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S136-operationalizing an enhanced recovery protocol after bariatric surgery: single institutional pilot experience
Elizabeth M Hechenbleikner1,2, Melissa C Majumdar3, Trent Gillingham4
1Division of General and GI Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. ehechen@emory.edu.
Surgical Endoscopy
|June 28, 2022
Summary
Implementing enhanced recovery protocols (ERPs) for metabolic and bariatric surgery (MBS) using a dashboard and checklist improved compliance. However, this pilot study found no significant impact on 30-day patient outcomes.
Area of Science:
- Surgery
- Clinical Informatics
- Patient Outcomes
Background:
- Enhanced Recovery Protocols (ERPs) are crucial for improving patient outcomes after Metabolic and Bariatric Surgery (MBS).
- Implementation of ERPs faces significant challenges, hindering widespread adoption and effectiveness.
- Standardizing ERPs with real-time data support is essential for successful integration.
Purpose of the Study:
- To standardize a metabolic and bariatric surgery (MBS) enhanced recovery protocol (ERP) using a real-time data support dashboard and checklist.
- To assess the impact of this standardized ERP on compliance with care elements.
- To evaluate the effect of the ERP on 30-day patient outcomes, including length of stay, readmissions, and re-operations.
Main Methods:
- A standardized ERP, paper checklist, and virtual dashboard were developed and implemented for pre-, intra-, and post-operative phases.
- The dashboard provided real-time data on surgical volumes, operative times, ERP compliance, and 30-day outcomes.
- Compliance rates and patient outcomes were compared pre- and post-implementation using two-tailed Student's t-tests.
Main Results:
- Overall compliance with ERP elements significantly improved post-implementation, particularly in the intra-operative phase (31.3%).
- Pre-operative acetaminophen administration compliance reached ≥99.1%, and TAP block use increased 3.2-fold.
- Average length of stay decreased from 2.0 to 1.7 days, with a 56% reduction in intra-operative morphine use; however, 30-day outcomes were not significantly impacted.
Conclusions:
- A checklist and dashboard effectively facilitated ERP integration and improved compliance with process measures in MBS.
- Despite improvements in compliance and some intermediate outcomes, the intervention did not significantly impact 30-day patient outcomes.
- Further research is needed to explore how clinical support tools can enhance ERP adoption and influence outcomes in MBS patients.
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