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\n\n \n \n 2024\n \n \n (1)\n \n \n
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\n \n \n\n \n \n \n \n \n Improving the Rate of Same Day Discharge in Gynecologic Oncology Patients Undergoing Minimally Invasive Surgery - An Enhanced Recovery After Surgery Quality Improvement Initiative.\n \n \n \n\n\n \n Mateshaytis, J.; Trudeau, P.; Bisch, S.; Pin, S.; Chong, M.; and Nelson, G.\n\n\n \n\n\n\n J Minim Invasive Gynecol. January 2024.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{mateshaytis_improving_2024,\n\ttitle = {Improving the {Rate} of {Same} {Day} {Discharge} in {Gynecologic} {Oncology} {Patients} {Undergoing} {Minimally} {Invasive} {Surgery} - {An} {Enhanced} {Recovery} {After} {Surgery} {Quality} {Improvement} {Initiative}},\n\tissn = {1553-4650},\n\tdoi = {10.1016/j.jmig.2024.01.015},\n\tabstract = {SETTING: Same-day discharge (SDD) in patients undergoing minimally invasive gynecologic oncology (GO) surgery is a recent trend aligned with Enhanced Recovery After Surgery (ERAS) principles. SDD in GO is safe and feasible based on several recent studies, including a quality improvement (QI) initiative in Edmonton, Alberta, which resulted in SDD rates {\\textgreater}70\\%. PATIENTS: A baseline audit of GO patients at our center (Calgary, Alberta) found the SDD rate to be 14\\%. Given that Edmonton and our center are within the same province, they have similar patient populations and available resources - suggesting that interventions from the Edmonton QI initiative may be translatable. OBJECTIVES: The objectives of our QI initiative were: 1) to increase the rate of SDD in eligible GO patients to 70\\%, and 2) to evaluate the ease with which QI methods demonstrated in one study could be applied at another center. DESIGN: A pre/post-intervention design was used (50 patients/group). INTERVENTIONS: Four interventions were designed to address root causes for failed SDD identified following QI diagnostics: 1) SDD as the default discharge plan, including a "Day Surgery" surgical booking, 2 \\& 3) development and implementation of ERAS SDD pre-operative and post-operative order sets, and 4) patient education SDD-specific documents. MEASUREMENTS: Rate of SDD was measured together with patient demographics and surgical outcomes. Process and balancing measures were defined and tracked. MAIN RESULTS: SDD in GO increased from 14\\% (7/50) to 82\\% (41/50) after the implementation of the above interventions (OR 28, p{\\textless}0.0001, 95\\%CI 9.54-82.11). Improved SDD was achieved without negatively impacting post-operative rates of emergency department visits: 8\\% pre-, 4\\% post-intervention within 7 days (OR 0.48, p=0.678, 95\\%CI 0.09-2.74), 12\\% pre-, 10\\% post-intervention within 30 days (OR 0.8148, p=1.0, 95\\% CI 0.2317-2.86). CONCLUSIONS: This ERAS QI initiative resulted in a substantial increase in SDD in GO, without a negative impact on balancing measures. We demonstrate that the "spread" of simple, clearly defined QI interventions across centers (where the patient population is similar) is feasible. This suggests that an ERAS SDD Program for GO could be a realistic goal for other centers with similar characteristics.},\n\tlanguage = {eng},\n\tjournal = {J Minim Invasive Gynecol},\n\tauthor = {Mateshaytis, J. and Trudeau, P. and Bisch, S. and Pin, S. and Chong, M. and Nelson, G.},\n\tmonth = jan,\n\tyear = {2024},\n\tkeywords = {Ambulatory surgery, enhanced recovery protocols, gynecologic malignancy, laparoscopic hysterectomy, laparoscopic surgery, outpatient surgery},\n}\n\n\n\n SETTING: Same-day discharge (SDD) in patients undergoing minimally invasive gynecologic oncology (GO) surgery is a recent trend aligned with Enhanced Recovery After Surgery (ERAS) principles. SDD in GO is safe and feasible based on several recent studies, including a quality improvement (QI) initiative in Edmonton, Alberta, which resulted in SDD rates \\textgreater70%. PATIENTS: A baseline audit of GO patients at our center (Calgary, Alberta) found the SDD rate to be 14%. Given that Edmonton and our center are within the same province, they have similar patient populations and available resources - suggesting that interventions from the Edmonton QI initiative may be translatable. OBJECTIVES: The objectives of our QI initiative were: 1) to increase the rate of SDD in eligible GO patients to 70%, and 2) to evaluate the ease with which QI methods demonstrated in one study could be applied at another center. DESIGN: A pre/post-intervention design was used (50 patients/group). INTERVENTIONS: Four interventions were designed to address root causes for failed SDD identified following QI diagnostics: 1) SDD as the default discharge plan, including a \"Day Surgery\" surgical booking, 2 & 3) development and implementation of ERAS SDD pre-operative and post-operative order sets, and 4) patient education SDD-specific documents. MEASUREMENTS: Rate of SDD was measured together with patient demographics and surgical outcomes. Process and balancing measures were defined and tracked. MAIN RESULTS: SDD in GO increased from 14% (7/50) to 82% (41/50) after the implementation of the above interventions (OR 28, p\\textless0.0001, 95%CI 9.54-82.11). Improved SDD was achieved without negatively impacting post-operative rates of emergency department visits: 8% pre-, 4% post-intervention within 7 days (OR 0.48, p=0.678, 95%CI 0.09-2.74), 12% pre-, 10% post-intervention within 30 days (OR 0.8148, p=1.0, 95% CI 0.2317-2.86). CONCLUSIONS: This ERAS QI initiative resulted in a substantial increase in SDD in GO, without a negative impact on balancing measures. We demonstrate that the \"spread\" of simple, clearly defined QI interventions across centers (where the patient population is similar) is feasible. This suggests that an ERAS SDD Program for GO could be a realistic goal for other centers with similar characteristics.\n
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\n \n \n\n \n \n \n \n \n Uterine Closure Technique at Cesarean Delivery: SOGC GMOC and the ERAS-Canada/ERAS-Cesarean Delivery Guideline.\n \n \n \n\n\n \n Wilson, R. D.\n\n\n \n\n\n\n J Obstet Gynaecol Can, 45(9): 633–636. September 2023.\n \n\n\n\n
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\n\n\n\n@article{wilson_uterine_2023,\n\ttitle = {Uterine {Closure} {Technique} at {Cesarean} {Delivery}: {SOGC} {GMOC} and the {ERAS}-{Canada}/{ERAS}-{Cesarean} {Delivery} {Guideline}},\n\tvolume = {45},\n\tissn = {1701-2163 (Print) 1701-2163},\n\tdoi = {10.1016/j.jogc.2023.05.033},\n\tlanguage = {eng},\n\tnumber = {9},\n\tjournal = {J Obstet Gynaecol Can},\n\tauthor = {Wilson, R. D.},\n\tmonth = sep,\n\tyear = {2023},\n\tkeywords = {*Cesarean Section, *Uterus/surgery, Canada, Female, Humans, Pregnancy, cesarean delivery, maternal risk, scar morbidity, surgical suture, uterine, uterine closure technique},\n\tpages = {633--636},\n}\n\n\n\n \n\n \n \n \n \n \n The impact of delayed nonurgent surgery during the COVID-19 pandemic on surgeons in Alberta: a qualitative interview study.\n \n \n \n\n\n \n Jaworska, N.; Schalm, E.; Kersen, J.; Smith, C.; Dorman, J.; Brindle, M.; Dort, J.; and Sauro, K. M.\n\n\n \n\n\n\n CMAJ Open, 11(4): E587–e596. July 2023.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{jaworska_impact_2023,\n\ttitle = {The impact of delayed nonurgent surgery during the {COVID}-19 pandemic on surgeons in {Alberta}: a qualitative interview study},\n\tvolume = {11},\n\tissn = {2291-0026},\n\tdoi = {10.9778/cmajo.20220188},\n\tabstract = {BACKGROUND: During the COVID-19 pandemic, nonurgent surgeries were delayed to preserve capacity for patients admitted with COVID-19; surgeons were challenged personally and professionally during this time. We aimed to describe the impact of delays to nonurgent surgeries during the COVID-19 pandemic from the surgeons' perspective in Alberta. METHODS: We conducted an interpretive description qualitative study in Alberta from January to March 2022. We recruited adult and pediatric surgeons via social media and through personal contacts from our research network. Semistructured interviews were conducted via Zoom, and we analyzed the data via inductive thematic analysis to identify relevant themes and subthemes related to the impact of delaying nonurgent surgery on surgeons and their provision of surgical care. RESULTS: We conducted 12 interviews with 9 adult surgeons and 3 pediatric surgeons. Six themes were identified: accelerator for a surgical care crisis, health system inequity, system-level management of disruptions in surgical services, professional and interprofessional impact, personal impact, and pragmatic adaptation to health system strain. Participants also identified strategies to mitigate the challenges experienced due to nonurgent surgical delays during the COVID-19 pandemic (i.e., additional operating time, surgical process reviews to reduce inefficiencies, and advocacy for sustained funding of hospital beds, human resources and community-based postoperative care). INTERPRETATION: Our study describes the impacts and challenges experienced by adult and pediatric surgeons of delayed nonurgent surgeries because of the COVID-19 pandemic response. Surgeons identified potential health system-, hospital- and physician-level strategies to minimize future impacts on patients from delays of nonurgent surgery.