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1. Results following implementation of a cardiac surgery ERAS protocol.

Author

Tomi Obafemi, Danielle Mullis, Simar Bajaj, Purnima Krishna, and Jack Boyd

Subjects
Medicine, Science
Abstract

IntroductionAdequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital.MethodsThis study is a single-center, retrospective analysis. Enhanced recovery after surgery (ERAS) protocols were implemented for CABG/Valve and open Aortic operations on 11/1/2017 and 6/1/2018, respectively. Propensity-score matched analysis was used to compare 30-day mortality and morbidity of patients from the pre- and post-implementation cohorts. Secondary endpoints included the following: total hospital length of stay (LOS), ICU LOS, time until extubation, and time until urinary catheter removal.ResultsAfter the implementation of the ERAS protocols for CABG/Valve operations, the median post-op LOS decreased from 7.0 days to 6.1 days (pConclusionAt Stanford Hospital, ERAS pathways have led to decreased morbidity and LOS while simultaneously improving mortality amongst our critically ill patient population.

Published
2023
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2. Association Between Implementation of a Geriatric Trauma Clinical Pathway and Changes in Rates of Delirium in Older Adults With Traumatic Injury

Author

Caroline Park, Ankur Bharija, Matthew Mesias, Ann Mitchell, Purnima Krishna, Nannette Storr-Street, Alyssa Brown, Marina Martin, Amy C. Lu, and Kristan L. Staudenmayer

Subjects
Aged, 80 and over, Male, Emergency Medical Services, Delirium, Trauma Centers, Case-Control Studies, Critical Pathways, Humans, Wounds and Injuries, Surgery, Female, Geriatric Assessment, Retrospective Studies, Original Investigation, Aged
Abstract

IMPORTANCE: Older adults (age ≥65 years) are at risk for high rates of delirium and poor outcomes; however, how to improve outcomes is still being explored. OBJECTIVE: To assess whether implementation of a geriatric trauma clinical pathway was associated with reduced rates of delirium in older adults with traumatic injury. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case-control study of electronic health records of patients aged 65 years or older with traumatic injury from 2018 to 2020 was conducted at a single level I trauma center. Eligible patients were age 65 years or older admitted to the trauma service and who did not undergo an operation. INTERVENTION: The implementation of a clinical pathway based on geriatric best practices, which included order sets, guidelines, automated consultations, and escalation pathways executed by a multidisciplinary team. MAIN OUTCOMES AND MEASURES: The primary outcome was delirium. The secondary outcome was hospital length of stay. Process measures for pathway compliance were also assessed. RESULTS: Of the 859 eligible patients, 712 patients were included in the analysis (442 [62.1%] in the baseline group; 270 [37.9%] in the postimplementation group; mean [SD] age: 81.4 [9.1] years; 394 [55.3%] were female). The mechanism of injury was not different between groups, with 247 in the baseline group (55.9%) and 162 in the postimplementation group (60.0%) (P = .43) experiencing a fall. Injuries were minor or moderate in both groups (261 in baseline group [59.0%] and 168 in postimplementation group [62.2%]; P = .87). The adjusted odds ratio for delirium in the postimplementation cohort was 0.54 (95% CI, 0.37-0.80; P

Published
2022

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