 million inhabitants, north-west Italy). The present analysis aims to compare the level of application of the ERAS protocol between hospitals already adopting it (ERAS, N = 3) with the rest of the regional hospitals (non-ERAS, N = 28) and to identify possible obstacles to its application. Methods: All patients surgically treated for a newly diagnosed colorectal cancer during September–November 2019, representing the baseline period of a randomized controlled trial with a cluster stepped-wedge design, were included. Indicators of compliance to the ERAS items were calculated overall and for groups of items (preoperative, intraoperative and postoperative) and analyzed with a multilevel linear model adjusting for patients’ characteristics, considering centers as random effects. Results: Overall, the average level of compliance to the ERAS protocol was 56% among non-ERAS centers (N = 364 patients) and 80% among ERAS ones (N = 79), with a difference of 24% (95% CI: −41.4; −7.3, p = 0.0053). For both groups of centers, the lowest level of compliance was recorded for postoperative items (42% and 66%). Sex, age, presence of comorbidities and American Society of Anesthesiologists (ASA) score were not associated with a different probability of compliance to the ERAS protocol. Conclusions: Several items of the ERAS protocol were poorly adopted in colorectal surgery units in the Piemonte region in the baseline period of the ERAS Colon-Rectum Piemonte study and in the ERAS group. No relevant obstacles to the ERAS protocol implementation were identified at patient level.
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Singh R, Gupta A, Gupta N, Kumar V. Enhanced recovery after surgery (ERAS): Are anaesthesiologists prepared for the paradigm shift in perioperative care? A prospective cross-sectional survey in India. Indian J Anaesth 2021; 65:S127-S138. [PMID: 34703058 PMCID: PMC8500193 DOI: 10.4103/ija.ija_122_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Ruchi Singh
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR. BRAIRCH, AIIMS, New Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR. BRAIRCH, AIIMS, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR. BRAIRCH, AIIMS, New Delhi, India
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Zorrilla-Vaca A, Stone AB, Ripolles-Melchor J, Abad-Motos A, Ramirez-Rodriguez JM, Galan-Menendez P, Mena GE, Grant MC. Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study. J Clin Anesth 2021; 74:110378. [PMID: 34144497 DOI: 10.1016/j.jclinane.2021.110378] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery. METHODS A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence. RESULTS The median adherence to ERAS was 68.2% (IQR 59.1%-81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P < 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P < 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P < 0.01) were independently associated with greater adherence. Case volume (-2.38% per 4 cases weekly, 95%CI -3.03 to -1.74, P < 0.01) and number of anesthesia providers (-1.19% per 10 providers, 95%CI +2.23 to -8.18%, P < 0.01) were negatively associated with adherence. CONCLUSION Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.
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Affiliation(s)
- Andres Zorrilla-Vaca
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Alexander B Stone
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Javier Ripolles-Melchor
- Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain
| | - Ane Abad-Motos
- Department of Anesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain
| | | | | | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, USA
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The Application of Enhanced Recovery After Surgery (ERAS) for Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2021; 31:1321-1331. [PMID: 33420977 DOI: 10.1007/s11695-020-05209-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022]
Abstract
To systematically evaluate the effectiveness and safety of the enhanced recovery after surgery (ERAS) pathway in bariatric surgery. A literature search was conducted using PubMed, Medline, EMBASE, OVID, World Health Organization International Trial Register, and Cochrane Library identifying all eligible studies comparing ERAS protocols with standard care (SC) in bariatric surgery through May 2020. Relevant perioperative parameters were extracted from the resulting studies for meta-analysis. The primary outcome was the length of hospital stay, and secondary outcomes included operation time, postoperative nausea, and vomiting (PONV), postoperative complications, readmission, reoperation, and subsequent emergency room visits. Postoperative complications were categorized according to the Clavien-Dindo classification. Final analysis included five randomized controlled trials (RCTs) and twelve observational studies which included 4964 patients in the ERAS group and 3218 patients in the SC group. The length of the hospital stay was significantly decreased (p < 0.01) after ERAS protocol management, as did the incidence of POVN (p < 0.01). No significant differences were observed between the ERAS group and SC group in terms of operation time (p = 0.37), postoperative complications (p = 0.18), readmission (p = 0.17), reoperation (p = 0.34), or emergency room visits (p = 0.65). The application of ERAS protocols in bariatric surgery is safe and feasible, effectively shortening the length of a hospital stay without compromising morbidity, and accelerating patient recovery.
