Background

ERAS protocol compliance is traditionally measured and reported as ‘items compliance’ which is retrospective longitudinal adherence of all patients to an index element. Reporting in this manner is restrictive and cannot impact care in real-time. In order to modify behavior effectively and instantaneously, we seek to introduce the novel concept of “vertical compliance”.

Methods

Vertical compliance is defined as assessment of an individual’s compliance along his/her own surgical pathway as ERAS index items are encountered. Prospectively entered data from the ERAS Interactive Audit System (EIAS) database was queried for all patients who underwent pancreatic or hepatic resections. Individual linear regression models were generated using compliance data from 46 ERAS index items against LOS. Significant items with p value < 0.05 were compiled into multivariable linear regression models; each with a unique coefficient that could be used to predict effect on LOS as well as control for the effect of the other items in the model.

Results

Compliance data from 483 patients who underwent pancreatic resections and 292 patients who underwent hepatic resections was compiled. Seven ERAS items for pancreatic resections and six ERAS items for hepatic resections were found to significantly impact LOS. Regression models were created for each of the items in an additive fashion. Calculations to determine predicted LOS as a patient progressed through a pathway was able to be determined.

Conclusion

Vertical compliance is a novel metric, described in this study, that can provide significant and accurate patient-specific risk prediction to impact care in real-time. This can allow for creation of a variable echelon such that pathway items can be ranked by importance on clinical outcome effect and patient progress can be monitored and altered.

中文翻译：

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纵向合规性：一种报告患者特定的ERAS合规性以进行实时风险评估的新颖方法。

背景

传统上对ERAS协议的依从性进行测量并报告为“项目依从性”，这是所有患者回顾性纵向依从性指标。以这种方式进行报告是限制性的，不能实时影响护理。为了有效且即时地修改行为，我们试图引入“垂直顺应性”这一新颖概念。

方法

垂直顺应性定义为当遇到ERAS指标项目时，沿着其自身的手术途径对患者的顺应性进行评估。从ERAS交互式审计系统（EIAS）数据库中输入的前瞻性数据用于所有接受胰腺或肝切除术的患者。使用来自46个ERAS指标项针对LOS的依从性数据生成了单个线性回归模型。p值<0.05的重要项目被编译成多元线性回归模型；每个参数都有一个唯一的系数，可用于预测对LOS的影响以及控制模型中其他项目的影响。

结果

汇总了483例行胰腺切除术和292例行肝切除术的患者的依从性数据。发现胰腺切除术有七个ERAS项目，肝切除术有六个ERAS项目对LOS有显着影响。以累加方式为每个项目创建了回归模型。能够确定确定患者随着路径前进而进行的预测LOS的计算。

结论

垂直顺应性是本研究中描述的一种新指标，可以提供重要而准确的针对特定患者的风险预测，以实时影响护理。这可以允许创建可变梯队，从而可以根据临床结局效果的重要性对途径项目进行排名，并可以监视和更改患者的病情。