Multimodal perioperative care pathways have evolved into enhanced recovery after surgery (ERAS). ERAS pathways improve the quality of patient care, reduce morbidity, and shorten length of stay. This project will test the hypothesis that implementation of a multi-modal ERAS perioperative care protocol in colorectal surgical patients will result in significantly reduced perioperative morbidity and mortality.
Multimodal perioperative care pathways have evolved into enhanced recovery after surgery (ERAS). ERAS pathways improve the quality of patient care, reduce morbidity, and shorten length of stay. This large quality improvement project will compare outcomes after standard perioperative practice with those after the implementation of a multi-modal evidence based care pathway, including standardized preoperative preparation, perioperative goal-directed fluid therapy (GFDT), multi-modal perioperative pain management, post operative nausea and vomiting prevention, surgical care and bowel isolation, and surgical site infection prevention. This project will test the hypothesis that implementation of a multi-modal ERAS perioperative care protocol in colorectal surgical patients will result in significantly reduced perioperative morbidity and mortality.
Study Type
OBSERVATIONAL
Enrollment
664
Standard of care implementation of multi-modal evidence-based care pathway, including standardized preoperative preparation (medical and diet), perioperative goal-directed fluid therapy, multi-modal perioperative pain management, postoperative nausea and vomiting prevention, surgical care and bowel isolation, and surgical site infection prevention
Standard perioperative care prior to implementation of ERAS care pathway
Standard of care perioperative noninvasive hemodynamic monitoring with the ClearSight System (Edwards LifeSciences)
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Incidence of surgical site infection
Time frame: Up to 30 days postoperative
ICU length of stay
Time frame: Up to 30 days postoperative
Time on ventilator
Time frame: Up to 30 days postoperative
Post operative pain assessment using 11-point Numeric Pain Rating Scale (NRS)
Post operative pain assessed using NRS when 0 is no nausea and 10 is worst pain.
Time frame: Up to 30 days postoperative
Post operative anti emetic consumption
Time frame: Up to 30 days postoperative
Occurrence of postoperative complications
Time frame: Up to 30 days postoperative
Analgesia consumption
Total opioid and non-opioid medication use
Time frame: Up to 30 days postoperative
Cardiac Index
Using time traces for cardiac index during the perioperative period, the time in range of pre-defined parameters will be measured.
Time frame: 1 day
Stroke volume
Using time traces for stroke volume during the perioperative period, the time in range of pre-defined parameters will be measured.
Time frame: 1 day
Systemic vascular resistance
Using time traces for systemic vascular resistance during the perioperative period, the time in range of pre-defined parameters will be measured.
Time frame: 1 day
Heart rate
Using time traces for heart rate during the perioperative period, the time in range of pre-defined parameters will be measured.
Time frame: 1 day
Hospital Length of stay (days)
Time frame: Up to 30 days post operative
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