ERAS Data Collection
Data
It is very early in the how, what, when, why, where and who of data collection:
Inchoate commercial products and productivity developments.
This page is menu of data sets to consider.
Please share your experiences to John@SaferAnesthesia.com.
Mechanics of Collecting Data
Data Coordinator
Estimated 1 FTE : 500 to 2500 Patients
Electronic Health Record - EHR
Smart Links to Find/Capture Compliance and Outcomes
Order Sets
ASCRS-SAGES 2017 (p.765)
Thiele 2015 (p.434)
Outcomes
In 2015 , the European Society of Anesthesiologist (ESA) and the European Society of Intensive Care Medicine (ESICM) proposed 22 adverse events (with severity grading) and 4 composite outcome, healthcare resource use and quality of life measures to evaluate postoperative outcomes [Jamer et al, Eur J Anaesthesiol 2015; 32:88-105].
Though these measures were intended to standardize reporting in large perioperative clinical trials, the authors also suggested value for clinical audit.
22 Single Organ Outome Measures
Acute Kidney Injury (AKI)
Acute Respiratory Distress Syndrome (ARDS)
Pneumonia
Deep Venous Thrombosis (DVT)
Pulmonary Embolus
Cardiogenic Pulmonary Edema
Myocardial Infarction
Myocardial Injury after non-cardiac Surgery (MINS)
Cardiac Arrest
Arrhythmia
Stroke
Anastomotic Breakdown
Paralytic Ileus
Gastrointestinal Bleed
Postoperative Hemorrhage
Delirium
Infection (unknown source)
Bloodstream Infection
Superficial Surgical Site Infection
Deep Surgical Site Infection
Organ/Space Surgical Site Infection
Urinary Tract Infection
4 Composite Outcome Measures
An advantage of using composite outcome measures is increased observed event rate to increase statistical power:
[If frequency of event is 1 in a 100 versus 1 in 10,000, an intervention difference can be apparent with much fewer observations].
Major Adverse Cardiac Event (MACE)
Postoperative Pulmonary Complications
Postoperative Morbidity Survey (POMS)
Quality of Recovery (QoR)
Other ERP Outcome Measure to Consider
Discharge to Home or Care Facility
Readmission Rate
Reoperation Rate
Blood Transfusion
Intraop Blood Loss
Nausea-PONV
Opiate Consumption (Morphine Equivalents)
Continued Opiate Usage at 30 days
Pain Scores
Cost of Care
Length of Hospital Stay
Mortality (30 day or other)
Composite Moderate to Severe Complication
(within 30 days after surgery)
Patient Reported Outcome Measures (PROM)
Outcomes Important to Patients:
Postdischarge Function
Sleeping
Eating
Drinking
Defecating
Thinking
Moving
ADLs
Free from Disability
Return to Work
Free from Opiate Usage
Free from Pain
Patient Function (return to work) and Satisfaction
QoR: Quality of Recovery
QoR 9 or 15 or 40 scales
World Health Organization Disability Assessment Schedule
(WHODAS 2.0)
Open Free Responses--i.e.
"Would You Have This Procedure Again?"
"Why or Why not?"
Compliance-Audit
Important to track Compliance:
Report Compliance
Back to Providers
Feedback = Compliance
ERAS 2018 (p.683-4)
Greater Compliance = Better Outcomes!
Benchmarking
Databases
Commercial Solutions