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {CMAJ Open},\n\tauthor = {Jaworska, N. and Schalm, E. and Kersen, J. and Smith, C. and Dorman, J. and Brindle, M. and Dort, J. and Sauro, K. M.},\n\tmonth = jul,\n\tyear = {2023},\n\tkeywords = {*COVID-19/epidemiology, *Surgeons, Adult, Alberta/epidemiology, Child, Humans, Pandemics, Qualitative Research},\n\tpages = {E587--e596},\n}\n\n\n\n BACKGROUND: During the COVID-19 pandemic, nonurgent surgeries were delayed to preserve capacity for patients admitted with COVID-19; surgeons were challenged personally and professionally during this time. We aimed to describe the impact of delays to nonurgent surgeries during the COVID-19 pandemic from the surgeons' perspective in Alberta. METHODS: We conducted an interpretive description qualitative study in Alberta from January to March 2022. We recruited adult and pediatric surgeons via social media and through personal contacts from our research network. Semistructured interviews were conducted via Zoom, and we analyzed the data via inductive thematic analysis to identify relevant themes and subthemes related to the impact of delaying nonurgent surgery on surgeons and their provision of surgical care. RESULTS: We conducted 12 interviews with 9 adult surgeons and 3 pediatric surgeons. Six themes were identified: accelerator for a surgical care crisis, health system inequity, system-level management of disruptions in surgical services, professional and interprofessional impact, personal impact, and pragmatic adaptation to health system strain. Participants also identified strategies to mitigate the challenges experienced due to nonurgent surgical delays during the COVID-19 pandemic (i.e., additional operating time, surgical process reviews to reduce inefficiencies, and advocacy for sustained funding of hospital beds, human resources and community-based postoperative care). INTERPRETATION: Our study describes the impacts and challenges experienced by adult and pediatric surgeons of delayed nonurgent surgeries because of the COVID-19 pandemic response. Surgeons identified potential health system-, hospital- and physician-level strategies to minimize future impacts on patients from delays of nonurgent surgery.\n
\n\n\n\n \n\n \n \n \n \n \n The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study.\n \n \n \n\n\n \n Sauro, K. M.; Smith, C.; Kersen, J.; Schalm, E.; Jaworska, N.; Roach, P.; Beesoon, S.; and Brindle, M. E.\n\n\n \n\n\n\n CMAJ Open, 11(1): E90–e100. January 2023.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{sauro_impact_2023,\n\ttitle = {The impact of delaying surgery during the {COVID}-19 pandemic in {Alberta}: a qualitative study},\n\tvolume = {11},\n\tissn = {2291-0026},\n\tdoi = {10.9778/cmajo.20210330},\n\tabstract = {BACKGROUND: The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS: Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS: We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION: Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {CMAJ Open},\n\tauthor = {Sauro, K. M. and Smith, C. and Kersen, J. and Schalm, E. and Jaworska, N. and Roach, P. and Beesoon, S. and Brindle, M. E.},\n\tmonth = jan,\n\tyear = {2023},\n\tkeywords = {*COVID-19/epidemiology, Adult, Alberta/epidemiology, Humans, Pandemics, Qualitative Research, Quality of Life},\n\tpages = {E90--e100},\n}\n\n\n\n BACKGROUND: The COVID-19 pandemic overwhelmed health care systems, leading many jurisdictions to reduce surgeries to create capacity (beds and staff) to care for the surge of patients with COVID-19; little is known about the impact of this on patients whose surgery was delayed. The objective of this study was to understand the patient and family/caregiver perspective of having a surgery delayed during the COVID-19 pandemic. METHODS: Using an interpretative descriptive approach, we conducted interviews between Sept. 20 and Oct. 8, 2021. Adult patients who had their surgery delayed or cancelled during the COVID-19 pandemic in Alberta, Canada, and their family/caregivers were eligible to participate. Trained interviewers conducted semistructured interviews, which were iteratively analyzed by 2 independent reviewers using an inductive approach to thematic content analysis. RESULTS: We conducted 16 interviews with 15 patients and 1 family member/caregiver, ranging from 27 to 75 years of age, with a variety of surgical procedures delayed. We identified 4 interconnected themes: individual-level impacts on physical and mental health, family and friends, work and quality of life; system-level factors related to health care resources, communication and perceived accountability within the system; unique issues related to COVID-19 (maintaining health and isolation); and uncertainty about health and timing of surgery. INTERPRETATION: Although the decision to delay nonurgent surgeries was made to manage the strain on health care systems, our study illustrates the consequences of these decisions, which were diffuse and consequential. The findings of this study highlight the need to develop and adopt strategies to mitigate the burden of waiting for surgery during and after the COVID-19 pandemic.\n
\n\n\n\n \n\n \n \n \n \n \n Patient and Provider Experiences With a Digital App to Improve Compliance With Enhanced Recovery After Surgery (ERAS) Protocols: Mixed Methods Evaluation of a Canadian Experience.\n \n \n \n\n\n \n Beesoon, S.; Drobot, A.; Smokeyday, M.; Ali, A. B.; Collins, Z.; Reynolds, C.; Berzins, S.; Gibson, A.; and Nelson, G.\n\n\n \n\n\n\n JMIR Form Res, 7: e49277. December 2023.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{beesoon_patient_2023,\n\ttitle = {Patient and {Provider} {Experiences} {With} a {Digital} {App} to {Improve} {Compliance} {With} {Enhanced} {Recovery} {After} {Surgery} ({ERAS}) {Protocols}: {Mixed} {Methods} {Evaluation} of a {Canadian} {Experience}},\n\tvolume = {7},\n\tissn = {2561-326x},\n\tdoi = {10.2196/49277},\n\tabstract = {BACKGROUND: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. OBJECTIVE: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. METHODS: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. RESULTS: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. CONCLUSIONS: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world.},\n\tlanguage = {eng},\n\tjournal = {JMIR Form Res},\n\tauthor = {Beesoon, S. and Drobot, A. and Smokeyday, M. and Ali, A. B. and Collins, Z. and Reynolds, C. and Berzins, S. and Gibson, A. and Nelson, G.},\n\tmonth = dec,\n\tyear = {2023},\n\tkeywords = {app, application, care, colorectal surgery, cost-effective, digital health, evaluation, gynecologic oncology, implementation, patient experience, provider satisfaction, recovery, surgery},\n\tpages = {e49277},\n}\n\n\n\n BACKGROUND: Of all the care provided in health care systems, major surgical interventions are the costliest and can carry significant risks. Enhanced Recovery After Surgery (ERAS) is a bundle of interventions that help improve patient outcomes and experience along their surgical journey. However, given that patients can be overwhelmed by the multiple tasks that they are expected to follow, a digital application, the ERAS app, was developed to help improve the implementation of ERAS. OBJECTIVE: The objective of this work was to conduct a thorough assessment of patient and provider experiences using the ERAS app. METHODS: Patients undergoing colorectal or gynecological oncology surgery at 2 different hospitals in the province of Alberta, Canada, were invited to use the ERAS app and report on their experiences using it. Likewise, care providers were recruited to participate in this study to provide feedback on the performance of this app. Data were collected by an online survey and using qualitative interviews with participants. NVivo was used to analyze qualitative interview data, while quantitative data were analyzed using Excel and SPSS. RESULTS: Overall, patients found the app to be helpful in preparation for and recovery after surgery. Patients reported having access to reliable unbiased information regarding their surgery, and the app provided them with clarity of actions needed along their surgical journey and enhanced the self-management of their care. Clinicians found that the ERAS app was easy to navigate, was simple for older adults, and has the potential to decrease unnecessary visits and phone calls to care providers. Overall, this proof-of-concept study on the use of a digital health app to accompany patients during their health care journey has shown positive results. CONCLUSIONS: This is an important finding considering the massive investment and interest in promoting digital health in health care systems around the world.\n
