Skip to main content
Top
Published in: World Journal of Surgery 4/2021

01-04-2021 | Heart Surgery | Original Scientific Report

Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery

Authors: Sameer A. Hirji, Rawn Salenger, Edward M. Boyle, Judson Williams, V. Seenu Reddy, Michael C. Grant, Subhasis Chatterjee, Alexander J. Gregory, Rakesh Arora, Daniel T. Engelman

Published in: World Journal of Surgery | Issue 4/2021

Login to get access

Abstract

Background

Despite the emergence of Enhanced Recovery Protocols (ERPs) in cardiac surgery, there is no consensus on the essential elements for data reporting for quality improvement efforts, as well as accountability and standardization of outcome reporting across institutions. The aim of this study was to establish a consensus on essential data elements for cardiac ERAS®.

Methods

A 2-round modified Delphi technique was utilized based on existing recommendations from the recently published ERAS® cardiac surgery consensus guidelines. Round 1 included a steering committee of 10 experts who oversaw formulation of a focused list of data elements into 3 main areas: Preoperative, intraoperative and postoperative. Round 2 consisted of a multidisciplinary, multinational, heterogenous group of 50 voting experts from across the United States and Europe. All participants evaluated their level of agreement with each data element using a 5-point Likert scale with consensus threshold of 70%.

Results

In round 1, 17 data elements were considered essential (consensus >  = 70%, either positive or negative) and 6 were considered marginal (consensus <  = 70%, either positive or negative). In round 2, positive consensus was achieved for 15/17 (88.2%) data elements in the essential category, and all six data elements (100%) in the marginal category, indicating a high level of overall agreement.

