학술논문
IMPLEMENTATION OF AN ENHANCED RECOVERY PROGRAM AFTER BARIATRIC SURGERY: CLINICAL AND COST-EFFECTIVENESS ANALYSIS/PRIMJENA PROGRAMA UBRZANOG OPORAVKA NAKON BARIJATRIJSKE KIRURGIJE: ANALIZA KLINICKIH ISHODA I ISPLATIVOSTI
Original Scientific Paper
Original Scientific Paper
Document Type
Report
Author
Source
Acta Clinica Croatica. June 2020, Vol. 59 Issue 2, p227, 6 p.
Subject
Language
English
ISSN
0353-9466
Abstract
Introduction The escalating global epidemic of obesity all over the world challenges allocation of national healthcare resources (1). Bariatric surgery is the most effective treatment for severe obesity, resulting in [...]
Enhanced recovery after surgery (ERAS) programs are perioperative evidence-based interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6[+ or -]10.9 days, whereas in the ERABS cohort it was 7.1[+ or -]2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive care unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety. Key words: Bariatric surgery; Enhanced recovery after surgery; Costs Programi ubrzanog oporavka nakon operacije (Enhanced Recovery After Surgery, ERAS) su perioperacijske intervencije zasnovane na dokazima kojima je svrha uciniti perioperacijski tijek ucinkovitijim osiguravajuci bolesnikovu sigurnost i kvalitetu skrbi. Odnedavno je nekoliko sastavnica programa ERAS uvedeno u okruenje barijatrijske kirurgije (Enhanced Recovery After Bariatric Surgery, ERABS). Cilj ovoga istraivanja bio je procijeniti klinicku ucinkovitost i isplativost provodenja programa ERABS. u ovoj retrospektivnoj studiji slucaja i kontrola usporedena je skupina odraslih pretilih bolesnika (indeks tjelesne mase >40) lijecenih prema protokolu ERABS (2014.-2015.) s povijesnom kontrolnom skupinom koja je primala standardnu skrb (2013.-2014.) u Klinici za opcu i hitnu kirurgiju, Bolnica Arcispedale S. Maria Nuova, Reggio Emilia, Italija. Podaci o pojavnosti komplikacija, smrtnosti, ponovnom prijmu i ponovljenim operacijama retrospektivno su izvedeni iz bolesnickih kartona i prijamnih lista. Duljina boravka u bolnici znacajno se razlikovala medu dvjema skupinama bolesnika. U kontrolnoj skupini srednja duljina boravka u bolnici bila je 12,6[+ or -]10,9 dana, dok je skupini ERABS iznosila 7,1[+ or -]2,9 dana (p=0,02). Kod prijma se kirurka komplikacija razvila u 7 osoba iz kontrolne skupine; od toga je jedan bolesnik imao tee komplikacije, dok su u skupini ERABS manje komplikacije zabiljeene kod 3 bolesnika. Ekonomska analiza pokazala je drukciju rasporedenost trokova u dvjema skupinama. Sve u svemu, znacajne utede u gotovo svim ispitivanim varijablama uglavnom su nastale zbog iskljucenja uporabe jedinice intenzivnog lijecenja, to je daleko skuplje od prosjecnih trokova u jedinici skrbi poslije anestezije. Nae je istraivanje potvrdilo da primjena protokola ERABS skracuje boravak u bolnici i sniava trokove pritom osiguravajuci sigurnost bolesnika. Kljucne rijeci: Bariatrijska kirurgija; Ubrzani oporavak nakon operacije; Trokovi
Enhanced recovery after surgery (ERAS) programs are perioperative evidence-based interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6[+ or -]10.9 days, whereas in the ERABS cohort it was 7.1[+ or -]2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive care unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety. Key words: Bariatric surgery; Enhanced recovery after surgery; Costs Programi ubrzanog oporavka nakon operacije (Enhanced Recovery After Surgery, ERAS) su perioperacijske intervencije zasnovane na dokazima kojima je svrha uciniti perioperacijski tijek ucinkovitijim osiguravajuci bolesnikovu sigurnost i kvalitetu skrbi. Odnedavno je nekoliko sastavnica programa ERAS uvedeno u okruenje barijatrijske kirurgije (Enhanced Recovery After Bariatric Surgery, ERABS). Cilj ovoga istraivanja bio je procijeniti klinicku ucinkovitost i isplativost provodenja programa ERABS. u ovoj retrospektivnoj studiji slucaja i kontrola usporedena je skupina odraslih pretilih bolesnika (indeks tjelesne mase >40) lijecenih prema protokolu ERABS (2014.-2015.) s povijesnom kontrolnom skupinom koja je primala standardnu skrb (2013.-2014.) u Klinici za opcu i hitnu kirurgiju, Bolnica Arcispedale S. Maria Nuova, Reggio Emilia, Italija. Podaci o pojavnosti komplikacija, smrtnosti, ponovnom prijmu i ponovljenim operacijama retrospektivno su izvedeni iz bolesnickih kartona i prijamnih lista. Duljina boravka u bolnici znacajno se razlikovala medu dvjema skupinama bolesnika. U kontrolnoj skupini srednja duljina boravka u bolnici bila je 12,6[+ or -]10,9 dana, dok je skupini ERABS iznosila 7,1[+ or -]2,9 dana (p=0,02). Kod prijma se kirurka komplikacija razvila u 7 osoba iz kontrolne skupine; od toga je jedan bolesnik imao tee komplikacije, dok su u skupini ERABS manje komplikacije zabiljeene kod 3 bolesnika. Ekonomska analiza pokazala je drukciju rasporedenost trokova u dvjema skupinama. Sve u svemu, znacajne utede u gotovo svim ispitivanim varijablama uglavnom su nastale zbog iskljucenja uporabe jedinice intenzivnog lijecenja, to je daleko skuplje od prosjecnih trokova u jedinici skrbi poslije anestezije. Nae je istraivanje potvrdilo da primjena protokola ERABS skracuje boravak u bolnici i sniava trokove pritom osiguravajuci sigurnost bolesnika. Kljucne rijeci: Bariatrijska kirurgija; Ubrzani oporavak nakon operacije; Trokovi