\n\n\n\n \n\n \n \n \n \n \n Enhanced Recovery in Gynecologic Oncology Surgery-State of the Science.\n \n \n \n\n\n \n Nelson, G.\n\n\n \n\n\n\n Curr Oncol Rep, 25(10): 1097–1104. October 2023.\n \n\n\n\n
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\n\n\n@article{nelson_enhanced_2023,\n\ttitle = {Enhanced {Recovery} in {Gynecologic} {Oncology} {Surgery}-{State} of the {Science}},\n\tvolume = {25},\n\tissn = {1523-3790},\n\tdoi = {10.1007/s11912-023-01442-0},\n\tabstract = {PURPOSEOF REVIEW: The purpose of this review is to describe the state of the science of enhanced recovery after surgery (ERAS) in gynecologic oncology. RECENT FINDINGS: Over the last 5 years, there is mounting evidence supporting ERAS in gynecologic oncology surgery. Despite this, surveys have found suboptimal uptake of ERAS, and stakeholders have highlighted the difficulty of ERAS implementation as a major barrier. To address this, the core components required for a successful ERAS implementation program (protocol, ERAS team, audit system) are reviewed. ERAS developments specific to gynecologic oncology are also discussed, including same-day discharge initiatives for minimally invasive surgery, implications of telemedicine, and methods to increase uptake of ERAS in low- and middle-income countries. ERAS is a surgical quality improvement program with strong evidence supporting its effectiveness in gynecologic oncology. Efforts are required to address ERAS implementation barriers to increase uptake globally, especially in low-income settings.},\n\tlanguage = {eng},\n\tnumber = {10},\n\tjournal = {Curr Oncol Rep},\n\tauthor = {Nelson, G.},\n\tmonth = oct,\n\tyear = {2023},\n\tkeywords = {*Enhanced Recovery After Surgery, *Genital Neoplasms, Female/surgery, Enhanced recovery after surgery, Eras, Female, Gynecologic Surgical Procedures/methods, Gynecologic cancer, Gynecologic oncology, Humans, Length of Stay, Perioperative Care, Perioperative care, Quality Improvement, Surgical quality improvement},\n\tpages = {1097--1104},\n}\n\n\n\n PURPOSEOF REVIEW: The purpose of this review is to describe the state of the science of enhanced recovery after surgery (ERAS) in gynecologic oncology. RECENT FINDINGS: Over the last 5 years, there is mounting evidence supporting ERAS in gynecologic oncology surgery. Despite this, surveys have found suboptimal uptake of ERAS, and stakeholders have highlighted the difficulty of ERAS implementation as a major barrier. To address this, the core components required for a successful ERAS implementation program (protocol, ERAS team, audit system) are reviewed. ERAS developments specific to gynecologic oncology are also discussed, including same-day discharge initiatives for minimally invasive surgery, implications of telemedicine, and methods to increase uptake of ERAS in low- and middle-income countries. ERAS is a surgical quality improvement program with strong evidence supporting its effectiveness in gynecologic oncology. Efforts are required to address ERAS implementation barriers to increase uptake globally, especially in low-income settings.\n
\n\n\n\n \n\n \n \n \n \n \n Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process.\n \n \n \n\n\n \n Pilkington, M.; Nelson, G.; Cauley, C.; Holder, K.; Ljungqvist, O.; Molina, G.; Oodit, R.; and Brindle, M. E.\n\n\n \n\n\n\n JAMA Netw Open, 6(2): e2248460. February 2023.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{pilkington_development_2023,\n\ttitle = {Development of an {Enhanced} {Recovery} {After} {Surgery} {Surgical} {Safety} {Checklist} {Through} a {Modified} {Delphi} {Process}},\n\tvolume = {6},\n\tissn = {2574-3805},\n\tdoi = {10.1001/jamanetworkopen.2022.48460},\n\tabstract = {IMPORTANCE: Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively. OBJECTIVE: To integrate the 2 tools to facilitate key perioperative decision-making. EVIDENCE REVIEW: Snowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65\\%-69\\% agreement) or consensus (≥70\\% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022. FINDINGS: Round 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70\\% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs. CONCLUSIONS AND RELEVANCE: The SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {JAMA Netw Open},\n\tauthor = {Pilkington, M. and Nelson, G. and Cauley, C. and Holder, K. and Ljungqvist, O. and Molina, G. and Oodit, R. and Brindle, M. E.},\n\tmonth = feb,\n\tyear = {2023},\n\tkeywords = {*Enhanced Recovery After Surgery, Checklist, Consensus, Female, Humans, Operating Rooms, Perioperative Care/methods},\n\tpages = {e2248460},\n}\n\n\n\n IMPORTANCE: Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively. OBJECTIVE: To integrate the 2 tools to facilitate key perioperative decision-making. EVIDENCE REVIEW: Snowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022. FINDINGS: Round 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs. CONCLUSIONS AND RELEVANCE: The SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.\n
\n\n\n\n \n\n \n \n \n \n \n Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) - a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery.\n \n \n \n\n\n \n Bisch, S. P.; Woo, L.; Ljungqvist, O.; and Nelson, G.\n\n\n \n\n\n\n BMJ Open, 13(11): e074649. November 2023.\n \n\n\n\n
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\n\n\n@article{bisch_ferric_2023,\n\ttitle = {Ferric derisomaltose and {Outcomes} in the {Recovery} of {Gynecologic} oncology: {ERAS} ({Enhanced} {Recovery} {After} {Surgery}) ({FORGE}) - a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery},\n\tvolume = {13},\n\tissn = {2044-6055},\n\tdoi = {10.1136/bmjopen-2023-074649},\n\tabstract = {INTRODUCTION: Iron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment courses associated with gastrointestinal side effects, poor compliance and variable absorption in cancer patients. Intravenous iron has been shown to decrease the need for allogeneic blood transfusion in gynaecological oncology patients undergoing chemotherapy, but the efficacy of this treatment in the preoperative period is unknown. The goal of this pilot study is to determine the effect of intravenous ferric derisomaltose on preoperative haemoglobin in patients undergoing surgery for gynaecological malignancy. METHODS AND ANALYSIS: We will conduct a pilot single-centre, parallel-arm randomised controlled trial of intravenous ferric derisomaltose versus placebo among consenting patients with iron-deficiency anaemia having elective major surgery on the gynaecological oncology service. Patients, clinicians and outcome assessors will be blinded. The intervention consists of a single infusion of 500-1000 mg of intravenous ferric derisomaltose administered a minimum of 21 days prior to the planned operation. The primary outcome is mean preoperative haemoglobin concentration measured 0-3 days prior to surgery in patients receiving intravenous ferric derisomaltose compared with those receiving placebo. Secondary outcomes include the following: change in haemoglobin concentration, postoperative haemoglobin concentration, perioperative blood transfusion rates, patient-reported quality of life scores (Quality of Recovery 15, Modified Short Form 36 v1, EuroQol 5-dimension 5-level and Functional Assessment of Cancer Therapy - Anaemia), surgical site infection, complication rates, length of hospital stay and readmission rate. Analyses will follow intention-to-treat principles for all randomised participants. All patients will be followed up to 60 days following surgery. ETHICS AND DISSEMINATION: Ethical approval has been granted by Health Research Ethics Board of Alberta (Project ID: HREBA.CC-22-0187) and Health Canada (HC6-024-c264013). Results will be disseminated through presentation at scientific conferences, peer-reviewed publication and social and traditional media. TRIAL REGISTRATION NUMBER: NCT05407987.