Adherence to ERAS elements in major visceral surgery—an observational pilot study

Wolk, Steffen; Distler, Marius; Müssle, Benjamin; Söthje, Susanne; Weitz, Jürgen; Welsch, Thilo

doi:10.1007/s00423-016-1407-2

Cited by 39 publications

(28 citation statements)

References 45 publications

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“…Process adherence Current literature [10][11][12] reported an average patients' adherence to ERAS items at 70%, ranging from 60% to more than 80%, depending on patients' age and the clinical phase. A relevant issue is to increase the adherence to protocol until a complete observance, considering its effect on survival [13] and outcomes [12].…”

Section: Discussionmentioning

confidence: 99%

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Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy

et al. 2020

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Background Bariatric surgery is the most effective treatment for patients affected by morbid obesity. The Enhanced Recovery After Surgery (ERAS) protocol increases clinical outcomes, but the most recent literature shows incomplete patients’ adherence. This study aims to demonstrate the feasibility of applying a Value-Based Healthcare (VBHC) strategy associated with ERAS to increase patients’ engagement and outcomes. Method A multiprofessional team redesigned the process considering ERAS recommendations and patients’ feedbacks. Outcomes that matter to patients were defined with structured patients’ interviews and collected in the electronic clinical record. Adherence to the pathway and the cost of the cycle of care were measured to demonstrate sustainability. A model was developed to grant its replicability. Results A total of 2.122 patients were included. The lowest adherence to the protocol for a single item was 82%. 74% of excess weight loss; 90% better comorbidities control; 77.5% had no pain after surgery; 61% no postoperative nausea and vomiting. Zero mortality; 1.8% overall morbidity; 0.4% readmission and reoperation rate within 30 days. The average length of stay is 2.1 days. Patient-Reported Outcome Measures (PROMs) documented increased productivity and quality of life. Conclusion Building a caring relationship by a multidisciplinary team, adding patient wellness in a VBHC framework on top of ERAS as a patient-centered approach, increases patients’ engagement and adherence to the pathway of care, resulting in better health outcomes (clinical and PROMs). The Value-Based Model is sustainable and replicable; it represents the prototype for redesigning other pathways and may become a model for other organizations.

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Section: Discussionmentioning

confidence: 99%

“…Clinical evidence [10][11][12] reported a substantial issue concerning patients' adherence to ERAS protocol. That is a relevant topic considering the relationship between adherence and survival [13] and outcome [12].…”

Section: Introductionmentioning

confidence: 99%

Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy

et al. 2020

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“…The lack of manpower is a main barrier to this practice [62]. Furthermore, many patients fail common ERAS mobilisation targets in major abdominal surgery [48].…”

Section: Discussionmentioning

confidence: 99%

“…Pain will be measured using an established patient-reported outcome measure, the NRS (0-no pain to 10-worst possible pain). Furthermore, pain is one of the main barriers to adequate postoperative mobilisation [48]. Finally, increased pain could hypothetically be associated with the intervention (enhanced mobilisation) and will thus be analysed in our trial.…”

Section: Outcome Measuresmentioning

confidence: 99%

Postoperative complications and mobilisation following major abdominal surgery with vs. without fitness tracker-based feedback (EXPELLIARMUS): study protocol for a student-led multicentre randomised controlled trial (CHIR-Net SIGMA study group)

Schwab

Brindl

Studier-Fischer

et al. 2020

Trials

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Background: Postoperative complications following major abdominal surgery are frequent despite progress in surgical technique and perioperative care. Early and enhanced postoperative mobilisation has been advocated to reduce postoperative complications, but it is still unknown whether it can independently improve outcomes after major surgery. Fitness trackers (FTs) are a promising tool to improve postoperative mobilisation, but their effect on postoperative complications and recovery has not been investigated in clinical trials.

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“…That is why there is no solid evidence that early mobilization in the ERAS setting is beneficial. A recent study done at our center emphasizes the fact that almost 50% of our patients after surgery of the upper GI tract do not request enhanced mobilization, indicating that ERAS principles and the mobilization targets of the available studies cited above were not achieved [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Use of activity tracking in major visceral surgery—the Enhanced Perioperative Mobilization (EPM) trial: study protocol for a randomized controlled trial

Wolk

Meißner

Linke

et al. 2017

Trials

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BackgroundEnhanced recovery after surgery (ERAS) programs are aimed at minimizing postoperative stress and accelerating postoperative recovery by implementing multiple perioperative principles. “Early mobilization” is one such principle, but the quality of assessment and monitoring is poor, and evidence of improved outcome is lacking. Activity trackers allow precise monitoring and automatic feedback to the patients to enhance their motivation for early mobilization. The aim of the study is to monitor and increase the postoperative mobilization of patients by giving them continuous automatic feedback in the form of a step count using activity-tracking wristbands.Methods/designPatients undergoing elective open and laparoscopic surgery of the colon, rectum, stomach, pancreas, and liver for any indication will be included. Further inclusion criteria are age between 18 and 75 years, American Society of Anesthesiologists Physical Status class less than IV, and a signed informed consent form. Patients will be stratified into two subgroups, laparoscopic and open surgery, and will be randomized 1:1 for automatic feedback of their step count using an activity tracker wristband. The control group will have no automatic feedback. The sample size (n = 30 patients in each of the four groups, overall n = 120) is calculated on the basis of an assumed difference in step count of 250 steps daily (intervention group versus control group). The primary study endpoint is the average step count during the first 5 postoperative days; secondary endpoints are the percentage of patients in the two groups who master the predefined mobilization (step count) targets, assessment of additional activity data obtained from the devices, assessment of preoperative mobility, length of hospital and intensive care unit stays, number of patients who receive physiotherapy, 30-day mortality, and overall 30-day morbidity.DiscussionEarly mobilization is a key element of ERAS. However, enhanced early mobilization is difficult to define, to assess objectively, and to implement in clinical practice. Consequently, there is a discrepancy between ERAS targets and actual practice, especially in patients undergoing major visceral surgery. This study is the first randomized controlled trial investigating the use and feasibility of activity tracking to monitor and enhance postoperative early mobilization.Trial registrationClinicalTrials.gov identifier: NCT02834338. Registered on 15 June 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1782-1) contains supplementary material, which is available to authorized users.

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Adherence to ERAS elements in major visceral surgery—an observational pilot study

Cited by 39 publications

References 45 publications

Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy

Value-Based Healthcare and Enhanced Recovery After Surgery Implementation in a High-Volume Bariatric Center in Italy

Postoperative complications and mobilisation following major abdominal surgery with vs. without fitness tracker-based feedback (EXPELLIARMUS): study protocol for a student-led multicentre randomised controlled trial (CHIR-Net SIGMA study group)

Use of activity tracking in major visceral surgery—the Enhanced Perioperative Mobilization (EPM) trial: study protocol for a randomized controlled trial

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