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International valid...
International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery
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- Wijk, Lena, 1971- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Obstetrics and Gynecology
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- Udumyan, Ruzan, 1971- (författare)
- Örebro universitet,Institutionen för medicinska vetenskaper,Clinical Epidemiology and Biostatistics
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- Pache, Basile (författare)
- Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland
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- Altman, Alon D. (författare)
- Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
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- Williams, Laura L. (författare)
- Gynecologic Oncology of Middle Tennessee, HCA Centennial Hospital, Nashville, TN, USA
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- Elias, Kevin M. (författare)
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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- McGee, Jake (författare)
- London Health Sciences Centre, London ON, Canada
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- Wells, Tiffany (författare)
- Royal Alexandra Hospital, Edmonton AB, Canada
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- Gramlich, Leah (författare)
- Royal Alexandra Hospital, Edmonton AB, Canada
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- Holcomb, Kevin (författare)
- Clinical Obstetrics and Gynecology, Weill Cornell Medical College, New York NY, USA
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- Achtari, Chahin (författare)
- Gynecology Service, CHUV, Lausanne, Switzerland
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- Ljungqvist, Olle, 1954- (författare)
- Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery, Örebro University Hospital, Örebro, Sweden
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- Dowdy, Sean C. (författare)
- Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA
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- Nelson, Gregg (författare)
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
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(creator_code:org_t)
- Harcourt International Publishers, 2019
- 2019
- Engelska.
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Ingår i: American Journal of Obstetrics and Gynecology. - : Harcourt International Publishers. - 0002-9378 .- 1097-6868. ; 221:3, s. 237.e1-237.e11
- Relaterad länk:
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https://doi.org/10.1...
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http://www.ajog.org/...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- BACKGROUND: The Enhanced Recovery After Surgery (ERAS) Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively.OBJECTIVES: To evaluate the association between compliance to ERAS Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort.STUDY DESIGN: The study was comprised of 2,101 patients undergoing elective gynecologic/oncology surgery between January 2011 - November 2017 in 10 hospitals across Canada, the United States and Europe. Patient demographics, surgical/anesthesia details and ERAS protocol compliance elements (pre-, intra- and post-operative phases) were entered into the ERAS Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low versus medium/high). The following covariates were accounted for in the analysis: age, Body Mass Index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open versus minimally invasive), intra-operative blood loss, hospital and ERAS implementation status. The primary end-points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates.RESULTS: Patient demographics: median age 56 years, 35.5% obese,15% smokers, 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤ 3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in ERAS guideline score was associated with 8% (IRR: 0.92 (95% CI: 0.90 - 0.95; p<0.001)) decrease in days in hospital among low-complexity, and 12% (IRR: 0.88 (95% CI: 0.82 - 0.93; p<0.001) decrease among patients with medium/high complexity scores. For every unit increase in ERAS guideline score, the odds of total complications were estimated to be 12% lower (p<0.05) among low-complexity patients.CONCLUSION: Audit of surgical practices demonstrates that improved compliance with ERAS Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of ERAS implementation.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- ERAS
- compliance
- gynecologic oncology
- gynecologic surgery
- length of stay
- perioperative care
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
Hitta via bibliotek
Till lärosätets databas
- Av författaren/redakt...
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Wijk, Lena, 1971 ...
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Udumyan, Ruzan, ...
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Pache, Basile
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Altman, Alon D.
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Williams, Laura ...
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Elias, Kevin M.
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visa fler...
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McGee, Jake
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Wells, Tiffany
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Gramlich, Leah
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Holcomb, Kevin
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Achtari, Chahin
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Ljungqvist, Olle ...
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Dowdy, Sean C.
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Nelson, Gregg
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Reproduktionsmed ...
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kirurgi
- Artiklar i publikationen
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American Journal ...
- Av lärosätet
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Örebro universitet
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Karolinska Institutet