Implementing Enhanced Recovery After Surgery for hysterectomy in a hospital network with audit and feedback: A stepped-wedge cluster randomised trial.
BJOG
; 131(9): 1207-1217, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38404145
ABSTRACT
OBJECTIVE:
To evaluate the effectiveness of implementing the Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing elective hysterectomy in a network of regional hospitals, supported by an intensive audit-and-feedback (A&F) approach.DESIGN:
A multi-centre, stepped-wedge cluster randomised trial (ClinicalTrials.gov NCT04063072).SETTING:
Gynaecological units in the Piemonte region, Italy. POPULATION Patients undergoing elective hysterectomy, either for cancer or for benign conditions.METHODS:
Twenty-three units (clusters), stratified by surgical volume, were randomised into four sequences. At baseline (first 3 months), standard care was continued in all units. Subsequently, the four sequences implemented the ERAS protocol successively every 3 months, after specific training. By the end of the study, each unit had a period in which standard care was maintained (control) and a period in which the protocol, supported by feedback, was applied (experimental). MAIN OUTCOMEMEASURES:
Length of hospital stay (LOS), without outliers (>98th percentile).RESULTS:
Between September 2019 and May 2021, 2086 patients were included in the main analysis with an intention-to-treatapproach:
1104 (53%) in the control period and 982 (47%) in the ERAS period. Compliance with the ERAS protocol increased from 60% in the control period to 76% in the experimental period, with an adjusted absolute difference of +13.3% (95% CI 11.6% to 15.0%). LOS, moving from 3.5 to 3.2 days, did not show a significant reduction (-0.12 days; 95% CI -0.30 to 0.07 days). No difference was observed in the occurrence of complications.CONCLUSIONS:
Implementation of the ERAS protocol for hysterectomy at the regional level, supported by an A&F approach, resulted in a substantial improvement in compliance, but without meaningful effects on LOS and complications. This study confirms the effectiveness of A&F in promoting important innovations in an entire hospital network and suggests the need of a higher compliance with the ERAS protocol to obtain valuable improvements in clinical outcomes.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Recuperação Pós-Cirúrgica Melhorada
/
Histerectomia
/
Tempo de Internação
Limite:
Adult
/
Female
/
Humans
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
BJOG
Assunto da revista:
GINECOLOGIA
/
OBSTETRICIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Itália