9 research outputs found
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
BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia," which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document
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.
BACKGROUND: Within an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver "optimal analgesia", which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects. METHODS: With input from a multidisciplinary, international group of experts and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients. DISCUSSION: As a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery within an ERP. The goal was twofold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus on care in the post-anesthesia care unit, general care ward, and transition to home after discharge. The preoperative and operative consensus statement for analgesia was covered in Part 1 of this paper. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of "optimal analgesia" as set forth in this document
Correction to: 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
After publication of this article (Scott et al. 2017), it was noticed that the HTML version contained technical errors regarding the collaborator information of the Perioperative Quality Initiative (POQI) I Workgroup. The Declarations section was missing the acknowledgements for the group. The correct information can be found in this correction. [This corrects the article DOI: 10.1186/s13741-017-0063-6.]
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway
Patient-reported outcomes (PROs) are measures of health status that come directly from
the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery
pathways (ERPs) have primarily focused on traditional measures of health care quality such
as complications and hospital length of stay. These measures do not capture postdischarge
outcomes that are meaningful to patients such as function or freedom from disability. PROs
can be used to facilitate shared decisions between patients and providers before surgery
and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative
Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine
best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3,
2016, to review the evidence supporting the use of PROs in the context of surgical recovery.
A modified Delphi method was used to capture the collective expertise of a diverse group
to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented
clinical questions based on a literature review, presented evidenced-based answers to those
questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to
evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The
POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative
setting should be collected in the framework of physical, mental, and social domains. (2)
These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we
recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we
recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a
tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future
study that consistently applies PROMs in an ERP will define the role these measures will have
evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation
of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with
traditional measures of health care quality after surgery provides an opportunity to improve
clinical care. (Anesth Analg 2018;126:1874–82
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery
The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the
time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to
be a routine and unavoidable consequence of surgery, but this has been shown to be false in
the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI
function is still common after colorectal surgery, and the current literature is ambiguous with
regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to
as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the
condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality
Initiative brought together a group of international experts to review the published literature
and provide consensus recommendations on this important topic with the goal to (1) develop a
rational definition for POGD that can serve as a framework for clinical and research efforts; (2)
critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway
Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite
these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express
recognition of the importance of nutrition screening and optimization in the perioperative period,
implementation of evidence-based perioperative nutrition guidelines and pathways in the United
States has been quite limited and needs to be addressed in surgery-focused recommendations.
The second Perioperative Quality Initiative brought together a group of international experts with
the objective of providing consensus recommendations on this important topic with the goal
of (1) developing guidelines for screening of nutritional status to identify patients at risk for
adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize
nutrition delivery in the postoperative period. Discussion led to strong recommendations for
implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately
after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein
delivery being more important than total calorie delivery. Finally, the role of often-inadequate
nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral
nutrition supplements was emphasized. (Anesth Analg 2018;126:1883–95