Enhanced recovery after surgery (ERAS) significantly decreases mortality, morbidity and hospital length of stay without increasing the rate of re-hospitalization. It reduces psychologic stress caused by surgery and decreases postoperative complications about 50 %, especially in colorectal surgery. ERAS is now the object of several Good Practices Recommendations and is about to become the reference strategy. The development of ambulatory surgery is a French national concern. Its interest has been demonstrated in many surgical fields. It requires a reflection centered on the patient and a health care pathway organization involving all health care actors. While hospitalization is still the standard practice for colonic surgery, the objective of this study is to evaluate the medical and economic impact of an ambulatory care for colorectal surgery. Ambulatory care will be compared to standard hospitalization of patients who benefit from the ERAS program.
Enhanced recovery after surgery (ERAS) significantly decreases mortality, morbidity and hospital length of stay without increasing the rate of re-hospitalization. It reduces psychologic stress caused by surgery and decreases postoperative complications about 50 %, especially in colorectal surgery. ERAS is now the object of several Good Practices Recommendations and is about to become the reference strategy. The development of ambulatory surgery is a French national concern. Its interest has been demonstrated in many surgical fields. It requires a reflection centered on the patient and a health care pathway organization involving all health care actors. Multiple interests have been shown: * Equivalent mortality and/or morbidity compared with standard hospitalizations * Medical and psychological benefits * Individualized and less invasive health care pathways, in favor of patient's autonomy * Multidisciplinary approach and innovative care * Heath care costs management (decrease of hospital length of stay, optimization of operating rooms). Ambulatory colectomies feasibility is recognized since 2013-2014 in France (Dr. Gignoux, MD in Lyon and Dr. Chasserant, MD in Le Havre). These ambulatory procedures are implemented in few expert centers with significant experience (more than 100 patients in Le Havre and more than 85 patients in Lyon) but several human and organizational limitations slow this innovative care. The risk of complications does not seem to be increased on condition of anticipate and provide a postoperative follow-up at home. While hospitalization is still the standard practice for colonic surgery, the objective of this study is to evaluate the medical and economic impact of an ambulatory care for colorectal surgery. Ambulatory care will be compared to standard hospitalization of patients who benefit from the ERAS program.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
5
Evaluation of the clinical and the economical impact of a colorectal surgery
Service de Chirurgie Digestive et Endocrinienne - Nouvel Hôpital Civil
Strasbourg, France
Mean cost evaluation
Mean cost evaluation, for the hospital, of the ambulatory care compared with standard hospitalization for patients who benefit from the ERAS program.
Time frame: 1 month
Quality of life evaluation: EQ-5D (EuroQoL-5 Dimensions) scale
The EQ-5D Quality of Life scale consists of : (i) a descriptive system, consists in 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, extreme problems. (ii) a visual analog scale, records the respondent's self-rated health on a vertical, visual analogue scale where the endpoints are labelled 'Best imaginable health state" and "Worst imaginable health state".
Time frame: 7 and 30 days
Mean hospital length of stay
Mean hospital length of stay for the "standard hospitalization" group
Time frame: 2 years and 3 months
Ambulatory colectomies rate
Rate of ambulatory colectomies compared to the total number of colectomies performed
Time frame: 2 years and 3 months
Ambulatory care failure rate
Rate of patients scheduled for ambulatory care and non-discharged the evening of surgery
Time frame: 2 years and 3 months
Duty desk call
Number of patients who called the duty desk (or for whom the duty desk has been called)
Time frame: 2 years and 3 months
Mean time period required for a postoperative complication care
Mean time period required for a postoperative complication care
Time frame: 2 years and 3 months
Hospital re-admissions rate
Rate of hospital re-admissions related to postoperative complications
Time frame: 30 days
Rate of complications (Morbidity)
Rate of complications related or not to surgery
Time frame: 30 days
Rate of death (Mortality)
Number of patients who died within the individual participation period
Time frame: 30 days
Complications rate
Clinical and economic evaluation of postoperative complications rates difference between "ambulatory care" group and "standard hospitalization" group
Time frame: 30 days
Complications severity classification
Clinical and economic evaluation of complications severity assessed by the Clavien-Dindo classification
Time frame: 30 days
Evaluation of complication severity according to Clavien classification
Severity of the complications will be evaluated according to the Clavien classification from Grade I "Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions" to Grade V "Death of a patient"
Time frame: 2 years and 3 months
Mean additional hospital length of stay
Clinical and economic evaluation of hospital length of stay related to complications difference between "ambulatory care" group and "standard hospitalization" group (additional hospitalizations, extension of hospitalization or new hospitalization).
Time frame: 2 years and 3 months
Costs related to postoperative complications
Costs related to postoperative complications difference between "ambulatory care" group and "standard hospitalization" group
Time frame: 2 years and 3 months
Costs related to the management of postoperative complications
Overall costs are evaluated by individual costs of: * unscheduled consultations, * surgical treatment, * medicated treatment * hospitalisation's duration
Time frame: 2 years and 3 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.