Conclusion

This initial study, which identified 21 key data elements for collection in an ERAS® cardiac program, will aid clinicians in establishing a framework for evaluating the quality of their contemporary ERP processes and will allow acquisition of data to help benchmark performance metrics between hospitals.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cui H, Sun Z, Ruan J, Yu Y, Fan C (2019) Effect of enhanced recovery after surgery (ERAS) pathway on the postoperative outcomes of elbow arthrolysis: A randomized controlled trial. Int J Surg 68:78–84CrossRef Cui H, Sun Z, Ruan J, Yu Y, Fan C (2019) Effect of enhanced recovery after surgery (ERAS) pathway on the postoperative outcomes of elbow arthrolysis: A randomized controlled trial. Int J Surg 68:78–84CrossRef
2.
go back to reference Medbery RL, Fernandez FG, Khullar OV (2019) ERAS and patient reported outcomes in thoracic surgery: a review of current data. J Thorac Dis 11(Suppl 7):S976–S986CrossRef Medbery RL, Fernandez FG, Khullar OV (2019) ERAS and patient reported outcomes in thoracic surgery: a review of current data. J Thorac Dis 11(Suppl 7):S976–S986CrossRef
3.
go back to reference Scarlet S, Isaak RS, McGinigle KL (2018) Design and Implementation of an Enhanced Recovery after Surgery (ERAS) Pathway for Major Limb Amputation in Vascular Surgery. Am Surg 84(4):e147–e149CrossRef Scarlet S, Isaak RS, McGinigle KL (2018) Design and Implementation of an Enhanced Recovery after Surgery (ERAS) Pathway for Major Limb Amputation in Vascular Surgery. Am Surg 84(4):e147–e149CrossRef
4.
go back to reference Liu F, Wang W, Wang C, Peng X (2018) Enhanced recovery after surgery (ERAS) programs for esophagectomy protocol for a systematic review and meta-analysis. Medicine (Baltimore) 97(8):e0016CrossRef Liu F, Wang W, Wang C, Peng X (2018) Enhanced recovery after surgery (ERAS) programs for esophagectomy protocol for a systematic review and meta-analysis. Medicine (Baltimore) 97(8):e0016CrossRef
5.
go back to reference Williams JB, McConnell G, Allender JE et al (2019) One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg 157(5):1881–1888CrossRef Williams JB, McConnell G, Allender JE et al (2019) One-year results from the first US-based enhanced recovery after cardiac surgery (ERAS Cardiac) program. J Thorac Cardiovasc Surg 157(5):1881–1888CrossRef
6.
go back to reference Hillman RT, Sanchez-Migallon A, Meyer LA et al (2019) Patient characteristics and opioid use prior to discharge after open gynecologic surgery in an enhanced recovery after surgery (ERAS) program. Gynecol Oncol 153(3):604–609CrossRef Hillman RT, Sanchez-Migallon A, Meyer LA et al (2019) Patient characteristics and opioid use prior to discharge after open gynecologic surgery in an enhanced recovery after surgery (ERAS) program. Gynecol Oncol 153(3):604–609CrossRef
7.
go back to reference Engelman DT, Ben Ali W, Williams JB et al (2019) Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg 154(8):755–766CrossRef Engelman DT, Ben Ali W, Williams JB et al (2019) Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg 154(8):755–766CrossRef
8.
go back to reference Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393–1402 e1397. Grant MC, Isada T, Ruzankin P, et al. Results from an enhanced recovery program for cardiac surgery. J Thorac Cardiovasc Surg. 2020;159(4):1393–1402 e1397.
9.
go back to reference Dalkey N, Helmer O (1963) An experimental application of the Delphi method to the use of experts. Manag Sci 9(3):458–467CrossRef Dalkey N, Helmer O (1963) An experimental application of the Delphi method to the use of experts. Manag Sci 9(3):458–467CrossRef
10.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341CrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341CrossRef
11.
go back to reference Bakaeen FG, Svensson LG, Mitchell JD, Keshavjee S, Patterson GA, Weisel RD (2017) The American Association for Thoracic Surgery/Society of Thoracic Surgeons position statement on developing clinical practice documents. J Thorac Cardiovasc Surg 153(4):999–1005CrossRef Bakaeen FG, Svensson LG, Mitchell JD, Keshavjee S, Patterson GA, Weisel RD (2017) The American Association for Thoracic Surgery/Society of Thoracic Surgeons position statement on developing clinical practice documents. J Thorac Cardiovasc Surg 153(4):999–1005CrossRef
12.
go back to reference Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines: Clinical Practice Guidelines We Can Trust. Washington, DC. US: National Academies Press; 2011. ISBN-13: 978–0–309–16422–1 Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines: Clinical Practice Guidelines We Can Trust. Washington, DC. US: National Academies Press; 2011. ISBN-13: 978–0–309–16422–1
13.
go back to reference Aloi TL, Camporese G, Izzo M, Kontothanassis D, Santoliquido A (2019) Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process. Eur J Intern Med 65:78–85CrossRef Aloi TL, Camporese G, Izzo M, Kontothanassis D, Santoliquido A (2019) Refining diagnosis and management of chronic venous disease: Outcomes of a modified Delphi consensus process. Eur J Intern Med 65:78–85CrossRef
14.
go back to reference Tarola CL, Hirji S, Yule SJ, et al. Cognitive Support to Promote Shared Mental Models during Safety-Critical Situations in Cardiac Surgery (Late Breaking Report). 2018 IEEE Conf Cogn Comput Asp Situat Manag CogSIMA (2018). 2018;2018:165–167. Tarola CL, Hirji S, Yule SJ, et al. Cognitive Support to Promote Shared Mental Models during Safety-Critical Situations in Cardiac Surgery (Late Breaking Report). 2018 IEEE Conf Cogn Comput Asp Situat Manag CogSIMA (2018). 2018;2018:165–167.
15.
go back to reference Fleming IO, Garratt C, Guha R et al (2016) Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 30(3):665–670CrossRef Fleming IO, Garratt C, Guha R et al (2016) Aggregation of Marginal Gains in Cardiac Surgery: Feasibility of a Perioperative Care Bundle for Enhanced Recovery in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 30(3):665–670CrossRef
16.
go back to reference Shah RM, Hirji SA, Percy E, et al. Cardiac Surgery in Patients with Opioid Use Disorder: An Analysis of 1.7 Million Surgeries. Ann Thorac Surg. 2020;Apr;109(4):1194–1201. Shah RM, Hirji SA, Percy E, et al. Cardiac Surgery in Patients with Opioid Use Disorder: An Analysis of 1.7 Million Surgeries. Ann Thorac Surg. 2020;Apr;109(4):1194–1201.
17.
go back to reference Orhurhu V, Olusunmade M, Urits I et al (2019) Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain. Pain Pract 19(6):656–663CrossRef Orhurhu V, Olusunmade M, Urits I et al (2019) Trends of Opioid Use Disorder Among Hospitalized Patients With Chronic Pain. Pain Pract 19(6):656–663CrossRef
18.
go back to reference Engelman DT, Crisafi C, Germain M, et al. Utilizing Urinary Biomarkers to Reduce Acute Kidney Injury Following Cardiac Surgery. J Thorac Cardiovasc Surg. 2019. Oct 17;S0022–5223(19)32245–7. Engelman DT, Crisafi C, Germain M, et al. Utilizing Urinary Biomarkers to Reduce Acute Kidney Injury Following Cardiac Surgery. J Thorac Cardiovasc Surg. 2019. Oct 17;S0022–5223(19)32245–7.
19.
go back to reference Balzer F, von Heymann C, Boyle EM, Wernecke KD, Grubitzsch H, Sander M. Impact of retained blood requiring reintervention on outcomes after cardiac surgery. J Thorac Cardiovasc Surg. 2016;152(2):595–601 e594. Balzer F, von Heymann C, Boyle EM, Wernecke KD, Grubitzsch H, Sander M. Impact of retained blood requiring reintervention on outcomes after cardiac surgery. J Thorac Cardiovasc Surg. 2016;152(2):595–601 e594.
20.
go back to reference Campbell SM, Braspenning J, Hutchinson A, Marshall M (2002) Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care 11(4):358–364CrossRef Campbell SM, Braspenning J, Hutchinson A, Marshall M (2002) Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care 11(4):358–364CrossRef
Metadata
Title
Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery
Authors
Sameer A. Hirji
Rawn Salenger
Edward M. Boyle
Judson Williams
V. Seenu Reddy
Michael C. Grant
Subhasis Chatterjee
Alexander J. Gregory
Rakesh Arora
Daniel T. Engelman
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 4/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-021-05964-1

Other articles of this Issue 4/2021

World Journal of Surgery 4/2021 Go to the issue