Evidence map›Paper›PMID 34482837›Full record

ArticlePerioperative medicine (London, England)2021

Limited impact of a top-down approach to improve enhanced recovery programme in French university hospitals: a before-after retrospective survey.

Hakim Harkouk, Perrine Capmas, Nawal Derridj, Anissa Belbachir, Lionelle Nkam, Philippe Aegerter, Eva Battaglia, Laure Tharel, Dominique Fletcher

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Perioperative medicine (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Hakim HarkoukAnaesthesia and Intensive Care Department, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
Perrine CapmasObstetric Gynecology Department, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.
Nawal DerridjClinical Research Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France.
Anissa BelbachirAnaesthesia and Intensive Care Department, Cochin Hospital, APHP, Paris, France.
Lionelle NkamClinical Research Unit, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France.
Philippe AegerterGIRCI-IDF, Cellule Méthodologie, Paris, France.
Eva BattagliaDirection de la Politique et de la Transformation, Assistance Publique Hôpitaux de Paris, Paris, France.
Laure TharelDirection de la Politique et de la Transformation, Assistance Publique Hôpitaux de Paris, Paris, France.
Dominique FletcherAnaesthesia and Intensive Care Department, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. dominique.fletcher@aphp.fr.ORCID http://orcid.org/0000-0001-6157-1331

Funding

Assistance Publique - Hôpitaux de Paris Contrat de recherche clinique
6 · The paper itself

Abstract

backgroundEnhanced recovery programme (ERP) after surgery needs development in Assistance Publique Hôpitaux de Paris (APHP).

methodsA retrospective before-and-after study was performed in 2015 and 2017 on three surgical models (total knee arthroplasty (TKA), colectomy and hysterectomy) in 17 hospitals including 29 surgical departments. Data were collected in one control intervention (total hip arthroplasty (THA), gastrectomy and ovariectomy). In 2016, Massive Open Online Course on ERP and a day meeting information were developed by APHP. A national update on ERP was also organized by HAS and a regional professional partnership programme was started. Primary outcomes were length of stay (LOS) and complications after surgery. Data on ERP items were collected in the patients' chart and in anaesthetist and surgeon interview. Seventy percent application rate reflects application of ERP procedure.

results1321 patient's files were analysed (812 in 2015 and 509 in 2017). The LOS (mean (SD)) is reduced by 1.6 day for TKA (2015, 8.7 (6.7) versus 7.1 (3.4) in 2017; p<0.001) but stable for colectomy and hysterectomy. Incidence of severe complications after surgery is unchanged in all types of surgical models. For TKA and hysterectomy respectively applied items of ERP (i.e. >70% application) increased respectively from 5 to 7 out of 17 and 16 in 2015 and 2017. For colectomy, they were stable at 6 out of 21 in 2015 and 2017. The mean application rates of ERP items stayed below 50% in all cases in 2017. The LOS was negatively correlated with ERP items' application when data collected in 2015 and 2017 were analysed together.

conclusionERP application did not significantly improved between 2015 and 2017 for three surgical models after an institutional information and diffusion of recommendations in 29 surgical departments of seventeen French University hospitals underlining the limit of a top-down approach.

Indexed as

Enhanced recoveryLength of stayPost-operative complicationsSurgery

Identifiers

PMID34482837
PMCPMC8419963

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.