Expanding Pharmacotherapy Data Collection, Analysis, and Implementation in ERAS® Programs—The Methodology of an Exploratory Feasibility Study

Abstract

Surgical organizations dedicated to the improvement of patient outcomes have led to a worldwide paradigm shift in perioperative patient care. Since 2012, the Enhanced Recovery After Surgery (ERAS®) Society has published guidelines pertaining to perioperative care in numerous disciplines including elective colorectal and gynecologic/oncology surgery patients. The ERAS® and ERAS-USA® Societies use standardized methodology for collecting and assessing various surgical parameters in real-time during the operative process. These multi-disciplinary groups have constructed a bundled framework of perioperative care that entails 22 specific components of clinical interventions, which are logged in a central database, allowing a system of audit and feedback. Of these 22 recommendations, nine of them specifically involve the use of medications or pharmacotherapy. This retrospective comparative pharmacotherapy project will address the potential need to (1) collect more specific pharmacotherapy data within the existing ERAS Interactive Audit System® (EIAS) program, (2) understand the relationship between medication regimen and patient outcomes, and (3) minimize variability in pharmacotherapy use in the elective colorectal and gynecologic/oncology surgical cohort. Primary outcomes measures include data related to surgical site infections, venous thromboembolism, and post-operative nausea and vomiting as well as patient satisfaction, the frequency and severity of post-operative complications, length of stay, and hospital re-admission at 7 and 30 days, respectively. The methodology of this collaborative research project is described.

Pharmacotherapeutic prophylaxis and post-operative outcomes within an Enhanced Recovery After Surgery (ERAS®) program: A randomized retrospective cohort study

“…The present study continues the research strategy for ERAS®-related pharmacotherapy that was introduced in a prior report [ 18 ]. In addition, the methodology and data dictionary of the present study was described previously and modified through several iterations by all authors [ 34 ]. Data were collected using REDCap (version 5.9.13, 2020) [ 35 ] by a trained individual with knowledge of EIAS® and the healthcare records maintained at Tom Baker Cancer Centre and Foothills Medical Centre in Calgary, Alberta, Canada.…”

CE: Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery

“…28 Early mobilization is considered one of the most important components of ERAS protocols. 29 However, MEP assessments are not considered standard because of differences in setting-specific resources and procedure-specific factors.…”

“…Perioperative preemptive multimodal analgesia, with early postoperative mobilization, sleep hygiene, and oral intake, has also been shown to have better outcomes than traditional restrictive approaches 28. Early mobilization is considered one of the most important components of ERAS protocols 29. However, MEP assessments are not considered standard because of differences in setting-specific resources and procedure-specific factors.…”

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Enhanced postoperative recovery programs are evidence-based, multimodal, multidisciplinary approaches to the care of a surgical patient that involves a perioperative team aimed at reducing operative stress responses by increasing patient resilience, preventing and minimizing postoperative complications, and decreasing hospitalization [ 1 , 2 ]. The pharmacotherapy embedded into enhanced recovery programs and protocols (ERPs) has only recently received attention in the scientific and professional literature [ 3 , 4 , 5 , 6 , 7 , 8 ]. Often conducted outside of ERAS ® Society sites and protocols, many reports are retrospective and single-center in nature, and earlier reports evaluated programmatic compliance with consensus-generated guidelines and recommendations from various perioperative groups.…”