ABSTRACT
BACKGROUND: Enhanced recovery pathways (ERPs) are thought to improve surgical outcomes by standardizing perioperative patient care established in evidence-based literature. The objective of this study was to determine the impact of a colorectal surgery ERP on hospital length of stay (LOS) and other patient outcomes. METHODS: This is a comparative effectiveness study of patients undergoing elective colorectal surgery 2 years prior (pre-ERP group) and 2 years after (ERP group) implementation of an ERP program. The primary outcome was hospital LOS. Secondary outcomes included postoperative complications, 30-day readmissions, and 30-day reoperations. Multivariable regression analyses were utilized to control for patient factors, general health factors, diagnosis, surgeon, colon versus rectal operations, and open versus minimally invasive operations-laparoscopic and robotic. An ERP checklist was developed to track adherence to components of the pathway. RESULTS: The study population included 1036 patients: 523 in the pre-ERP group and 513 in the ERP group. Unadjusted LOS was significantly shorter in the ERP group than the control pre-ERP group [3 (IQR 3.5) vs 5 days (IQR 4.6); p < 0.0001]. Multivariable regression analysis confirmed the reduction in LOS, controlling for age, colon/rectum procedure, open/laparoscopic/robotic approach, primary diagnosis, and alvimopan use. Postoperative outcomes were not significantly different between groups except for 30-day readmissions, which were unexpectedly higher in the ERP group (14.6 vs 8.7 %, p = 0.04). CONCLUSIONS: A newly implemented ERP on a dedicated colorectal surgery service in an academic non-university hospital setting resulted in shorter hospital LOS, but increased readmissions, for patients undergoing elective open and minimally invasive colon and rectal surgery. Future multi-institutional studies are needed to understand the impact of ERP on postoperative complications and readmissions.
Subject(s)
Colon/surgery , Digestive System Surgical Procedures , Length of Stay/statistics & numerical data , Perioperative Care/methods , Rectum/surgery , Comparative Effectiveness Research , Elective Surgical Procedures , Female , Humans , Male , Michigan , Middle Aged , Patient Readmission/statistics & numerical dataABSTRACT
OBJECTIVE: To translate the Sport Concussion Assessment Tool 2 (SCAT2) based on the French spoken in Quebec and to confirm its acceptability for Quebec's francophone population. METHODOLOGY: The original SCAT2 was translated using a modified approach of the tool translation and adaptation method as proposed by the World Health Organization. A parallel translation was done first. A review of that translation by a committee then led to a preliminary SCAT2-Qc version. A parallel back-translation was then done and compared to the original version. The preliminary version was subsequently modified. The final version was then obtained through comments and suggestions during testing of the tool on two healthy subjects and from the comparison of the SCAT2-Qc with the existing French version by three reviewers from the health field. The final version of the SCAT2-Qc was eventually tested on 12 healthy subjects to ensure its acceptability. RESULTS: The 12 healthy subjects did not experience any comprehension difficulties when using the SCAT2-Qc. CONCLUSION: The translation steps undertaken made it possible to create the SCAT2-Qc that can now be validly used in the Quebec sport and scientific community.
