title: Impact of the ACERTO project in the postoperative morbi-mortality in a university hospital.
abstract: OBJECTIVE
  To evaluate the postoperative outcomes of patients in the Department of General Surgery, University Hospital Julio Muller, before and after implementation of the ACERTO multimodal protocol.
  
  
  METHODS
  We conducted a retrospective study from 5974 patients' charts. We compared two periods: from January 2002 to December 2004 (before implementation of the ACERTO protocol: AA period, n = 1987) and January 2005 to December 2008 (after implementation of the protocol: DA period, n = 3987). The variables studied were length of hospital stay, blood transfusions, surgical site infections (SSI), postoperative complications and deaths.
  
  
  RESULTS
  There was a decrease in one day in length of stay between the AA and DA period (median [range]: 4 [0-137] vs 3. [0-126] days and mode: 3 vs. 2 days, p < 0.001). During AA there was a relationship of 2.53 packs of blood products transfused per patient against 0.77 in the DA period (p <0.001). A downward trend in the number of cases of SSI was noticeable over the years (A =-153.08; AA: 7.51% vs. DA: 3.36% (p <0.001, RR = 2.23, 95 % CI:1.73-2.89). There was also a decreasing trend in operative complications (A =- 51.41, AA: 7.9% vs. DA: 6.14%, p = 0.02, RR = 1.29, 95% CI:1.03-1.60), reoperation (A =- 57.10; AA: 2.65%. vs DA: 1.19%, p <0.001, RR = 2, 22, 95% CI: 1.43 to 3.44) and deaths (A =- 62.07, 2.81 vs. 1%, 73%, p <0.01, RR = 1.63, 95% CI: 1.15 to 2.31).
  
  
  CONCLUSIONS
  The introduction of the ACERTO protocol improved the surgical results, expressed as a shorter hospital stay, blood transfusion, and reduction in cases of surgical site infection, postoperative complications and deaths.
authors.affiliation: Department of Surgery, Faculty of Medical Sciences, Federal University of Mato Grosso (UFMT)-MT-BR.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bicudo-Salomão
authors.forename: Márcio Bertocco
authors.initials: MB
authors.lastname: Meireles
authors.forename: Cervantes
authors.initials: C
authors.lastname: Caporossi
authors.forename: Pedro Luis Reis
authors.initials: PL
authors.lastname: Crotti
authors.forename: José Eduardo
authors.initials: JE
authors.lastname: de Aguilar-Nascimento
mesh_terms: D002985:Clinical Protocols; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000592:standards*