Abstract
Background:
In Brazil, the goal-based approach was named Project ACERTO and has obtained
good results when applied in elective surgeries with shorter hospitalization
time, earlier return to activities without increased morbidity and
mortality.
Aim:
To analyze the impact of ACERTO on emergency surgery care.
Methods:
An intervention study was performed at a trauma hospital. Were compared 452
patients undergoing emergency surgery and followed up by the general surgery
service from October to December 2018 (pre-ACERTO, n=243) and from March to
June 2019 (post-ACERTO, n=209). Dietary reintroduction, volume of infused
postoperative venous hydration, duration of use of catheters, probes and
drains, postoperative analgesia, prevention of postoperative vomiting, early
mobilization and physiotherapy were evaluated.
Results:
After the ACERTO implantation there was earlier reintroduction of the diet,
the earlier optimal caloric intake, earlier venous hydration withdrawal,
higher postoperative analgesia prescription, postoperative vomiting
prophylaxis and higher physiotherapy and mobilization prescription were
achieved early in all (p<0.01); in the multivariate analysis there was no
change in the complication rates observed before and after ACERTO (10.7% vs.
7.7% (p=0.268) and there was a decrease in the length of hospitalization
after ACERTO (8,5 vs. 6,1 dias (p=0.008).
Conclusion:
The implementation of the ACERTO project decreased the length of hospital
stay, improved medical care provided without increasing the rates of
complications evaluated.
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