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- Gillis, Chelsia, et al.
(author)
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Patients' perspectives of prehabilitation as an extension of Enhanced Recovery After Surgery protocols
- 2021
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In: Canadian journal of surgery. - : Canadian Medical Association. - 0008-428X .- 1488-2310. ; 64:6, s. E578-E587
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Journal article (peer-reviewed)abstract
- BACKGROUND: Enhanced Recovery After Surgery (ERAS) and prehabilitation programs are evidence-based and patient-focused, yet meaningful patient input could further enhance these interventions to produce superior patient outcomes and patient experiences. We conducted a qualitative study with patients who had undergone colorectal surgery under ERAS care to determine how they prepared for surgery, their views on prehabilitation and how prehabilitation could be delivered to best meet patient needs.METHODS: We conducted semistructured interviews with adult patients who had undergone colorectal surgery under ERAS care within 3 months after surgery. Patients were enrolled between April 2018 and June 2019 through purposive sampling from 1 hospital in Alberta. The interview transcripts were analyzed independently by a researcher and a trained patient-researcher using inductive thematic analysis.RESULTS: Twenty patients were interviewed. Three main themes were identified. First, waiting for surgery: patients described fear, anxiety, isolation and deterioration of their mental and physical states as they waited passively for surgery. Second, preparing would have been better than just waiting: patients perceived that a prehabilitation program could prepare them for their operation if it addressed their emotional and physical needs, provided personalized support, offered home strategies, involved family and included surgical expectations (both what to expect and what is expected of them). Third, partnering with patients: preoperative preparation should occur on a continuum that meets patients where they are at and in a partnership that respects patients' expertise and desired level of engagement.CONCLUSION: We identified several patient priorities for the preoperative period. Integrating these priorities within ERAS and prehabilitative programs could improve patient satisfaction, experiences and outcomes. Actively engaging patients in their care might alleviate some of the anxiety and fear associated with waiting passively for surgery.
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- Murillo Perez, Carla F., et al.
(author)
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Trends in liver transplantation for autoimmune liver diseases : a Canadian study
- 2022
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In: Canadian journal of surgery. - : CMA Impact Inc.. - 0008-428X .- 1488-2310. ; 65:5, s. E665-E674
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Journal article (peer-reviewed)abstract
- Background: To our knowledge, no analysis of data from liver transplantation registries exists in Canada. We aimed to describe temporal trends in the number of liver transplantation procedures, patient characteristics and posttransplantation outcomes for autoimmune liver diseases (AILDs) in Canada.Methods: We used administrative data from the Canadian Organ Replacement Register, which contains liver transplantation information from 6 centres in Canada. This study included transplantation information from 5 of the centres, as liver transplantation procedures in children were not included. We included adult (age ≥ 18 yr) patients with a diagnosis of primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH) or overlap syndrome (PBC–AIH or PSC–AIH) who received a liver transplant from 2000 to 2018.Results: Of 5722 primary liver transplantation procedures performed over the study period, 1070 (18.7%) were for an AILD: 489 (45.7%) for PSC, 341 (31.9%) for PBC, 220 (20.6%) for AIH and 20 (1.9%) for overlap syndrome. There was a significant increase in the absolute number of procedures for PSC, with a yearly increase of 0.6 (95% confidence interval 0.1 to 1.2), whereas the absolute number of procedures for PBC and AIH remained stable. The proportion of transplantation procedures decreased for PBC and AIH but remained stable for PSC. Recipient age at transplantation increased over time for males with PBC (median 53 yr in 2000–2005 to 57 yr in 2012–2018, p = 0.03); whereas the median age among patients with AIH decreased, from 53 years in 2000–2005 to 44 years in 2006–2011 (p = 0.03). The Model for Endstage Liver Disease score at the time of transplantation increased over time for all AILDs, particularly AIH (median 16 in 2000–2005 v. 24 in 2012–2018, p < 0.001). There was a trend toward improved survival in the PBC group, with a 5-year survival rate of 81% in 2000–2005 and 90% in 2012–2018 (p = 0.06).Conclusion: Between 2000 and 2018, the absolute number of liver transplantation procedures in Canada increased for PSC but remained stable for PBC and AIH; proportionally, PBC and AIH decreased as indications for transplantation. Posttransplantation survival improved only for the PBC group. An improved understanding of trends and outcomes on a national scale among patients with AILD undergoing liver transplantation can identify disparities and areas for potential health care improvement.
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- Søreide, Eldar, et al.
(author)
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Preoperative fasting
- 2006
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In: Canadian journal of surgery. - 0008-428X .- 1488-2310. ; 49:3, s. 218-219
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Journal article (peer-reviewed)
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- Thanh, Nguyen X., et al.
(author)
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An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta
- 2016
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In: Canadian journal of surgery. - Ottowa, Canada : Canadian Medical Association. - 0008-428X .- 1488-2310. ; 59:6, s. 415-421
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Journal article (peer-reviewed)abstract
- Background: In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites.Methods: We assessed the impact of ERAS on patients' health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique.Results: We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000-$3 391 000), or $1768 (range $920-$2619) per patient. The probability for the program to be cost-saving was 73%-83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4-$5.1) in return.Conclusion: The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.
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