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KMID : 1812420220550020118
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Journal of Chest Surgery
2022 Volume.55 No. 2 p.118 ~ p.125
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Evolution of Process and Outcome Measures during an Enhanced Recovery after Thoracic Surgery Program
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Lee Alex
Seyednejad Nazgol
Al Lawati Yaseen
Mattice Amanda
Anstee Caitlin
Legacy Mark
Gilbert Sebastien
Maziak Donna E.
Sundaresan Ramanadhan S.
Villeneuve Patrick J.
Thompson Calvin
Seely Andrew J. E.
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Abstract
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Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program.
Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1?3, 4?6, and 7?9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters.
Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1?3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4?6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7?9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7?9 months post-ERATS (p=0.06).
Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.
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KEYWORD
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Enhanced recovery after surgery, Postoperative care, Outcome and process assessment, Interrupted time series analysis, Thoracic surgery
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