Evolution of Process and Outcome Measures during an Enhanced Recovery after Thoracic Surgery Program

• DOI: 10.5090/jcs.21.139
• Publication Date: 2022-02-09T08:36:36Z
• Authors: Alex Lee; Nazgol Seyednejad; Yaseen Al Lawati; Amanda Mattice; Caitlin Anstee; Mark Legacy; Sebastien Gilbert; Donna E. Maziak; Ramanadhan S. Sun...; Patrick J. Villen...; Calvin Thompson; Andrew J. E. Seely
• Keywords: Foley; Foley catheter

A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery thoracic surgery (ERATS) program.Outcome were compared between patients undergoing major elective during a 9-month pre-ERATS period those at 1-3, 4-6, 7-9 months post-ERATS implementation. Outcome included length stay, the 30-day readmission rate, emergency department visits, minor adverse events. Process first activity, out-of-bed, ambulation, fluid diet, diet as tolerated, well removal last chest tube, epidural, patient-controlled analgesia, Foley intravenous catheters.In total, 704 (352 pre-ERATS, 352 post-ERATS) included. Mobilization-related process measures, including activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 8.9 ambulation (32.4 25.4 p=0.04) saw statistically significant improvements by 1-3 pre-ERATS. Time improved 4-6 (19.5 18.2 p=0.003). rate steadily decreased post-ERATS. By post-ERATS, both (18.2% 7.9%, p=0.009) (13.6% 4.4%, p=0.007) events demonstrated improvements. Length stay trended towards improvement from 6.2 days 4.8 (p=0.06).The adoption ERATS led in multiple which may collectively gradually achieve optimization clinical outcomes.