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

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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.

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Funding

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Authors and Affiliations

  1. Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sameer A. Hirji

  2. Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, MD, USA

    Rawn Salenger

  3. Department of Cardiac Surgery, St. Charles Medical Center, Bend, OR, USA

    Edward M. Boyle

  4. Department of Cardiothoracic Surgery, WakeMed Heart Center, WakeMed Clinical Research Institute, Raleigh, NC, USA

    Judson Williams

  5. TriStar Cardiovascular Surgery, Nashville, TN, USA

    V. Seenu Reddy

  6. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institution, Baltimore, MD, USA

    Michael C. Grant

  7. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Subhasis Chatterjee

  8. Department of Anesthesiology, Perioperative and Pain Medicine Program, Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Foothills Medical Center, Calgary, AB, Canada

    Alexander J. Gregory

  9. Department of Surgery, Max Rady College of Medicine, University of Manitoba, St. Boniface Hospital, Winnipeg, MB, Canada

    Rakesh Arora

  10. Heart and Vascular Program, Baystate Health, Springfield, MA, USA

    Daniel T. Engelman

  11. Springfield, MA, USA

    Daniel T. Engelman

Authors
  1. Sameer A. Hirji
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  2. Rawn Salenger
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  3. Edward M. Boyle
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  4. Judson Williams
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  5. V. Seenu Reddy
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  6. Michael C. Grant
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  7. Subhasis Chatterjee
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  8. Alexander J. Gregory
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  9. Rakesh Arora
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  10. Daniel T. Engelman
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Corresponding author

Correspondence to Rakesh Arora.

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Conflict of interest

Dr Boyle reports personal fees from ClearFlow Medical during the conduct of the study and is a founder of and has a patent to ClearFlow Medical pending and issued. Dr R. Engelman is a consultant for Cryolife. Dr D. Engelman reported personal fees from Astute Medical, Edwards Lifescience, and Zimmer-Biomet outside the submitted work. Dr Arora has received honoraria from Mallinckrodt Pharmaceuticals and an unrestricted education Grant from Pfizer Canada. There are no other conflicts of interest to disclose.

Disclosures

Dr. Sameer Hirji reports and is a member of the Cardiac ERAS Society. Dr. Rawn Salenger reports and is a member of the Cardiac ERAS Society. Dr. Edward Boyle reports personal fees from ClearFlow Medical, outside the submitted work; In addition, Dr. Boyle has a patent ClearFlow Medical issued and is a member of the Cardiac ERAS Society. Dr. Judson Williams reports and is a member of the Cardiac ERAS Society. Dr. V. Seenu Reddy reports and is a member of the Cardiac ERAS Society. Dr. Michael Grant reports and is a member of the Cardiac ERAS Society. Dr.Subhasis Chatterjee reports and is a member of the Cardiac ERAS Society. Dr. Alexander Gregory reports and is a member of the Cardiac ERAS Society. Dr. Rakesh Arora reports other from Mallinckrodt Pharmaceuticals, grants from Pfizer Canada, outside the submitted work and is a member of the Cardiac ERAS Society. Dr. Daniel Engelman reports personal fees and other from Cryolife, personal fees from Astute Medical, personal fees from Edwards Lifescience, personal fees from Zimmer-Biomet, outside the submitted work and is a member of the Cardiac ERAS Society.

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Hirji, S.A., Salenger, R., Boyle, E.M. et al. Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery. World J Surg 45, 917–925 (2021). https://doi.org/10.1007/s00268-021-05964-1

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  • DOI: https://doi.org/10.1007/s00268-021-05964-1

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