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Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, Aldecoa C, Abad-Motos A, Logroño-Egea M, García-Erce JA, Camps-Cervantes Á, Ferrando-Ortolá C, Suarez de la Rica A, Cuellar-Martínez A, Marmaña-Mezquita S, Abad-Gurumeta A, Calvo-Vecino JM. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg 2020; 154:725-736. [PMID: 31066889 DOI: 10.1001/jamasurg.2019.0995] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, Setting, and Participants The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main Outcomes and Measures The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates. Conclusions and Relevance An increase in ERAS adherence appears to be associated with a decrease in postoperative complications.
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Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - José M Ramírez-Rodríguez
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Rubén Casans-Francés
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine. Lozano Blesa University Hospital, Zaragoza, Spain
| | - César Aldecoa
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Río Hortega University Hospital, Valladolid, Spain
| | - Ane Abad-Motos
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - Margarita Logroño-Egea
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Alava University Hospital, Alava, Spain
| | - José Antonio García-Erce
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Blood and Tissue Bank of Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, Spain.,Anemia Working Group Spain, Barcelona, Spain
| | - Ángels Camps-Cervantes
- Department of Anaesthesia and Critical Care, Vall d´Hebrón University Hospital, Barcelona, Spain
| | - Carlos Ferrando-Ortolá
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Perioperative Medicine, Hospital Clínic Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Suarez de la Rica
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, La Paz University Hospital, Madrid, Spain
| | - Ana Cuellar-Martínez
- Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sandra Marmaña-Mezquita
- Department of Anaesthesia and Perioperative Medicine, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Alfredo Abad-Gurumeta
- Department of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain
| | - José M Calvo-Vecino
- Spanish Perioperative Audit and Research Network, Zaragoza, Spain.,Grupo Español de Rehabilitación Multimodal. Enhanced Recovery After Surgery Spain Chapter, Zaragoza, Spain.,Department of Anaesthesia and Critical Care, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Achkasov SI, Sushkov OI, Lukashevych IV, Surovegin ES. [Enhanced recovery program for colorectal surgery in cinical practice. Survey of surgeons of the Russian Federation]. Khirurgiia (Mosk) 2018:52-58. [PMID: 30199052 DOI: 10.17116/hirurgia201808252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To analyze RF surgeons' attitude to accelerated recovery program (ERP) and to determine how often it is used in daily work. MATERIAL AND METHODS 223 physicians from 42 Russian regions were interviewed in 2017. RESULTS ERP is unknown among 11.7% of specialists; 8.9% heard about ERP but did not think that it is used in the Russian Federation; 16.6% know but do not apply the program; 55.6% use some elements of ERP; complete application of ERP was found in 7.2% of surgeons. This technique is more often used by more active surgeons (p = 0.001) and less often - by female surgeons (p = 0.0066). The most controversial and difficult elements of ERP are administration of carbohydrate mixtures prior to surgery, optimal body temperature maintenance, restrictive protocol of infusion therapy, refusal mechanical intestinal depuration and routine abdominal drainage, and administrative control over the protocol. CONCLUSION The majority of surgeons are ready to apply ERP. Some elements are difficult to apply for use in real healthcare. More educational activities are needed for wider and complete use of the protocol. New scientific available data should be used to improve this approach.
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Affiliation(s)
- S I Achkasov
- Ryzhikh State Research Coloproctology Centre of Healthcare Ministry of Russia, Moscow, Russia
| | - O I Sushkov
- Ryzhikh State Research Coloproctology Centre of Healthcare Ministry of Russia, Moscow, Russia
| | - I V Lukashevych
- Ryzhikh State Research Coloproctology Centre of Healthcare Ministry of Russia, Moscow, Russia
| | - E S Surovegin
- Ryzhikh State Research Coloproctology Centre of Healthcare Ministry of Russia, Moscow, Russia
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