37
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evidence-Based Perioperative Medicine comes of age: the Perioperative Quality Initiative (POQI) : The 1st Consensus Conference of the Perioperative Quality Initiative (POQI)

      editorial
      1 , , 2 , 3 , 4 , For the Perioperative Quality Initiative (POQI) I Workgroup
      Perioperative Medicine
      BioMed Central
      Enhanced recovery, Enhanced recovery pathway, Colorectal surgery, Analgesia, Fluid management, Infection, Measurement, Quality

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The 1st POQI Consensus Conference occurred in Durham, NC, on March 4–5, 2016, and was supported by the American Society of Enhanced Recovery (ASER) and Evidence-Based Perioperative Medicine (EBPOM). The conference focused on enhanced recovery for colorectal surgery and discussed four topics—perioperative analgesia, perioperative fluid management, preventing nosocomial infection, and measurement and quality in enhanced recovery pathways.

          Related collections

          Most cited references3

          • Record: found
          • Abstract: found
          • Article: not found

          Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.

          The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations. The National Surgical Quality Improvement Program (NSQIP) database contains pre-, intra-, and 30-day postoperative data, prospectively collected in a standardized fashion by a dedicated nurse reviewer, on major surgery in the Veterans Administration (VA). The Beneficiary Identification and Records Locator Subsystem (BIRLS) is a VA file that depicts the vital status of U.S. veterans with 87% to 95% accuracy. NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999, providing an average follow up of 8 years. Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival, respectively. The most important determinant of decreased postoperative survival was the occurrence, within 30 days postoperatively, of any one of 22 types of complications collected in the NSQIP. Independent of preoperative patient risk, the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69%. The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses. The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA. Quality and process improvement in surgery should be directed toward the prevention of postoperative complications.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

            Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Functional status after colon cancer surgery in elderly nursing home residents.

              To determine functional status and mortality rates after colon cancer surgery in older nursing home residents. Retrospective cohort study. Nursing homes in the United States. Six thousand eight hundred twenty-two nursing home residents aged 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005. Changes in functional status were assessed before and after surgery using the Minimum Data Set Activity of Daily Living (MDS-ADL) summary scale, a 28-point scale in which score increases as functional dependence increases. Regression techniques were used to identify patient characteristics associated with mortality and functional decline 1 year after surgery. On average, residents who underwent colectomy had a 3.9-point worsening in MDS-ADL score at 1 year. One year after surgery, rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (≥ 80 vs 65-69, adjusted relative risk (ARR) = 1.53, 95% confidence interval (CI) = 1.15-2.04, P < .001), readmission after surgical hospitalization (ARR = 1.15, 95% CI = 1.03-1.29, P = .02), surgical complications (ARR = 1.11, 95% CI = 1.02-1.21, P = .01), and functional decline before surgery (ARR = 1.21, 95% CI = 1.11-1.32, P < .001) were associated with functional decline at 1 year. Mortality and sustained functional decline are common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
                Bookmark

                Author and article information

                Contributors
                timothy.miller2@duke.edu
                Journal
                Perioper Med (Lond)
                Perioper Med (Lond)
                Perioperative Medicine
                BioMed Central (London )
                2047-0525
                13 October 2016
                13 October 2016
                2016
                : 5
                : 26
                Affiliations
                [1 ]Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, NC 27710 USA
                [2 ]Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN USA
                [3 ]UCL/UCLH National Institute of Health Research Biomedical Research Centre, London, UK
                [4 ]Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, NY USA
                Article
                55
                10.1186/s13741-016-0055-y
                5062900
                27777751
                571e8116-a098-4a06-99c6-ee0681d83e45
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 September 2016
                : 30 September 2016
                Categories
                Editorial
                Custom metadata
                © The Author(s) 2016

                enhanced recovery,enhanced recovery pathway,colorectal surgery,analgesia,fluid management,infection,measurement,quality

                Comments

                Comment on this article