},\n\tlanguage = {eng},\n\tnumber = {11},\n\tjournal = {BMJ Open},\n\tauthor = {Bisch, S. P. and Woo, L. and Ljungqvist, O. and Nelson, G.},\n\tmonth = nov,\n\tyear = {2023},\n\tkeywords = {*Anemia, Iron-Deficiency/drug therapy, *Enhanced Recovery After Surgery, *Genital Neoplasms, Female/complications/surgery/drug therapy, Adult surgery, Alberta, Anaemia, Clinical Trial, Feasibility Studies, Female, Gynaecological oncology, Hemoglobins, Humans, Iron/therapeutic use, Pilot Projects, Preoperative Care/methods, Quality of Life, Randomized Controlled Trials as Topic, Surgery},\n\tpages = {e074649},\n}\n\n\n INTRODUCTION: Iron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment courses associated with gastrointestinal side effects, poor compliance and variable absorption in cancer patients. Intravenous iron has been shown to decrease the need for allogeneic blood transfusion in gynaecological oncology patients undergoing chemotherapy, but the efficacy of this treatment in the preoperative period is unknown. The goal of this pilot study is to determine the effect of intravenous ferric derisomaltose on preoperative haemoglobin in patients undergoing surgery for gynaecological malignancy. METHODS AND ANALYSIS: We will conduct a pilot single-centre, parallel-arm randomised controlled trial of intravenous ferric derisomaltose versus placebo among consenting patients with iron-deficiency anaemia having elective major surgery on the gynaecological oncology service. Patients, clinicians and outcome assessors will be blinded. The intervention consists of a single infusion of 500-1000 mg of intravenous ferric derisomaltose administered a minimum of 21 days prior to the planned operation. The primary outcome is mean preoperative haemoglobin concentration measured 0-3 days prior to surgery in patients receiving intravenous ferric derisomaltose compared with those receiving placebo. Secondary outcomes include the following: change in haemoglobin concentration, postoperative haemoglobin concentration, perioperative blood transfusion rates, patient-reported quality of life scores (Quality of Recovery 15, Modified Short Form 36 v1, EuroQol 5-dimension 5-level and Functional Assessment of Cancer Therapy - Anaemia), surgical site infection, complication rates, length of hospital stay and readmission rate. Analyses will follow intention-to-treat principles for all randomised participants. All patients will be followed up to 60 days following surgery. ETHICS AND DISSEMINATION: Ethical approval has been granted by Health Research Ethics Board of Alberta (Project ID: HREBA.CC-22-0187) and Health Canada (HC6-024-c264013). Results will be disseminated through presentation at scientific conferences, peer-reviewed publication and social and traditional media. TRIAL REGISTRATION NUMBER: NCT05407987.\n
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\n \n \n\n \n \n \n \n \n Nutrition education: Optimising preparation and recovery for benign oesophageal surgery.\n \n \n \n\n\n \n Yeung, S.; Gill, M.; and Gillis, C.\n\n\n \n\n\n\n J Hum Nutr Diet. July 2022.\n \n\n\n\n
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\n\n\n \n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{yeung_nutrition_2022,\n\ttitle = {Nutrition education: {Optimising} preparation and recovery for benign oesophageal surgery},\n\tissn = {0952-3871},\n\tdoi = {10.1111/jhn.13064},\n\tabstract = {BACKGROUND: Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care. METHODS: Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking. RESULTS: Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. CONCLUSIONS: Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.},\n\tlanguage = {eng},\n\tjournal = {J Hum Nutr Diet},\n\tauthor = {Yeung, S. and Gill, M. and Gillis, C.},\n\tmonth = jul,\n\tyear = {2022},\n\tkeywords = {enhanced recovery after surgery, medical nutrition therapy, patient engagement, perioperative education, prehabilitation, surgical nutrition},\n}\n\n\n\n BACKGROUND: Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care. METHODS: Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking. RESULTS: Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. CONCLUSIONS: Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.\n
\n\n\n\n \n\n \n \n \n \n \n From clinical guidelines to practice: The nutrition elements for enhancing recovery after colorectal surgery.\n \n \n \n\n\n \n Hasil, L.; Fenton, T. R.; Ljungqvist, O.; and Gillis, C.\n\n\n \n\n\n\n Nutr Clin Pract, 37(2): 300–315. April 2022.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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\n\n\n@article{hasil_clinical_2022,\n\ttitle = {From clinical guidelines to practice: {The} nutrition elements for enhancing recovery after colorectal surgery},\n\tvolume = {37},\n\tissn = {0884-5336},\n\tdoi = {10.1002/ncp.10751},\n\tabstract = {The Enhanced Recovery After Surgery (ERAS) Care System improves patient outcomes. The ERAS Protocol describes multimodal, evidence-based processes that are bundled into {\\textgreater}20 care elements, and the ERAS Implementation Program provides strategies to guide the successful adoption of the care elements. Although formal training is essential to implement ERAS correctly, with this article we aim to bridge the gap between the nutritionally relevant care elements of the protocol and their implementation for colorectal surgery. This article also describes how dietitians can support optimal patient outcomes by playing an active role in implementing, monitoring, and evaluating ERAS practices.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Nutr Clin Pract},\n\tauthor = {Hasil, L. and Fenton, T. R. and Ljungqvist, O. and Gillis, C.},\n\tmonth = apr,\n\tyear = {2022},\n\tkeywords = {*Colorectal Surgery, *Digestive System Surgical Procedures, *Enhanced Recovery After Surgery, Eras, Humans, Perioperative Care/methods, Postoperative Complications, clinical guidelines, clinical protocols, colorectal surgery, nutrition therapy, oral nutrition supplements, prehabilitation},\n\tpages = {300--315},\n}\n\n\n\n The Enhanced Recovery After Surgery (ERAS) Care System improves patient outcomes. The ERAS Protocol describes multimodal, evidence-based processes that are bundled into \\textgreater20 care elements, and the ERAS Implementation Program provides strategies to guide the successful adoption of the care elements. Although formal training is essential to implement ERAS correctly, with this article we aim to bridge the gap between the nutritionally relevant care elements of the protocol and their implementation for colorectal surgery. This article also describes how dietitians can support optimal patient outcomes by playing an active role in implementing, monitoring, and evaluating ERAS practices.\n
\n\n\n\n \n\n \n \n \n \n \n Malnutrition modifies the response to multimodal prehabilitation: a pooled analysis of prehabilitation trials.\n \n \n \n\n\n \n Gillis, C.; Fenton, T. R.; Gramlich, L.; Keller, H.; Sajobi, T. T.; Culos-Reed, S. N.; Richer, L.; Awasthi, R.; and Carli, F.\n\n\n \n\n\n\n Appl Physiol Nutr Metab, 47(2): 141–150. February 2022.\n \n\n\n\n
