Enhanced Recovery After Surgery for Total Knee Arthroplasty, Left Colectomy and Hysterectomy

Study Overview
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Brief Summary
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The objective of the study is to assess retrospectively the effect of an awareness-raising phase in favour of Enhanced Recovery After Surgery across the Assistance Publique-Hopitaux Paris institution and to explore the determinants of compliance with modalities of Enhanced Recovery After Surgery. This multicenter study is performed for three types of surgery: total knee arthroplasty, left colectomy and hysterectomy.

Detailed Description
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The primary goal of the study is to quantify the effect of an awareness-raising phase in favour of Enhanced Recovery After Surgery which was organized in 2016 within the public hospitals in Paris (Assistance Publique - Hôpitaux de Paris). The study aims to document and compare the compliance with fast track modalities and its impact for the year before (2015) and the year following (2017) the awareness-raising phase. Durations of hospital stay, compliance with recommendations, benefits on lowering complication rates and cost reductions will be studied for three types of interventions: total knee arthroplasty, left colectomy and hysterectomy. Preoperative information provided to patients, counselling and physical optimisation will be evaluated through a survey among physicians whereas compliance with pre-, intra- and postoperative patient management guidelines will be retrospectively retrieved from the medical records of randomly selected patients. Survival and hospital trajectories will be obtained through the centralised national medical data system. Three groups of patients having underwent total hip prosthesis, ovariectomy or gastrectomy in the same years (2015 and 2017) will serve as control groups, as for these surgeries no specific program has been implemented toward any practice change.

Official Title
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Enhanced Recovery After Surgery for Total Knee Arthroplasty, Left Colectomy and Hysterectomy: A Multicenter Study Assessing Care Practice and Prevention

Conditions
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Surgery, Total Knee Arthroplasty, Colectomy, Hysterectomy

Intervention / Treatment
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* Procedure: One year before awareness-raising phase in favour of Enhanced Recovery After Surgery
* Procedure: One year after awareness-raising phase in favour of Enhanced Recovery After Surgery
* Procedure: No specific program toward improving practices


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Patient aged > 18 years; Resident in France; Patient who underwent surgery in 2015 or 2017 Exclusion criteria: Patient operated in emergency.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 2015 Total knee arthroplasty, hysterectomy or left colectomy<br>Group of patients having a total knee arthroplasty, hysterectomy or left colectomy in 2015 | Procedure: One year before awareness-raising phase in favour of Enhanced Recovery After Surgery<br>* One year before awareness-raising phase in favour of Enhanced Recovery After Surgery<br>|
| 2017 Total knee arthroplasty, hysterectomy or left colectomy<br>Group of patients having a total knee arthroplasty, hysterectomy or left colectomy in 2017 | Procedure: One year after awareness-raising phase in favour of Enhanced Recovery After Surgery<br>* One year after awareness-raising phase in favour of Enhanced Recovery After Surgery<br>|
| 2015 Total hip prosthesis, ovariectomy or gastrectomy<br>Group of patients having total hip prosthesis, ovariectomy or gastrectomy in 2015 | Procedure: No specific program toward improving practices<br>* No specific program toward improving practices<br>|
| 2017 Total hip prosthesis, ovariectomy or gastrectomy<br>Group of patients having total hip prosthesis, ovariectomy or gastrectomy in 2017 | Procedure: No specific program toward improving practices<br>* No specific program toward improving practices<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of hospital stay | The average duration of hospital stay will be compared for the year before (2015) and following (2017) the awareness-raising program implemented in 2016 for patients with knee arthroplasty, hysterectomy or left colectomy. | through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance with modalities of Enhanced Recovery After Surgery program | Modalities of Enhanced Recovery After Surgery recommendations will be compared between the year before (2015) and the year following (2017) the awareness-raising program implemented in 2016. | through study completion, an average of 1 year | 
| Number of surgery related complications | Benefits on lowering complications rates | through study completion, an average of 1 year | 
| Costs per patient | To determine if the awareness-raising program implemented in 2016 has produced a significant cost per patient reduction. The total cost for hospitalization, readmission and surgery related complications will be assessed. | through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Surgery, Enhanced Recovery After Surgery, Fast track, Hysterectomy, Left colectomy, Total knee arthroplasty