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Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study

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Memtsoudis, SG, Fiasconaro, M, Soffin, EM, Liu, J, Wilson, LA, Poeran, J, Bekeris, J & Kehlet, H 2020, 'Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study' British Journal of Anaesthesia, vol. 124, no. 5, pp. 638-647. https://doi.org/10.1016/j.bja.2020.01.017

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Memtsoudis, Stavros G ; Fiasconaro, Megan ; Soffin, Ellen M ; Liu, Jiabin ; Wilson, Lauren A ; Poeran, Jashvant ; Bekeris, Janis ; Kehlet, Henrik. / Enhanced recovery after surgery components and perioperative outcomes : a nationwide observational study. In: British Journal of Anaesthesia. 2020 ; Vol. 124, No. 5. pp. 638-647.

Bibtex

@article{55d7877fa3c54f69932421c88e77788a,
title = "Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study",
abstract = "BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been shown to benefit recovery after several operations. However, large-scale data on the association between the level of ERAS use and perioperative complications are scarce, particularly in surgeries with increasing ERAS uptake, including total hip (THA) and knee arthroplasty (TKA). Using US national data, we examined the relationship between the number of ERAS components implemented ('level') and perioperative outcomes.METHODS: After ethics approval, we included 1 540 462 elective THA/TKA procedures (2006-2016, as recorded in the Premier Healthcare claims database) in this retrospective cohort study. Main outcomes were any complication, cardiopulmonary complications, mortality, blood transfusions, and length of stay. Eight commonly used ERAS components were included. Mixed-effects models measured associations between ERAS level and outcomes, with odds ratios (OR) and confidence intervals (CI) reported.RESULTS: ERAS use increased over time; overall, 21.6{\%} (n=324 437), 62.7{\%} (n=965 953), and 18.0{\%} (n=250 072) of cases were classified as 'High', 'Medium', or 'Low' ERAS. 'High ERAS', 'Medium ERAS', and 'Low ERAS' level of use were defined as such if they received either >6, 5-6, or <5 ERAS components, respectively. After adjustment for relevant covariates, higher levels of ERAS use were associated with incremental reductions in 'any complication': 'Medium' vs 'Low' (OR=0.84; CI, 0.82-0.86) and 'High' vs 'Low' (OR=0.71; CI, 0.68-0.74). Similar patterns were found for the other study outcomes. Individual ERAS components with the strongest effect estimates were early physical therapy, avoidance of a urinary catheter, and tranexamic acid administration.CONCLUSIONS: ERAS components were used more frequently over time, and the level of utilisation was independently associated with incrementally improved complication odds and reduced length of stay during the primary admission. Possible indication bias limits the certainty of these findings.",
keywords = "enhanced recovery after surgery, fast-track surgery, perioperative outcomes, retrospective cohort study, total joint arthroplasty",
author = "Memtsoudis, {Stavros G} and Megan Fiasconaro and Soffin, {Ellen M} and Jiabin Liu and Wilson, {Lauren A} and Jashvant Poeran and Janis Bekeris and Henrik Kehlet",
note = "Copyright {\circledC} 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.",
year = "2020",
month = "5",
doi = "10.1016/j.bja.2020.01.017",
language = "English",
volume = "124",
pages = "638--647",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "5",

}

RIS

TY - JOUR

T1 - Enhanced recovery after surgery components and perioperative outcomes

T2 - a nationwide observational study

AU - Memtsoudis, Stavros G

AU - Fiasconaro, Megan

AU - Soffin, Ellen M

AU - Liu, Jiabin

AU - Wilson, Lauren A

AU - Poeran, Jashvant

AU - Bekeris, Janis

AU - Kehlet, Henrik

N1 - Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

PY - 2020/5

Y1 - 2020/5

N2 - BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been shown to benefit recovery after several operations. However, large-scale data on the association between the level of ERAS use and perioperative complications are scarce, particularly in surgeries with increasing ERAS uptake, including total hip (THA) and knee arthroplasty (TKA). Using US national data, we examined the relationship between the number of ERAS components implemented ('level') and perioperative outcomes.METHODS: After ethics approval, we included 1 540 462 elective THA/TKA procedures (2006-2016, as recorded in the Premier Healthcare claims database) in this retrospective cohort study. Main outcomes were any complication, cardiopulmonary complications, mortality, blood transfusions, and length of stay. Eight commonly used ERAS components were included. Mixed-effects models measured associations between ERAS level and outcomes, with odds ratios (OR) and confidence intervals (CI) reported.RESULTS: ERAS use increased over time; overall, 21.6% (n=324 437), 62.7% (n=965 953), and 18.0% (n=250 072) of cases were classified as 'High', 'Medium', or 'Low' ERAS. 'High ERAS', 'Medium ERAS', and 'Low ERAS' level of use were defined as such if they received either >6, 5-6, or <5 ERAS components, respectively. After adjustment for relevant covariates, higher levels of ERAS use were associated with incremental reductions in 'any complication': 'Medium' vs 'Low' (OR=0.84; CI, 0.82-0.86) and 'High' vs 'Low' (OR=0.71; CI, 0.68-0.74). Similar patterns were found for the other study outcomes. Individual ERAS components with the strongest effect estimates were early physical therapy, avoidance of a urinary catheter, and tranexamic acid administration.CONCLUSIONS: ERAS components were used more frequently over time, and the level of utilisation was independently associated with incrementally improved complication odds and reduced length of stay during the primary admission. Possible indication bias limits the certainty of these findings.

AB - BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been shown to benefit recovery after several operations. However, large-scale data on the association between the level of ERAS use and perioperative complications are scarce, particularly in surgeries with increasing ERAS uptake, including total hip (THA) and knee arthroplasty (TKA). Using US national data, we examined the relationship between the number of ERAS components implemented ('level') and perioperative outcomes.METHODS: After ethics approval, we included 1 540 462 elective THA/TKA procedures (2006-2016, as recorded in the Premier Healthcare claims database) in this retrospective cohort study. Main outcomes were any complication, cardiopulmonary complications, mortality, blood transfusions, and length of stay. Eight commonly used ERAS components were included. Mixed-effects models measured associations between ERAS level and outcomes, with odds ratios (OR) and confidence intervals (CI) reported.RESULTS: ERAS use increased over time; overall, 21.6% (n=324 437), 62.7% (n=965 953), and 18.0% (n=250 072) of cases were classified as 'High', 'Medium', or 'Low' ERAS. 'High ERAS', 'Medium ERAS', and 'Low ERAS' level of use were defined as such if they received either >6, 5-6, or <5 ERAS components, respectively. After adjustment for relevant covariates, higher levels of ERAS use were associated with incremental reductions in 'any complication': 'Medium' vs 'Low' (OR=0.84; CI, 0.82-0.86) and 'High' vs 'Low' (OR=0.71; CI, 0.68-0.74). Similar patterns were found for the other study outcomes. Individual ERAS components with the strongest effect estimates were early physical therapy, avoidance of a urinary catheter, and tranexamic acid administration.CONCLUSIONS: ERAS components were used more frequently over time, and the level of utilisation was independently associated with incrementally improved complication odds and reduced length of stay during the primary admission. Possible indication bias limits the certainty of these findings.

KW - enhanced recovery after surgery

KW - fast-track surgery

KW - perioperative outcomes

KW - retrospective cohort study

KW - total joint arthroplasty

U2 - 10.1016/j.bja.2020.01.017

DO - 10.1016/j.bja.2020.01.017

M3 - Journal article

VL - 124

SP - 638

EP - 647

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 5

ER -

ID: 59511537