Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey

Perioperative Medicine

Hakim Harkouk¹  Dominique Fletcher¹  Anissa Belbachir²  Lionelle Nkam³  Nawal Derridj³  Eva Battaglia⁴  Laure Tharel⁴  Philippe Aegerter⁵  Perrine Capmas⁶ 

[1]Anaesthesia and Intensive Care Department, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France

[2]Université Paris-Saclay, UVSQ, Inserm, LPPD, 92100, Boulogne, France

[3]Anaesthesia and Intensive Care Department, Cochin Hospital, APHP, Paris, France

[4]Clinical Research Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France

[5]Direction de la Politique et de la Transformation, Assistance Publique Hôpitaux de Paris, Paris, France

[6]GIRCI-IDF, Cellule Méthodologie, Paris, France

[7]Université Paris-Saclay, UVSQ, Inserm, Équipe d’Épidémiologie respiratoire intégrative, CESP - Centre de recherche en Epidémiologie et Santé des Populations U1018 INSERM UPS UVSQ, 94807, Villejuif, France

[8]Obstetric Gynecology Department, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France

关键词: Surgery;    Enhanced recovery;    Length of stay;    Post-operative complications;   

DOI  :  10.1186/s13741-021-00200-9

来源: Springer

【 摘 要 】

BackgroundEnhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP).MethodsA retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients’ chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure.Results1321 patient’s files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items’ application when data collected in 2015 and 2017 were analysed together.ConclusionERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.

【 授权许可】

CC BY