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\n\n\n@article{gillis_malnutrition_2022,\n\ttitle = {Malnutrition modifies the response to multimodal prehabilitation: a pooled analysis of prehabilitation trials},\n\tvolume = {47},\n\tissn = {1715-5312},\n\tdoi = {10.1139/apnm-2021-0299},\n\tabstract = {Patients with colorectal cancer are at risk of malnutrition before surgery. Multimodal prehabilitation (nutrition, exercise, stress reduction) readies patients physically and mentally for their operation. However, it is unclear whether extent of malnutrition influences prehabilitation outcomes. We conducted a pooled analysis from five 4-week multimodal prehabilitation trials in colorectal cancer surgery (prehabilitation: n = 195; control: n = 71). Each patient's nutritional status was evaluated at baseline using the Patient-Generated Subjective Global Assessment (PG-SGA; higher score, greater need for treatment of malnutrition). Functional walking capacity was measured with the 6-minute walk test distance (6MWD) at baseline and before surgery. A multivariable mixed effects logistic regression model evaluated the potential modifying effect of PG-SGA on a clinically meaningful change of ≥19 m in 6MWD before surgery. Multimodal prehabilitation increased the odds by 3.4 times that colorectal cancer patients improved their 6MWD before surgery as compared with control (95\\% confidence interval (CI): 1.6 to 7.3; P = 0.001, n = 220). Nutritional status significantly modified this outcome (P = 0.007): Neither those patients with PG-SGA ≥9 (adjusted odds ratio: 1.3; 95\\% CI: 0.23 to 7.2, P = 0.771, n = 39) nor PG-SGA {\\textless}4 (adjusted odds ratio: 1.3; 95\\% CI: 0.5 to 3.8, P = 0.574, n = 87) improved in 6MWD with prehabilitation. In conclusion, baseline nutritional status modifies prehabilitation effectiveness before colorectal cancer surgery. Patients with a PG-SGA score 4-8 appear to benefit most (physically) from 4 weeks of multimodal prehabilitation. Novelty: Nutritional status is an effect modifier of prehabilitation physical function outcomes. Patients with a PG-SGA score 4-8 benefited physically from 4 weeks of multimodal prehabilitation.},\n\tlanguage = {eng},\n\tnumber = {2},\n\tjournal = {Appl Physiol Nutr Metab},\n\tauthor = {Gillis, C. and Fenton, T. R. and Gramlich, L. and Keller, H. and Sajobi, T. T. and Culos-Reed, S. N. and Richer, L. and Awasthi, R. and Carli, F.},\n\tmonth = feb,\n\tyear = {2022},\n\tkeywords = {*Nutritional Status, *Preoperative Exercise, *Severity of Illness Index, Aged, Clinical Trials as Topic, Colorectal Neoplasms/*complications/physiopathology/surgery, Combined Modality Therapy, Enhanced Recovery After Surgery, Female, Functional Status, Humans, Logistic Models, Male, Malnutrition/etiology/*therapy, Middle Aged, Nutrition Assessment, Preoperative Period, Treatment Outcome, nutrition risk, pre-habilitation, preoperative, préadaptation, préopératoire, risque nutritionnel, récupération améliorée après chirurgie},\n\tpages = {141--150},\n}\n\n\n\n Patients with colorectal cancer are at risk of malnutrition before surgery. Multimodal prehabilitation (nutrition, exercise, stress reduction) readies patients physically and mentally for their operation. However, it is unclear whether extent of malnutrition influences prehabilitation outcomes. We conducted a pooled analysis from five 4-week multimodal prehabilitation trials in colorectal cancer surgery (prehabilitation: n = 195; control: n = 71). Each patient's nutritional status was evaluated at baseline using the Patient-Generated Subjective Global Assessment (PG-SGA; higher score, greater need for treatment of malnutrition). Functional walking capacity was measured with the 6-minute walk test distance (6MWD) at baseline and before surgery. A multivariable mixed effects logistic regression model evaluated the potential modifying effect of PG-SGA on a clinically meaningful change of ≥19 m in 6MWD before surgery. Multimodal prehabilitation increased the odds by 3.4 times that colorectal cancer patients improved their 6MWD before surgery as compared with control (95% confidence interval (CI): 1.6 to 7.3; P = 0.001, n = 220). Nutritional status significantly modified this outcome (P = 0.007): Neither those patients with PG-SGA ≥9 (adjusted odds ratio: 1.3; 95% CI: 0.23 to 7.2, P = 0.771, n = 39) nor PG-SGA \\textless4 (adjusted odds ratio: 1.3; 95% CI: 0.5 to 3.8, P = 0.574, n = 87) improved in 6MWD with prehabilitation. In conclusion, baseline nutritional status modifies prehabilitation effectiveness before colorectal cancer surgery. Patients with a PG-SGA score 4-8 appear to benefit most (physically) from 4 weeks of multimodal prehabilitation. Novelty: Nutritional status is an effect modifier of prehabilitation physical function outcomes. Patients with a PG-SGA score 4-8 benefited physically from 4 weeks of multimodal prehabilitation.\n
\n\n\n\n \n\n \n \n \n \n \n Cesarean delivery using an ERAS-CD process for nonopioid anesthesia and analgesia drug/medication management.\n \n \n \n\n\n \n Wilson, R. D.\n\n\n \n\n\n\n Best Pract Res Clin Obstet Gynaecol, 85(Pt B): 35–52. December 2022.\n \n\n\n\n
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\n\n\n@article{wilson_cesarean_2022,\n\ttitle = {Cesarean delivery using an {ERAS}-{CD} process for nonopioid anesthesia and analgesia drug/medication management},\n\tvolume = {85},\n\tissn = {1521-6934},\n\tdoi = {10.1016/j.bpobgyn.2022.07.004},\n\tabstract = {Cesarean delivery (CD) is a surgical delivery of a neonate with surgical access through the maternal abdominal and uterine structures. The Enhanced Recovery After Surgery (ERAS) protocol is a standardized perioperative care program and surgery quality improvement process that has had global spread across numerous surgical disciplines. The medical and surgical use of opioids for pain management and the nonmedical opioid use, over the last three decades, have significantly increased the prevalence of abuse and addiction to opioids. This review summarizes pain, pregnancy substance use, and ERAS-directed analgesia and anesthesia for opioid use reduction or elimination in the operative and postoperative periods. Enhanced recovery (quality and safety) in the surgical CD context requires collaboration, consensus, and appropriate clinical prioritization to allow for the identification of 'the right patient, in the right clinical situation, with the right informed consent, and the right clinical care team and health system'.},\n\tlanguage = {eng},\n\tnumber = {Pt B},\n\tjournal = {Best Pract Res Clin Obstet Gynaecol},\n\tauthor = {Wilson, R. D.},\n\tmonth = dec,\n\tyear = {2022},\n\tkeywords = {*Anesthesia, *Enhanced Recovery After Surgery, Analgesics, Opioid/therapeutic use, ERAS/enhanced recovery after surgery, Female, Humans, Infant, Newborn, Medication Therapy Management, Multimodal, Operative, Pain, Postoperative/drug therapy/etiology/epidemiology, Postoperative, Pregnancy, Quality improvement, Surgical opioid use},\n\tpages = {35--52},\n}\n\n\n\n Cesarean delivery (CD) is a surgical delivery of a neonate with surgical access through the maternal abdominal and uterine structures. The Enhanced Recovery After Surgery (ERAS) protocol is a standardized perioperative care program and surgery quality improvement process that has had global spread across numerous surgical disciplines. The medical and surgical use of opioids for pain management and the nonmedical opioid use, over the last three decades, have significantly increased the prevalence of abuse and addiction to opioids. This review summarizes pain, pregnancy substance use, and ERAS-directed analgesia and anesthesia for opioid use reduction or elimination in the operative and postoperative periods. Enhanced recovery (quality and safety) in the surgical CD context requires collaboration, consensus, and appropriate clinical prioritization to allow for the identification of 'the right patient, in the right clinical situation, with the right informed consent, and the right clinical care team and health system'.\n
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\n \n \n\n \n \n \n \n \n Third-Variable Effects: Tools to Understand Who, When, Why, and How Patients Benefit From Surgical Prehabilitation.\n \n \n \n\n\n \n Gillis, C.; Gramlich, L.; Culos-Reed, S. N.; Sajobi, T. T.; Fiest, K. M.; Carli, F.; and Fenton, T. R.\n\n\n \n\n\n\n J Surg Res, 258: 443–452. February 2021.\n \n\n\n\n
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\n\n\n@article{gillis_third-variable_2021,\n\ttitle = {Third-{Variable} {Effects}: {Tools} to {Understand} {Who}, {When}, {Why}, and {How} {Patients} {Benefit} {From} {Surgical} {Prehabilitation}},\n\tvolume = {258},\n\tissn = {0022-4804},\n\tdoi = {10.1016/j.jss.2020.09.026},\n\tabstract = {Prehabilitation is a new field of research that aims to optimize modifiable surgical risk factors before surgery to improve patient-oriented outcomes preoperatively and postoperatively. As with any new intervention, the pressing questions that arise include what interventions work, for whom they work, and when do they work best? Given that prehabilitation can be resource intensive, and that preoperative patient characteristics are likely to produce variation in response to treatment, establishing answers to these questions is critical for successful implementation of prehabilitation in clinical practice. The objective of this review article is to describe the illuminating potential of including "third-variable effects" into the integration of research design; by planning for and including measurements of mediators, moderators, and confounders in the design and analysis of prehabilitation research, we can begin to answer practical, clinically relevant questions.