Improving Surgical Outcomes in Greater Manchester

Abstract

Background: Post-operative complications are recognised as a significant problem for patients and healthcare professionals alike. In the post-pandemic world, ensuring institutions have structured, feasible and implementable pathways to reduce the burden of postoperative morbidity and mortality has never been more important. ERAS+ is a surgical pathway that focuses on patient education and preparation through surgery school and prehabilitation principles, supporting a focussed in-hospital stepped recovery programme which prioritizes early mobilization, establishment of nutrition, chest recovery using incentive spirometer and oral health care measures. It has previously been shown to be successful in a single tertiary hospital in reducing post-operative pulmonary complications and length of stay (LOS) following major surgery. Methods: Greater Manchester ERAS+ (GM ERAS+) was a Health Foundation supported programme which set out to implement ERAS+ in colorectal surgical patient pathways across seven acute NHS hospitals in Greater Manchester. GM ERAS+ for colorectal patients was implemented between 2018 and 2020 using quality improvement methodology and aimed to replicate the benefits seen in the original implementation. Results: Overall, all 7 sites implemented ERAS+ successfully for colorectal pathways, with 1472 colorectal surgical patients taking part in the scale up of GM ERAS+ between April 2018 and December 2019. Sites with historical LOS demonstrated a reduction in LOS following implementation of ERAS+. From factorial analysis; surgery school, early mobilisation and early nutrition interventions were the ones most associated with a reduction in LOS. Detailed analysis of hospital sites A and E, where data collection was in place for the duration of the programme, demonstrated that implementation of ERAS+ was associated with a reduction in PCP, statistical significant improvement in LOS and a reduction in 1 year mortality rate. Qualitative analysis of the findings of GM ERAS+ implementation identified facilitators and barriers for implementation, with the ‘implemenability’ of ERAS+ examined in detail. Conclusions: The GM ERAS+ colorectal surgical pathway was successfully implemented into seven GM NHS institutions. This system level implementation delivered excellent patient outcomes and confirmed that the pathway was transferable out of a single centre. ERAS+ supports the triple aim of improving patient experience of care; improving population health by reducing complications and reducing the per capita cost of healthcare.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	M Nirmalan (Supervisor) & Jane Eddleston (Supervisor)