Original Article
Enhanced recovery pathway for thoracic surgery in the UK
Abstract
Background: Enhanced recovery (ER) refers to a combination of perioperative interventions designed to minimise the impact of surgery on patients’ recovery in order to reduce postoperative complications and to allow an early discharge reducing hospital costs.
Methods: An ER protocol was established at our institution following a review of the best evidence available. We introduced a multi-disciplinary integrated perioperative pathway by engaging with every person involved, including the patients themselves. The programme was monitored using specificallydesigned patients related outcome measures (PROMs).
Results: One-hundred and fifty-four ER patients were compared with 171 controls from the year before ER was introduced. There was an 80% increase in same-day admissions, with a net gain of more than 300 patient bed-days. The ER group had a significantly higher number of procedures performed by video assisted thoracoscopic surgery (VATS) (ER, 32.9% versus 9.4%, P=0.0001) and a lower rate of admission to the intensive care unit (ER, 5.8% versus 12.9%, P=0.04). Patients on the ER programme had a significantly reduced postoperative length of stay (mean ER, 5.2 versus 11.7 days, P<0.0001). Patient satisfaction was higher in the ER group after a patient survey. The project resulted in a net saving of £214,000 for the Trust for the 2013/2014 financial year. We were also able to increase the number of patients who underwent thoracic surgery in 2013/2014 by 30% (159 patients) compared with 2012/2013.
Conclusions: The ER pathway has proven to be a safe perioperative management strategy to improve patient satisfaction and to reduce the length of hospital stay and cost after major thoracic surgery, without increasing morbidity or mortality.
Methods: An ER protocol was established at our institution following a review of the best evidence available. We introduced a multi-disciplinary integrated perioperative pathway by engaging with every person involved, including the patients themselves. The programme was monitored using specificallydesigned patients related outcome measures (PROMs).
Results: One-hundred and fifty-four ER patients were compared with 171 controls from the year before ER was introduced. There was an 80% increase in same-day admissions, with a net gain of more than 300 patient bed-days. The ER group had a significantly higher number of procedures performed by video assisted thoracoscopic surgery (VATS) (ER, 32.9% versus 9.4%, P=0.0001) and a lower rate of admission to the intensive care unit (ER, 5.8% versus 12.9%, P=0.04). Patients on the ER programme had a significantly reduced postoperative length of stay (mean ER, 5.2 versus 11.7 days, P<0.0001). Patient satisfaction was higher in the ER group after a patient survey. The project resulted in a net saving of £214,000 for the Trust for the 2013/2014 financial year. We were also able to increase the number of patients who underwent thoracic surgery in 2013/2014 by 30% (159 patients) compared with 2012/2013.
Conclusions: The ER pathway has proven to be a safe perioperative management strategy to improve patient satisfaction and to reduce the length of hospital stay and cost after major thoracic surgery, without increasing morbidity or mortality.
