ArticlePerioperative medicine (London, England)2016
A perioperative consult service results in reduction in cost and length of stay for colorectal surgical patients: evidence from a healthcare redesign project.
Article in Perioperative medicine (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04625283 (The Effect and Contribution of a Perioperative Ketamine Infusion in an Established Enhanced Recovery Pathway), which is not on this map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The Effect and Contribution of a Perioperative Ketamine Infusion in an Established Enhanced Recovery Pathway
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Intraperitoneal local anesthetics for postoperative pain management following intra-abdominal surgery: a systematic review and meta-analysis.BMC anesthesiology · 2025Pooled it
- Safety of postoperative lidocaine infusions on general care wards without continuous cardiac monitoring in an established enhanced recovery program.Regional anesthesia and pain medicine · 2022Article
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- Implementation science for the adductor canal block: A new and adaptable methodology process.World journal of orthopedics · 2021Article
- Postoperative Pulmonary Complications' Association with Sugammadex versus Neostigmine: A Retrospective Registry Analysis.Anesthesiology · 2021Article
- Perioperative Pain Management and Opioid Stewardship: A Practical Guide.Healthcare (Basel, Switzerland) · 2021Review
- The effect of adding goal-directed hemodynamic management for elective patients in an established enhanced recovery program for colorectal surgery: results of quasi-experimental pragmatic trial.Perioperative medicine (London, England) · 2020Article
- An enhanced recovery program in colorectal surgery is associated with decreased organ level rates of complications: a difference-in-differences analysis.Surgical endoscopy · 2019Article
- Enhanced Recovery after Surgery for Colorectal Surgery: A Review of the Economic Implications.Clinics in colon and rectal surgery · 2019Review
- Cancer Tsunami: Emerging Trends, Economic Burden, and Perioperative Implications.Current anesthesiology reports · 2018Article
- American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) Joint Consensus Statement on Optimal Analgesia within an Enhanced Recovery Pathway for Colorectal Surgery: Part 2-From PACU to the Transition Home.Perioperative medicine (London, England) · 2017Article
- American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU.Perioperative medicine (London, England) · 2017Article
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Authors and funding
10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundA major restructuring of perioperative care delivery is required to reduce cost while improving patient outcomes. In a test implementation of this notion, we developed and implemented a perioperative consult service (PCS) for colorectal surgery patients.
methodsA 6-month planning process was undertaken to engage key stakeholders from surgery, nursing, and anesthesia in a healthcare redesign project that resulted in the creation of a PCS to implement a coordinated clinical pathway. After Institutional Review Board (IRB) approval, data were collected for all elective colorectal procedures for three phases: phase 0 (pre-implementation; 1/2014-6/2014), phase 1 (7/2014-10/2014), and phase 2 (11/2014-10/2015). Length of stay (primary endpoint; LOS), total hospital cost, use of clinical pathway components, markers of functional recovery, and readmission and reoperation rates were analyzed. Outcomes and patient characteristics among phases were compared by two-tailed t tests and Wilcoxon rank-sum tests. Categorical variables were analyzed by chi-square and Fisher's exact tests.
resultsWe studied 544 patients (phase 0 = 179; phase 1 = 124; phase 2 = 241), with 365 consecutive patients being cared for in the redesigned care structure. Median LOS was reduced and sustained after implementation (phase 0, 4.24 days; phase 1, 3.32 days; phase 2, 3.32 days, P < 0.01 phase 0 v. phases 1 and 2), and mean LOS was reduced in phase 2 (phase 0, 5.26 days; phase 1, 4.93 days; phase 2, 4.36 days, P < 0.01 phase 0 v. phase 2). Total hospital cost was reduced by 17 % (P = 0.05, median). Application of clinical pathway components was higher in phases 1 and 2 compared to phase 0 (P < 0.01 for all components except anti-emetics); measures of functional recovery improved with successive phases. Reoperation and 30-day readmission rates were no different in phase 1 or phase 2 compared to phase 0 (P > 0.15).
conclusionsRestructuring of perioperative care delivery through the launch of a PCS-reduced LOS and total cost in a significant and sustainable fashion for colorectal surgery patients. Based on the success of this care redesign project, hospital administration is funding expansion to additional services.
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