Preoperative Education Regarding the Enhanced Recovery After Surgery (ERAS) Guideline for Colorectal Surgical Patients: A Quality Improvement Project

BACKGROUND: Advancements in colorectal surgeries can be attributed to the adoption of the Enhanced Recovery After Surgery (ERAS) clinical guideline, which is a system of perioperative interventions bundled together cohesively to enhance a patient’s surgical experience, especially their post-operative recovery. One of the first interventions that initiates the ERAS process is the delivery of patient education before surgery. However, there are currently no standardizations on the kind of content or method of delivery for this education. PURPOSE: This Quality Improvement (QI) project determined the effects of a private, in-person, educational program discussing in detail the ERAS guideline adopted by their treating facility and the patient’s active role in the recovery process. An enhanced quality of recovery for these colorectal surgical patients was evaluated by measures of an early return to normal activities of daily living (ADLs), symptom incidence, levels of anxiety, and patient satisfaction when compared to patients who receive usual care. METHODS: A multivariate, repeated measures design was used, which followed the Plan, Do, Study, and Act (PDSA) model. The sample consisted of ten participants who were scheduled for colorectal surgery at a community medical center. Participants were given code numbers where odd numbered participants received the educational intervention and even numbered participants represented the usual care, control group. After informed consent, a Demographic and Clinical Data form was completed for each participant. The Quality of Recovery- 40 (QoR-40) questionnaire was administered to the intervention and usual care groups at two time points: upon hospital discharge and one week following hospital discharge. Descriptive analysis was used to identify trends in the Demographic and Clinical Data forms, while changes in the scores on the QoR-40 questionnaires was measured by independent and paired t-tests. RESULTS: A two-tailed paired t-test analyzed the difference in mean scores of the intervention group on Discharge Day and One-week Post-Discharge, revealing statistical significance with a t-score (5) = 3.9198 and p-value = 0.0173. Another two-tailed paired t-test analyzed the difference in mean scores of the control group on Discharge Day and One-week Post-Discharge, revealing statistical significance by a t-score (5) = 2.9994 and a p-value = 0.004. However, completing a one-tailed independent t-test on Discharge Day scores between the intervention and control group revealed no statistical significance as demonstrated by t-score (5) = 0.6551, and a p-value = 0.5308 (p\u3e0.05). Another one-tailed independent t-test on One-week Post-Discharge scores between the intervention and control group revealed no statistical significance as demonstrated by a t-score (5) = 1.2421, and a p-value = 0.2494. DISCUSSION: The results of this QI project indicate that for elective colorectal surgical patients, education regarding the ERAS guideline is not required to enhance their surgical recovery, measured by an early return to ADLs, decreases postoperative symptoms, decreased levels of anxiety, and overall increased patient satisfaction. Further research is needed to study the effects of different preoperative educational material to determine what content is most influential on patients’ surgical recovery

Beating the empty pelvis syndrome: the PelvEx Collaborative core outcome set study protocol

Introduction The empty pelvis syndrome is a significant source of morbidity following pelvic exenteration surgery. It remains poorly defined with research in this field being heterogeneous and of low quality. Furthermore, there has been minimal engagement with patient representatives following pelvic exenteration with respect to the empty pelvic syndrome. ‘PelvEx—Beating the empty pelvis syndrome’ aims to engage both patient representatives and healthcare professionals to achieve an international consensus on a core outcome set, pathophysiology and mitigation of the empty pelvis syndrome.Methods and analysis A modified-Delphi approach will be followed with a three-stage study design. First, statements will be longlisted using a recent systematic review, healthcare professional event, patient and public engagement, and Delphi piloting. Second, statements will be shortlisted using up to three rounds of online modified Delphi. Third, statements will be confirmed and instruments for measurable statements selected using a virtual patient-representative consensus meeting, and finally a face-to-face healthcare professional consensus meeting.Ethics and dissemination The University of Southampton Faculty of Medicine ethics committee has approved this protocol, which is registered as a study with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of this study will increase the potential for comparative research to further understanding and prevent the empty pelvis syndrome.Trial registration number NCT05683795