title: Enhanced recovery after surgery program for elective abdominal surgery at three Victorian hospitals.
abstract: The aim of this study was to evaluate the anaesthesia care of an enhanced recovery after surgery (ERAS) program for patients having abdominal surgical in Victorian hospitals. The main outcome measure was the number of ERAS items implemented following introduction of the ERAS program. Secondary endpoints included process of care measures, outcomes and hospital stay. We used a before-and-after design; the control group was a prospective cohort (n=154) representing pre-existing practice for elective abdominal surgical patients from July 2009. The introduction of a comprehensive ERAS program took place over two months and included the education of surgeons, anaesthetists, nurses and allied health professionals. A post-implementation cohort (n=169) was enrolled in early 2010. From a total of 14 ERAS-recommended items, there were significantly more implemented in the post-ERAS period, median 8 (interquartile range 7 to 9) vs 9 (8 to 10), P <0.0001. There were, however, persistent low rates of intravenous fluid restriction (25%) and early removal of urinary catheter (31%) in the post-ERAS period. ERAS patients had less pain and faster recovery parameters, and this was associated with a reduced hospital stay, geometric mean (SD) 5.7 (2.5) vs 7.4 (2.1) days, P=0.006. We found that perioperative anaesthesia practices can be readily modified to incorporate an enhanced recovery program in Victorian hospitals.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia. g.thompson@alfred.org.au
authors.forename: E G E
authors.initials: EG
authors.lastname: Thompson
authors.forename: S T
authors.initials: ST
authors.lastname: Gower
authors.forename: D S
authors.initials: DS
authors.lastname: Beilby
authors.forename: S
authors.initials: S
authors.lastname: Wallace
authors.forename: S
authors.initials: S
authors.lastname: Sophie
authors.forename: S
authors.initials: S
authors.lastname: Tomlinson
authors.forename: G D
authors.initials: GD
authors.lastname: Guest
authors.forename: R
authors.initials: R
authors.lastname: Cade
authors.forename: R
authors.initials: R
authors.lastname: Richard
authors.forename: J S
authors.initials: JS
authors.lastname: Serpell
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000758:Anesthesia; D000762:Anesthesia Recovery Period; D004434:Early Ambulation; D017558:Elective Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control / Q000628:therapy; D016896:Treatment Outcome; D014739:Victoria