TY - JOUR
T1 - The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay
T2 - Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort
AU - Grant, Michael C.
AU - Pio Roda, Claro M.
AU - Canner, Joseph K.
AU - Sommer, Philip
AU - Galante, Daniel
AU - Hobson, Deborah
AU - Gearhart, Susan
AU - Wu, Christopher L.
AU - Wick, Elizabeth
N1 - Publisher Copyright:
Copyright © 2018 International Anesthesia Research Society
PY - 2019/1
Y1 - 2019/1
N2 - BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). RESULTS: Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70–0.85); P < .001) compared to low compliance (0–2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68–0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67–0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51–0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. CONCLUSIONS: Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.
AB - BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). RESULTS: Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70–0.85); P < .001) compared to low compliance (0–2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68–0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67–0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51–0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. CONCLUSIONS: Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.
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U2 - 10.1213/ANE.0000000000003458
DO - 10.1213/ANE.0000000000003458
M3 - Article
C2 - 29782405
AN - SCOPUS:85059286035
SN - 0003-2999
VL - 128
SP - 68
EP - 74
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 1
ER -