},\n\tlanguage = {eng},\n\tjournal = {J Surg Res},\n\tauthor = {Gillis, C. and Gramlich, L. and Culos-Reed, S. N. and Sajobi, T. T. and Fiest, K. M. and Carli, F. and Fenton, T. R.},\n\tmonth = feb,\n\tyear = {2021},\n\tkeywords = {*Preoperative Exercise, Colorectal surgery, Confounding, Confounding Factors, Epidemiologic, Effect Modifier, Epidemiologic, Enhanced recovery after surgery, Humans, Mediation, Moderation, Preoperative, Surgical Procedures, Operative/rehabilitation},\n\tpages = {443--452},\n}\n\n\n\n Prehabilitation is a new field of research that aims to optimize modifiable surgical risk factors before surgery to improve patient-oriented outcomes preoperatively and postoperatively. As with any new intervention, the pressing questions that arise include what interventions work, for whom they work, and when do they work best? Given that prehabilitation can be resource intensive, and that preoperative patient characteristics are likely to produce variation in response to treatment, establishing answers to these questions is critical for successful implementation of prehabilitation in clinical practice. The objective of this review article is to describe the illuminating potential of including \"third-variable effects\" into the integration of research design; by planning for and including measurements of mediators, moderators, and confounders in the design and analysis of prehabilitation research, we can begin to answer practical, clinically relevant questions.\n
\n\n\n\n \n\n \n \n \n \n \n Real World Outcomes in Patients with Advanced Melanoma Treated in Alberta, Canada: A Time-Era Based Analysis.\n \n \n \n\n\n \n Rigo, R.; Doherty, J.; Koczka, K.; Kong, S.; Ding, P. Q.; Cheng, T.; Cheung, W. Y.; and Monzon, J. G.\n\n\n \n\n\n\n Curr Oncol, 28(5): 3978–3986. October 2021.\n \n\n\n\n
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\n\n\n@article{rigo_real_2021,\n\ttitle = {Real {World} {Outcomes} in {Patients} with {Advanced} {Melanoma} {Treated} in {Alberta}, {Canada}: {A} {Time}-{Era} {Based} {Analysis}},\n\tvolume = {28},\n\tissn = {1198-0052 (Print) 1198-0052},\n\tdoi = {10.3390/curroncol28050338},\n\tabstract = {Immune checkpoint and MAP kinase pathway inhibitors can significantly improve long-term survival for patients with melanoma. There is limited real-world data of these regimens' effectiveness. We retrospectively analyzed 402 patients with unresectable and metastatic melanoma between August 2013 and July 2020 treated with immune checkpoint inhibitors and MAP kinase pathway targeted therapy in Alberta, Canada. Overall survival (OS) was compared using Kaplan-Meier and Cox regression analyses. Subgroup survival outcomes were analyzed by first-line treatment regime and BRAF mutation status. Three treatment eras were defined based on drug access: prior to August 2013, August 2013 to November 2016, and November 2016 to July 2020. Across each era, there were improvements in median OS: 11.7 months, 15.9 months, and 33.6 months, respectively. Patients with BRAF mutant melanoma had improved median OS when they were treated with immunotherapy in the first line as opposed to targeted therapy (median OS not reached for immunotherapy versus 17.4 months with targeted treatment). Patients with BRAF wild-type melanomas had improved survival with ipilimumab and nivolumab versus those treated with a single-agent PD-1 inhibitor (median OS not reached and 21.2 months). Our real-world analysis confirms significant survival improvements with each subsequent introduction of novel therapies for advanced melanoma.},\n\tlanguage = {eng},\n\tnumber = {5},\n\tjournal = {Curr Oncol},\n\tauthor = {Rigo, R. and Doherty, J. and Koczka, K. and Kong, S. and Ding, P. Q. and Cheng, T. and Cheung, W. Y. and Monzon, J. G.},\n\tmonth = oct,\n\tyear = {2021},\n\tkeywords = {*Melanoma/drug therapy/genetics, Alberta, BRAF mutation, Humans, Ipilimumab, Nivolumab, Retrospective Studies, ipilimumab, melanoma, nivolumab, overall survival, real-world study, targeted therapy},\n\tpages = {3978--3986},\n}\n\n\n\n Immune checkpoint and MAP kinase pathway inhibitors can significantly improve long-term survival for patients with melanoma. There is limited real-world data of these regimens' effectiveness. We retrospectively analyzed 402 patients with unresectable and metastatic melanoma between August 2013 and July 2020 treated with immune checkpoint inhibitors and MAP kinase pathway targeted therapy in Alberta, Canada. Overall survival (OS) was compared using Kaplan-Meier and Cox regression analyses. Subgroup survival outcomes were analyzed by first-line treatment regime and BRAF mutation status. Three treatment eras were defined based on drug access: prior to August 2013, August 2013 to November 2016, and November 2016 to July 2020. Across each era, there were improvements in median OS: 11.7 months, 15.9 months, and 33.6 months, respectively. Patients with BRAF mutant melanoma had improved median OS when they were treated with immunotherapy in the first line as opposed to targeted therapy (median OS not reached for immunotherapy versus 17.4 months with targeted treatment). Patients with BRAF wild-type melanomas had improved survival with ipilimumab and nivolumab versus those treated with a single-agent PD-1 inhibitor (median OS not reached and 21.2 months). Our real-world analysis confirms significant survival improvements with each subsequent introduction of novel therapies for advanced melanoma.\n
\n\n\n\n \n\n \n \n \n \n \n Maternal perceptions of cesarean birth care: A qualitative study to inform ERAS guideline development.\n \n \n \n\n\n \n Wollny, K.; Metcalfe, A.; Corrigan, C.; Drobot, A.; Gilmour, L.; Wood, S.; Wilson, R. D.; Gramlich, L.; and Nelson, G.\n\n\n \n\n\n\n Birth, 48(4): 550–557. December 2021.\n \n\n\n\n
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\n\n\n@article{wollny_maternal_2021,\n\ttitle = {Maternal perceptions of cesarean birth care: {A} qualitative study to inform {ERAS} guideline development},\n\tvolume = {48},\n\tissn = {0730-7659},\n\tdoi = {10.1111/birt.12561},\n\tabstract = {BACKGROUND: Cesarean birth (CB) is the most common inpatient surgical procedure, and until recently, there were no internationally accepted, standardized clinical guidelines available. The Enhanced Recovery After Surgery (ERAS(®) ) program aims to improve outcomes through the development of international guidelines (IGs). As an ERAS IG for CB was being developed, this qualitative study was conducted to explore and consolidate women's experiences with CB. METHODS: Qualitative methods were used to assess the patient experience with current evidence-based CB protocols across operative phases. Twelve women who experienced CB at a single center in Canada were interviewed using an open-ended, semi-structured interview guide at six weeks postpartum. Two researchers coded the emerging themes separately and compared findings. RESULTS: Women described feeling informed, but felt they did not have a choice. Presurgery, women wanted more information about the risks of CB. Preoperatively, women expressed confusion with the procedures, but felt informed about local anesthesia and thermoregulation. Post-CB, women felt informed about pain and nausea control; however, urinary catheter removal was delayed when compared to the ERAS recommendations. Information about postpartum infant care was not well communicated, as many women were uninformed about delayed cord clamping and infant thermoregulation. CONCLUSIONS: This qualitative study provides opportunities to improve communication, the patient-practitioner relationship, and the overall satisfaction throughout the CB process. The findings support the implementation of patient decision aids and training with the shared decision model. The improved procedures recommended in the ERAS IG for CB have the potential to deliver significant improvements to patient care and patient satisfaction.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Birth},\n\tauthor = {Wollny, K. and Metcalfe, A. and Corrigan, C. and Drobot, A. and Gilmour, L. and Wood, S. and Wilson, R. D. and Gramlich, L. and Nelson, G.