Implantación de un nuevo protocolo de recuperación intensificada en cirugía colorrectal en un hospital de tercer nivelcalidad percibida por el paciente

Abstract

The RICA Protocol (Intensified Recovery in Abdominal Surgery) in colorectal surgery at the Hospital Universitario Ramón y Cajal (HURYC), was implemented in January 2020, and includes 23 variables of those included in the “Clinical Pathway for Intensified Recovery in Adult Surgery”. This is a single-centre, observational, ambispective cohort study, in which we compared a prospective cohort of 150 patients who underwent scheduled colorectal cancer surgery included in the RICA protocol from January 2020 to October 2022, with another historical cohort of 150 patients who underwent surgery without this protocol, between January 2016 and January 2018. The main objective is to describe the implementation of this protocol and the degree of compliance with the items. As secondary objectives, to analyse whether the implementation of the protocol is associated with a decrease in hospital stay and complications, leading to savings in economic terms for the centre. The quality perceived by patients was also assessed. Results: The implementation of the RICA protocol in colorectal surgery has had a high degree of overall compliance (81.94%). Moreover, this percentage has improved during the observation period, being 80.25% from 2020 to 2021 and 82.55% in the second period (year 2022). The implementation of the protocol also resulted in a decrease in the mean hospital stay from 12.42 days (SD 8.09) to 6.97 days (SD 4.53); (p<0.001) and in the total complication rate (19.3% vs 42%), (p<0.001), with no increase in the 30-day readmission rate. No statistically significant differences were found in medical complications between the two groups. Regarding surgical complications, the most frequent was postoperative ileus, but statistically significant differences were only found in the occurrence of anastomotic dehiscence (7.3% vs 1.3%); (p=0.01), surgical wound infection (SWI) (9.3% vs 2%); (p=0.006) and surgical site infection (SSI) (6.7% vs 2%); (p=0.047) in favour of the RICA group vs the NON-RIACA group. The implementation of the RICA protocol was cost-effective, saving €112,811 in economic terms, i.e. €752.07 per patient. In terms of perceived quality, 100% of the patients rated the treatment received by the healthcare staff during their hospital admission as “very good” or “good” and 46.6% rated the protocol with the maximum score of 10 points. In the qualitative analysis of perceived quality in the form of a group interview, patients expressed their experiences and perceptions of the hospitalisation process and expressed the need for more emotional and psychological support during the process. Conclusions: After two years of implementation of the RICA protocol in colorectal surgery, overall compliance was 81.94%. It has also led to a reduction in HD, the rate of surgical complications (anastomotic dehiscence, IHQ and ISQ) and economic costs, without increasing the 30- day readmission rate. The quality perceived by patients in the RICA group was very good.