Large-scale implementation of enhanced recovery programs after surgery. A francophone experience

Area of Science:

• Multidisciplinary surgical care
• Perioperative medicine
• Health services research

Background:

• Enhanced Recovery Programs (ERP) have moved beyond clinical trials into large-scale implementation challenges.
• This study reports the initial year of ERP implementation across three French-speaking countries.

Purpose of the Study:

• To evaluate the feasibility and safety of large-scale Enhanced Recovery Programs (ERP) implementation.
• To assess the impact of ERP on hospital stay duration and postoperative morbidity.
• To analyze compliance rates and their correlation with patient outcomes.

Main Methods:

• A prospective study involving 67 healthcare centers across three French-speaking countries.
• Data collected from 1904 patients undergoing colorectal (CRS), bariatric (BS), or orthopedic hip and knee surgery (OS) within an ERP.
• Key endpoints included hospital stay, postoperative morbidity, ERP element compliance, and data completeness.

Main Results:

• High implementation rates observed: 83.7% for CRS, 75.0% for BS, and 83.5% for OS.
• Mean hospital stays were 6.5 days (CRS), 2.6 days (BS), and 3.4 days (OS).
• Significant correlation found between ERP compliance and reduced hospital stay, particularly when ≥15 elements were applied (P<0.001).

Conclusions:

• Large-scale ERP implementation is feasible and safe in French-speaking healthcare settings.
• While encouraging, implementation requires improvement in specific areas like bariatric surgery.
• Enhanced data collection is crucial for future analysis and program refinement.