Objective: 

This multicenter study aimed to assess (1) the effect of an improvement collaborative on enhanced recovery after surgery (ERAS) protocol adherence after elective colectomy and (2) the association between adherence and patient outcomes.

Summary Background Data: 

ERAS pathways provide a framework to standardize care processes and improve postoperative outcomes in patients after colon surgery. Despite growing evidence of its effectiveness, adherence to these guidelines remains a challenge.

Methods: 

This prospective, multicenter collaborative was initiated throughout 11 hospitals in Flanders, Belgium. A structured audit tool was used to study patient outcomes and adherence to 12 ERAS components, defined by the collaborative. Three retrospective audits (based on patient record analysis) were conducted in 2017, 2019, and 2021, respectively.

Results: 

Overall, 740 patients were included (45.4% female; mean±SD age, 71±12 y). The overall adherence increased from 42.8% in 2017 to 58.4% in 2019 and 69.2% in 2021. Compared to low adherence, LOS was increasingly reduced by 1.3 days for medium (95% CI, −2.5; 0.0), 3.6 days for high (95% CI, −4.9; −2.2), and up to 4.4 days for very high adherence (95% CI, −6.1; −2.7). Corresponding odds ratios for postoperative complications were 0.62 (95% CI, 0.33; 1.17), 0.19 (95% CI, 0.09; 0.43), and 0.14 (95% CI, 0.05; 0.39), respectively. No increase in 30-day readmissions was observed.

Conclusions: 

A peer-constructed improvement collaborative effectively increases adherence to an ERAS protocol in individual hospitals. Across time, LOS and postoperative complications decreased significantly, and a dose-response relationship was observed.

中文翻译：

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一项突破性的改进合作显着减少了整个医疗保健系统癌症选择性结肠切除术后的住院时间

客观的： 

这项多中心研究旨在评估 (1) 改进协作对择期结肠切除术后加速康复 (ERAS) 方案依从性的影响，以及 (2) 依从性和患者结果之间的关联。

摘要背景数据： 

ERAS 途径提供了一个框架来标准化护理流程并改善结肠手术后患者的术后结果。尽管越来越多的证据表明其有效性，但遵守这些指南仍然是一个挑战。

方法： 

这种前瞻性的多中心合作是在比利时佛兰德斯的 11 家医院发起的。一个结构化的审计工具被用来研究患者的结果和对协作定义的 12 个 ERAS 组件的依从性。分别在 2017 年、2019 年和 2021 年进行了三项回顾性审计（基于患者记录分析）。

结果： 

总体而言，包括 740 名患者（45.4% 为女性；平均年龄±标准差，71±12 岁）。总体依从性从 2017 年的 42.8% 增加到 2019 年的 58.4% 和 2021 年的 69.2%。与低依从性相比，中等（95% CI，-2.5；0.0）的 LOS 减少了 1.3 天，高的为 3.6 天（ 95% CI，-4.9；-2.2），对于非常高的依从性长达 4.4 天（95% CI，-6.1；-2.7）。术后并发症的相应比值比分别为 0.62（95% CI，0.33；1.17）、0.19（95% CI，0.09；0.43）和 0.14（95% CI，0.05；0.39）。未观察到 30 天再入院率增加。

结论： 

同行构建的改进协作有效地提高了各个医院对 ERAS 协议的依从性。随着时间的推移，LOS 和术后并发症显着减少，并观察到剂量反应关系。