Authors (including presenting author) :
Yeung WKW (1), Ho MY (1), Chau YL (1), Lo KY (1), Yeung CYJ (2), Kwok HCS (3), Choi WYZ (3)
Affiliation :
(1)Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital
(2)Physiotherapy Department, Prince of Wales Hospital
(3)Department of Dietetics, Prince of Wales Hospital
Introduction :
The Early Recovery After Surgery (ERAS) program is an evidence-based, multimodal, and multidisciplinary strategy that has been proven to benefit clinical outcomes and quality of care, as well as to shorten hospital length of stay and reduce costs. Prince of Wales Hospital (PWH) cardiothoracic team provides elective and emergency thoracic surgical service within NTEC, performing around 350 elective thoracic operations each year. To improve the effectiveness of care, enhance surgical outcomes, and reduce reliance on inpatient care, the ERAS program has been introduced.
Objectives :
-To improve surgical outcomes by optimizing patients’ physical and psychological condition before elective thoracic surgery in Prince of Wales Hospital.
-To shorten hospital length of stay by improving same-day admission rate.
Methodology :
Since October 2021, a multidisciplinary and outpatient-based ERAS program, including cardiothoracic surgeons, nurses, physiotherapists, and dietitians has been setup. In the pre-operative period, patients were contacted once the operation date was decided. Outpatient appointments with assessment and stratification, pre-operative optimization, prehabilitation with exercise training, health education, counselling, and nutrition optimization were arranged as indicated. Cardiothoracic specialty nurses coordinate and ensure that all necessary preparation were completed before the operation. Same-day admission on the date of operation were then arranged to patients, along with clear explanations provided. In the post-operative period, selected patients received post-operative rehabilitation, diet modification and health education before exiting the ERAS program.
Result & Outcome :
In the years 2022 and 2023, a total 242 out of 371 cases and 208 out of 363 cases were recruited to the ERAS program respectively. Exclusion criteria for recruitment included a preparation time for operation less than 2 weeks and operations expected to cause minimal alteration of lung function, such as biopsy and mediastinoscopy. All recruited ERAS cases successfully underwent same-day admission arrangements, saving a total 242 hospital inpatient bed days in 2022 and 208 bed days in 2023. Secondly, ERAS nurses were able to screen out those cases that were not ready for the operation, which included incomplete investigations, patient who refused the operation, deteriorated patients who were not suitable for operation and patients requiring specialty consultations. A total 35 and 28 not-ready cases were identified in 2022 and 2023 respectively, resulting 35 and 28 surgical operation sessions saved without urgent amendments or cancellations. In terms of patient satisfaction, a comparison was made between various aspects of patients in the ERAS group and those in traditional pathway (non-ERAS group). The satisfaction survey was conducted in the first 6 months of program implementation. It revealed that patient education and information delivery were enhanced, particularly in the areas of logistic flow on the day of admission, post-operative care during hospitalization and discharge home care.
To conclude, the PWH ERAS program for elective thoracic patients was effective in shortening hospital inpatient bed days, screening out cases that were not ready for operation, and improving patient satisfaction.
