A uniform, consensual and multicentric implementation of the multidisciplinary Perioperative
Medicine Program is proposed, the program comes form the Clinical Pathway of Intensified
Recovery in Abdominal Surgery -RICA-, published by the Spanish National Health System as
clinical guideline.
It covers the perioperative area in complex abdominal surgery and extends from the moment of
diagnosis in the Surgery office until the last revision performed one year after surgery.
It is proposed as a double study; a first retrospective analysis of the results and
perioperative complications referred and available in the Centers involved in the study; and
a second analysis of results after the implementation of the Program, in the same Centers.
Once both are finished, the comparison between them and their communication will be carried
out using the appropriate reports.
Actors: Multidisciplinary teams made up of nurses, surgeons, anesthesiologists, nutritionists
/ endocrinologists, physiotherapists and rehabilitators.
Patients: All patients recruited in the different hospitals for the RICA Perioperative
Medicine Program susceptible to performing complex abdominal surgery.
Variables under study: Perioperative complications according to the Clavien-Dindo
classification and the European Perioperative Clinical Outcome definitions (EPCO); Times of
global hospital stay and in critical care units; the rate of readmissions and the
complications derived from them, the rate of surgical reoperations, the analysis of cost per
process (including the total cost in the study period-two years-), the time until complete
reincorporation into the family environment and socio-labor, the indices of quality perceived
by the patient and / or their caregivers, the final quality of life index obtained by each
patient (resulting quality of life).
Data collection and analysis: Record of described variables were be included in an "on
line"database available to all centers.
Limitations of the Study: impossibility to include all the patients that can be recruited in
surgery consultations due to rejection of the staff (negative to the benchmarking and / or to
the program) or negative of the patient. Loss of data in follow-up due to the failure of
patients. Difficulty in analyzing costs due to lack of economic data in the Centers. Lack of
motivation in the multidisciplinary teams. Rupture of the program in case of emergency /
emergency.
Material and Methodology:
Participating Centers: Previously selected for their well-known Organizational capacity and
their experience and interest.
First Phase: Realization of retrospective study of existing results in each Center in the six
months prior to the implementation of the Program and Conformation of the multidisciplinary
teams that will implement the Intensified Recovery Program.
Second phase: Training of the Teams in IACS (Instituto Aragones Ciencias de la Salud) on the
implementation of enhanced recovery programs provided with online training through platform
built "ad hoc" and in person for training with experts. Development of the Normalized Work
Protocol (NTP) in each assigned Center and implementation of the forms and database in the
Clinical History of the Centers (considering electronic Clinical History).
Third phase: Progressive recruitment of patients and inclusion in the Program (on-line
database) and start of the one-year prospective study from the patient's inclusion.
Inclusion Criteria:
-Patients over 18 years old, scheduled for major abdominal surgical surgery, due to malignant
or benign causes. (It is defined as complex major surgery that lasts more than two hours, it
is estimated that it may require the transfusion of at least 2 red cell concentrates or it is
estimated a loss greater than or equal to 15% of the patient's blood volumen).