Implementing Enhanced Recovery After Surgery for hysterectomy in a hospital network with audit and feedback: A stepped‐wedge cluster randomised trial

Objective To evaluate the effectiveness of implementing the Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing elective hysterectomy in a network of regional hospitals, supported by an intensive audit‐and‐feedback (A&F) approach. Design A multi‐centre, stepped‐wedge cluster r...

Full description

Saved in:

Bibliographic Details
Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 131; no. 9; pp. 1207 - 1217
Main Authors:	Piovano, Elisa, Puppo, Andrea, Camanni, Marco, Castiglione, Anna, Delpiano, Elena Maria, Giacometti, Lisa, Rolfo, Monica, Rizzo, Alessio, Zola, Paolo, Ciccone, Giovannino, Pagano, Eva, Aguggia, Vittorio, Borromeo, Federica, Schipani, Katia, Surico, Daniela, Badellino, Enrico, Ferrero, Annamaria, Franzoso, Barbara, Ponzone, Riccardo, Marocco, Francesco, Uccella, Stefano, Violino, Chiara, Torello, Monica, Bianciotto, Andrea, Canestrelli, Marco, Dompè, Daniela, Molina, Gabriele, Bocci, Carlo, Ferraris, Paola, Fiorentino, Riccardo, Brusati, Maurizio, Alfeo, Antonio, Gallo, Mario, Geranio, Romeo, Bogliatto, Fabrizio, Mossetti, Massimo, Vaudano, Giacomo, Carus, Alice Peroglio, Sciandra, Marta, Montironi, Pier Luigi, Tuo, Federico, Bar, Enrica, Buda, Alessandro Antonio, Zorzetti, Stefania Cigna, Lemut, Francesco, Garetto, Alessio, Mascher, Monica, Negrone, Enrico, Sorbilli, Elvira, Biggiogera, Roberto, Mastrantuono, Donato, Plazzotta, Claudio, Del Piano, Elena, Coata, Paola, De Magistris, Anna, Mitola, Barbara, Giannone, Laura Ceretto, Bongiovanni, Daria, Scoletta, Andrea, Orlando, Anna, Bertetto, Oscar, Aglietta, Massimo, Airoldi, Mario, Comandone, Alessandro, Brunetti, Francesco, Defilè, Corinna, Martins, Vitor Hugo, Papurello, Matteo, Saccona, Fabio, Turco, Danila
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-08-2024
Subjects:	Adult audit and feedback benign gynaecological surgery Cervical cancer Compliance Elective Surgical Procedures Endometrial cancer Enhanced Recovery After Surgery ERAS protocol Feedback Female Humans Hysterectomy Hysterectomy - methods Italy Length of Stay - statistics & numerical data Medical Audit Middle Aged Patients Postoperative Complications - prevention & control Recovery (Medical) stepped‐wedge cluster randomised trial Surgery Italy benign gynaecological surgery hysterectomy ERAS protocol audit and feedback endometrial cancer cervical cancer stepped‐wedge cluster randomised trial
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective To evaluate the effectiveness of implementing the Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing elective hysterectomy in a network of regional hospitals, supported by an intensive audit‐and‐feedback (A&F) approach. Design A multi‐centre, stepped‐wedge cluster randomised trial (ClinicalTrials.gov NCT04063072). Setting Gynaecological units in the Piemonte region, Italy. Population Patients undergoing elective hysterectomy, either for cancer or for benign conditions. Methods Twenty‐three units (clusters), stratified by surgical volume, were randomised into four sequences. At baseline (first 3 months), standard care was continued in all units. Subsequently, the four sequences implemented the ERAS protocol successively every 3 months, after specific training. By the end of the study, each unit had a period in which standard care was maintained (control) and a period in which the protocol, supported by feedback, was applied (experimental). Main outcome measures Length of hospital stay (LOS), without outliers (>98th percentile). Results Between September 2019 and May 2021, 2086 patients were included in the main analysis with an intention‐to‐treat approach: 1104 (53%) in the control period and 982 (47%) in the ERAS period. Compliance with the ERAS protocol increased from 60% in the control period to 76% in the experimental period, with an adjusted absolute difference of +13.3% (95% CI 11.6% to 15.0%). LOS, moving from 3.5 to 3.2 days, did not show a significant reduction (−0.12 days; 95% CI −0.30 to 0.07 days). No difference was observed in the occurrence of complications. Conclusions Implementation of the ERAS protocol for hysterectomy at the regional level, supported by an A&F approach, resulted in a substantial improvement in compliance, but without meaningful effects on LOS and complications. This study confirms the effectiveness of A&F in promoting important innovations in an entire hospital network and suggests the need of a higher compliance with the ERAS protocol to obtain valuable improvements in clinical outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1470-0328 1471-0528 1471-0528
DOI:	10.1111/1471-0528.17797