},\n\tmonth = dec,\n\tyear = {2021},\n\tkeywords = {*Cesarean Section, *Postnatal Care, *Postpartum Period, Enhanced Recovery After Surgery®, Female, Humans, Mothers, Pregnancy, Qualitative Research, Umbilical Cord Clamping, cesarean birth, guidelines, qualitative research},\n\tpages = {550--557},\n}\n\n\n\n BACKGROUND: Cesarean birth (CB) is the most common inpatient surgical procedure, and until recently, there were no internationally accepted, standardized clinical guidelines available. The Enhanced Recovery After Surgery (ERAS(®) ) program aims to improve outcomes through the development of international guidelines (IGs). As an ERAS IG for CB was being developed, this qualitative study was conducted to explore and consolidate women's experiences with CB. METHODS: Qualitative methods were used to assess the patient experience with current evidence-based CB protocols across operative phases. Twelve women who experienced CB at a single center in Canada were interviewed using an open-ended, semi-structured interview guide at six weeks postpartum. Two researchers coded the emerging themes separately and compared findings. RESULTS: Women described feeling informed, but felt they did not have a choice. Presurgery, women wanted more information about the risks of CB. Preoperatively, women expressed confusion with the procedures, but felt informed about local anesthesia and thermoregulation. Post-CB, women felt informed about pain and nausea control; however, urinary catheter removal was delayed when compared to the ERAS recommendations. Information about postpartum infant care was not well communicated, as many women were uninformed about delayed cord clamping and infant thermoregulation. CONCLUSIONS: This qualitative study provides opportunities to improve communication, the patient-practitioner relationship, and the overall satisfaction throughout the CB process. The findings support the implementation of patient decision aids and training with the shared decision model. The improved procedures recommended in the ERAS IG for CB have the potential to deliver significant improvements to patient care and patient satisfaction.\n
\n\n\n\n \n\n \n \n \n \n \n Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications.\n \n \n \n\n\n \n Gillis, C.; Fenton, T. R.; Gramlich, L.; Sajobi, T. T.; Culos-Reed, S. N.; Bousquet-Dion, G.; Elsherbini, N.; Fiore; Minnella, E. M.; Awasthi, R.; Liberman, A. S.; Boutros, M.; and Carli, F.\n\n\n \n\n\n\n Eur J Surg Oncol, 47(4): 874–881. April 2021.\n \n\n\n\n
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\n\n\n@article{gillis_older_2021,\n\ttitle = {Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications},\n\tvolume = {47},\n\tissn = {0748-7983},\n\tdoi = {10.1016/j.ejso.2020.09.041},\n\tabstract = {INTRODUCTION: Recent efforts to prehabilitate intermediately frail and frail (Fried frailty criteria ≥2) elective colorectal cancer patients did not influence clinical nor functional outcomes. The objective of this secondary analysis was to describe the subset of intermediately frail and frail prehabilitated patients who could not attain a minimum 400 m (a prognostic cut-point used in other patient populations) 6-min walking distance (6MWD) before elective surgery. MATERIALS AND METHODS: Secondary analysis of a randomized controlled trial. Patients participated in multimodal prehabilitation at home and in-hospital for approximately four weeks before colorectal surgery. Primary outcome was incidence of postoperative complications within 30 days of hospital discharge. RESULTS: Sixty percent of the patients who participated in prehabilitation did not reach a minimum walking distance of 400 m in 6 min before surgery. Compared to the group that attained ≥400 m 6MWD (n = 19), the {\\textless}400 m group (n = 28) were older, had higher percent body fat, lower physical function, lower self-reported physical activity, higher American Society of Anesthesiologists (ASA) classification, and twice as many were in critical need of a nutrition intervention at baseline. No group differences were observed regarding frailty status (P = 0.775). Sixty-one percent of the {\\textless}400 m 6MWD group experienced at least one complication within 30 days of surgery compared to 21\\% in the ≥400 m group (P = 0.009). CONCLUSION: Several preoperative characteristics were identified in the {\\textless}400 m 6MWD group that could be useful in screening and targeting future prehabilitative treatments. Future trials should investigate use of a 400 m standard for the 6MWD as a minimal treatment target for prehabilitation.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {Eur J Surg Oncol},\n\tauthor = {Gillis, C. and Fenton, T. R. and Gramlich, L. and Sajobi, T. T. and Culos-Reed, S. N. and Bousquet-Dion, G. and Elsherbini, N. and Fiore, Jr., J. F. and Minnella, E. M. and Awasthi, R. and Liberman, A. S. and Boutros, M. and Carli, F.},\n\tmonth = apr,\n\tyear = {2021},\n\tkeywords = {*Frail Elderly, *Preoperative Exercise, Adiposity/physiology, Aged, Aged, 80 and over, Before surgery, Colorectal Neoplasms/*surgery, Elective Surgical Procedures/adverse effects, Enhanced recovery after surgery, Exercise, Health Status Indicators, Humans, Nutritional Status, Physical Functional Performance, Postoperative Complications/*etiology, Pre-surgery, Prehabilitation, Preoperative, Preoperative Period, Walk Test},\n\tpages = {874--881},\n}\n\n\n\n INTRODUCTION: Recent efforts to prehabilitate intermediately frail and frail (Fried frailty criteria ≥2) elective colorectal cancer patients did not influence clinical nor functional outcomes. The objective of this secondary analysis was to describe the subset of intermediately frail and frail prehabilitated patients who could not attain a minimum 400 m (a prognostic cut-point used in other patient populations) 6-min walking distance (6MWD) before elective surgery. MATERIALS AND METHODS: Secondary analysis of a randomized controlled trial. Patients participated in multimodal prehabilitation at home and in-hospital for approximately four weeks before colorectal surgery. Primary outcome was incidence of postoperative complications within 30 days of hospital discharge. RESULTS: Sixty percent of the patients who participated in prehabilitation did not reach a minimum walking distance of 400 m in 6 min before surgery. Compared to the group that attained ≥400 m 6MWD (n = 19), the \\textless400 m group (n = 28) were older, had higher percent body fat, lower physical function, lower self-reported physical activity, higher American Society of Anesthesiologists (ASA) classification, and twice as many were in critical need of a nutrition intervention at baseline. No group differences were observed regarding frailty status (P = 0.775). Sixty-one percent of the \\textless400 m 6MWD group experienced at least one complication within 30 days of surgery compared to 21% in the ≥400 m group (P = 0.009). CONCLUSION: Several preoperative characteristics were identified in the \\textless400 m 6MWD group that could be useful in screening and targeting future prehabilitative treatments. Future trials should investigate use of a 400 m standard for the 6MWD as a minimal treatment target for prehabilitation.\n
\n\n\n\n \n\n \n \n \n \n \n Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction.\n \n \n \n\n\n \n Twomey, R.; Matthews, T. W.; Nakoneshny, S.; Schrag, C.; Chandarana, S. P.; Matthews, J.; McKenzie, D.; Hart, R. D.; Li, N.; Sauro, K. M.; and Dort, J. C.\n\n\n \n\n\n\n Cancers (Basel), 13(12). June 2021.\n \n\n\n\n
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\n\n\n@article{twomey_impact_2021,\n\ttitle = {Impact of {Early} {Mobilization} on {Recovery} after {Major} {Head} and {Neck} {Surgery} with {Free} {Flap} {Reconstruction}},\n\tvolume = {13},\n\tissn = {2072-6694 (Print) 2072-6694},\n\tdoi = {10.3390/cancers13122852},\n\tabstract = {Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95\\% CI [confidence interval] = 1.16-2.57) and more major complications (OR = 1.76; 95\\% CI = 1.00-3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95\\% CI = 1.10-6.21) and prolonged length of stay ({\\textgreater}10 days; OR = 2.85, 95\\% CI = 1.41-5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.},\n\tlanguage = {eng},\n\tnumber = {12},\n\tjournal = {Cancers (Basel)},\n\tauthor = {Twomey, R. and Matthews, T. W. and Nakoneshny, S. and Schrag, C. and Chandarana, S. P. and Matthews, J. and McKenzie, D. and Hart, R. D. and Li, N. and Sauro, K. M. and Dort, J. C.},\n\tmonth = jun,\n\tyear = {2021},\n\tkeywords = {care pathways, clinical outcomes improvement, clinical pathways, early mobilization, enhanced recovery, head and neck cancer, head and neck surgery},\n}\n\n\n\n Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16-2.57) and more major complications (OR = 1.76; 95% CI = 1.00-3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10-6.21) and prolonged length of stay (\\textgreater10 days; OR = 2.85, 95% CI = 1.41-5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.\n
