Colorectal Surgery, Quality Improvement, Perioperative Care, ERAS
Conditions
Brief summary
Multimodal perioperative care pathways have evolved into enhanced recovery after surgery (ERAS). ERAS pathways improve the quality of patient care, reduce morbidity, and shorten length of stay. This project will test the hypothesis that implementation of a multi-modal ERAS perioperative care protocol in colorectal surgical patients will result in significantly reduced perioperative morbidity and mortality.
Detailed description
Multimodal perioperative care pathways have evolved into enhanced recovery after surgery (ERAS). ERAS pathways improve the quality of patient care, reduce morbidity, and shorten length of stay. This large quality improvement project will compare outcomes after standard perioperative practice with those after the implementation of a multi-modal evidence based care pathway, including standardized preoperative preparation, perioperative goal-directed fluid therapy (GFDT), multi-modal perioperative pain management, post operative nausea and vomiting prevention, surgical care and bowel isolation, and surgical site infection prevention. This project will test the hypothesis that implementation of a multi-modal ERAS perioperative care protocol in colorectal surgical patients will result in significantly reduced perioperative morbidity and mortality.
Interventions
PROCEDUREERAS perioperative care
Standard of care implementation of multi-modal evidence-based care pathway, including standardized preoperative preparation (medical and diet), perioperative goal-directed fluid therapy, multi-modal perioperative pain management, postoperative nausea and vomiting prevention, surgical care and bowel isolation, and surgical site infection prevention
PROCEDUREStandard perioperative care
Standard perioperative care prior to implementation of ERAS care pathway
PROCEDURENoninvasive hemodynamic monitoring
Standard of care perioperative noninvasive hemodynamic monitoring with the ClearSight System (Edwards LifeSciences)
Sponsors
Edwards Lifesciences
Vanderbilt University Medical Center
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients who underwent colorectal surgery at Vanderbilt University Medical Center and whose data is stored in the perioperative data warehouse.
Exclusion criteria
* Age \<18 years * Weight \<40 kg
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Incidence of surgical site infection | Up to 30 days postoperative |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time on ventilator | Up to 30 days postoperative | — |
| Post operative pain assessment using 11-point Numeric Pain Rating Scale (NRS) | Up to 30 days postoperative | Post operative pain assessed using NRS when 0 is no nausea and 10 is worst pain. |
| Post operative anti emetic consumption | Up to 30 days postoperative | — |
| Occurrence of postoperative complications | Up to 30 days postoperative | — |
| Analgesia consumption | Up to 30 days postoperative | Total opioid and non-opioid medication use |
| ICU length of stay | Up to 30 days postoperative | — |
| Stroke volume | 1 day | Using time traces for stroke volume during the perioperative period, the time in range of pre-defined parameters will be measured. |
| Systemic vascular resistance | 1 day | Using time traces for systemic vascular resistance during the perioperative period, the time in range of pre-defined parameters will be measured. |
| Heart rate | 1 day | Using time traces for heart rate during the perioperative period, the time in range of pre-defined parameters will be measured. |
| Hospital Length of stay (days) | Up to 30 days post operative | — |
| Cardiac Index | 1 day | Using time traces for cardiac index during the perioperative period, the time in range of pre-defined parameters will be measured. |
Countries
United States
Outcome results
None listed