\n\n\n\n \n\n \n \n \n \n \n From Pathways to Practice: Impact of Implementing Mobilization Recommendations in Head and Neck Cancer Surgery with Free Flap Reconstruction.\n \n \n \n\n\n \n Twomey, R.; Matthews, T. W.; Nakoneshny, S. C.; Schrag, C.; Chandarana, S. P.; Matthews, J.; McKenzie, D.; Hart, R. D.; Li, N.; Dort, J. C.; and Sauro, K. M.\n\n\n \n\n\n\n Cancers (Basel), 13(12). June 2021.\n \n\n\n\n
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\n\n\n@article{twomey_pathways_2021,\n\ttitle = {From {Pathways} to {Practice}: {Impact} of {Implementing} {Mobilization} {Recommendations} in {Head} and {Neck} {Cancer} {Surgery} with {Free} {Flap} {Reconstruction}},\n\tvolume = {13},\n\tissn = {2072-6694 (Print) 2072-6694},\n\tdoi = {10.3390/cancers13122890},\n\tabstract = {One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10\\% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10\\% to 64\\%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman's rho = -0.80; p {\\textless} 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9-16) to 10 (1QR = 8-14) days (z = 3.82; p {\\textless} 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.},\n\tlanguage = {eng},\n\tnumber = {12},\n\tjournal = {Cancers (Basel)},\n\tauthor = {Twomey, R. and Matthews, T. W. and Nakoneshny, S. C. and Schrag, C. and Chandarana, S. P. and Matthews, J. and McKenzie, D. and Hart, R. D. and Li, N. and Dort, J. C. and Sauro, K. M.},\n\tmonth = jun,\n\tyear = {2021},\n\tkeywords = {administrative data, care pathways, clinical outcomes improvement, clinical pathways, clinical practice guidelines, early mobilization, enhanced recovery, evidence-based medicine, head and neck surgery, implementation science, quality improvement, registry},\n}\n\n\n\n One of the foundational elements of enhanced recovery after surgery (ERAS) guidelines is early postoperative mobilization. For patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction, the ERAS guideline recommends patients be mobilized within 24 h postoperatively. The objective of this study was to evaluate compliance with the ERAS recommendation for early postoperative mobilization in 445 consecutive patients who underwent HNC surgery in the Calgary Head and Neck Enhanced Recovery Program. This retrospective analysis found that recommendation compliance increased by 10% despite a more aggressive target for mobilization (from 48 to 24 h). This resulted in a decrease in postoperative mobilization time and a stark increase in the proportion of patients mobilized within 24 h (from 10% to 64%). There was a significant relationship between compliance with recommended care and time to postoperative mobilization (Spearman's rho = -0.80; p \\textless 0.001). Hospital length of stay was reduced by a median of 2 days, from 12 (1QR = 9-16) to 10 (1QR = 8-14) days (z = 3.82; p \\textless 0.001) in patients who received guideline-concordant care. Engaging the clinical team and changing the order set to support clinical decision-making resulted in increased adherence to guideline-recommended care for patients undergoing major HNC surgery with free flap reconstruction.\n
\n\n\n\n \n\n \n \n \n \n \n Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada.\n \n \n \n\n\n \n Nelson, G.; Wang, X.; Nelson, A.; Faris, P.; Lagendyk, L.; Wasylak, T.; Bathe, O. F.; Bigam, D.; Bruce, E.; Buie, W. D.; Chong, M.; Fairey, A.; Hyndman, M. E.; MacLean, A.; McCall, M.; Pin, S.; Wang, H.; and Gramlich, L.\n\n\n \n\n\n\n JAMA Netw Open, 4(8): e2119769. August 2021.\n \n\n\n\n
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\n\n\n@article{nelson_evaluation_2021,\n\ttitle = {Evaluation of the {Implementation} of {Multiple} {Enhanced} {Recovery} {After} {Surgery} {Pathways} {Across} a {Provincial} {Health} {Care} {System} in {Alberta}, {Canada}},\n\tvolume = {4},\n\tissn = {2574-3805},\n\tdoi = {10.1001/jamanetworkopen.2021.19769},\n\tabstract = {IMPORTANCE: Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. OBJECTIVE: To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. INTERVENTIONS: Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. MAIN OUTCOMES AND MEASURES: Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. RESULTS: A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 526 [53.5\\%] female) and 6773 in the post-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 3470 [51.2\\%] male). In the total cohort, care-element adherence improved from 52\\% to 76\\% (P {\\textless} .001), no significant differences were found in serious complications (from 6.2\\% to 4.9\\%; P = .08) or 30-day mortality (from 0.71\\% to 0.93\\%; P = .50), 1-year mortality decreased from 7.1\\% to 4.6\\% (P {\\textless} .001), mean (SD) LOS decreased from 9.4 (7.0) to 7.8 (5.0) days (P {\\textless} .001), and 30-day readmission rates were unchanged (from 13.4\\% to 11.7\\%; P = .12). After adjustment for patient characteristics, the LOS mean difference decreased 0.71 days (95\\% CI, -1.13 to -0.29 days; P {\\textless} .001), with no significant differences in adjusted 30-day readmission (-3.5\\%; 95\\% CI, -22.7\\% to 20.4\\%; P = .75), serious complications (1.3\\%; 95\\% CI, -26.2\\% to 39.0\\%; P = .94), or mortality (30-day mortality: 42\\% [95\\% CI, -35.4\\% to 212.3\\%]; P = .38; 1-year mortality: 8\\% [95\\% CI, -20.5\\% to 46.8\\%]; P = .62). The adjusted 1-year readmission rate was -15.6\\% (95\\% CI, -27.7\\% to -1.5\\%; P = .03) in favor of ERAS, and readmission LOS was shorter by 1.7 days (95\\% CI, -3.3 to -0.1 days; P = .04). CONCLUSIONS AND RELEVANCE: The results of this quality improvement study suggest that implementation of ERAS across multiple pathways may improve health care practitioner adherence to ERAS guidelines, LOS, and readmission rates at a system level.},\n\tlanguage = {eng},\n\tnumber = {8},\n\tjournal = {JAMA Netw Open},\n\tauthor = {Nelson, G. and Wang, X. and Nelson, A. and Faris, P. and Lagendyk, L. and Wasylak, T. and Bathe, O. F. and Bigam, D. and Bruce, E. and Buie, W. D. and Chong, M. and Fairey, A. and Hyndman, M. E. and MacLean, A. and McCall, M. and Pin, S. and Wang, H. and Gramlich, L.},\n\tmonth = aug,\n\tyear = {2021},\n\tkeywords = {*Practice Guidelines as Topic, Aged, Alberta, Cohort Studies, Enhanced Recovery After Surgery/*standards, Female, Guideline Adherence/*statistics \\& numerical data, Humans, Length of Stay/statistics \\& numerical data, Male, Middle Aged, Neoplasms/*surgery, Patient Readmission/standards/statistics \\& numerical data, Postanesthesia Nursing/*standards/statistics \\& numerical data, Quality Improvement/*standards/statistics \\& numerical data, Quality of Health Care/*standards/statistics \\& numerical data, State Medicine/*organization \\& administration/statistics \\& numerical data},\n\tpages = {e2119769},\n}\n\n\n\n IMPORTANCE: Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. OBJECTIVE: To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. INTERVENTIONS: Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. MAIN OUTCOMES AND MEASURES: Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. RESULTS: A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 526 [53.5%] female) and 6773 in the post-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 3470 [51.2%] male). In the total cohort, care-element adherence improved from 52% to 76% (P \\textless .001), no significant differences were found in serious complications (from 6.2% to 4.9%; P = .08) or 30-day mortality (from 0.71% to 0.93%; P = .50), 1-year mortality decreased from 7.1% to 4.6% (P \\textless .001), mean (SD) LOS decreased from 9.4 (7.0) to 7.8 (5.0) days (P \\textless .001), and 30-day readmission rates were unchanged (from 13.4% to 11.7%; P = .12). After adjustment for patient characteristics, the LOS mean difference decreased 0.71 days (95% CI, -1.13 to -0.29 days; P \\textless .001), with no significant differences in adjusted 30-day readmission (-3.5%; 95% CI, -22.7% to 20.4%; P = .75), serious complications (1.3%; 95% CI, -26.2% to 39.0%; P = .94), or mortality (30-day mortality: 42% [95% CI, -35.4% to 212.3%]; P = .38; 1-year mortality: 8% [95% CI, -20.5% to 46.8%]; P = .62). The adjusted 1-year readmission rate was -15.6% (95% CI, -27.7% to -1.5%; P = .03) in favor of ERAS, and readmission LOS was shorter by 1.7 days (95% CI, -3.3 to -0.1 days; P = .04). CONCLUSIONS AND RELEVANCE: The results of this quality improvement study suggest that implementation of ERAS across multiple pathways may improve health care practitioner adherence to ERAS guidelines, LOS, and readmission rates at a system level.\n
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