Abstract
Background: Enhanced recovery pathways are associated with improved postoperative outcomes. However, as enhanced
recovery pathways have become more complex and varied, compliance has reduced. The ‘DrEaMing’ bundle re-
prioritises early postoperative delivery of drinking, eating, and mobilising. We investigated relationships between
DrEaMing compliance, postoperative hospital length of stay (LOS), and complications in a prospective multicentre major
surgical cohort.
Methods: We interrogated the UK Perioperative Quality Improvement Programme dataset. Analyses were conducted in
four stages. In an exploratory cohort, we identified independent predictors of DrEaMing. We quantified the association
between delivery of DrEaMing (and its component variables) and prolonged LOS in a homogenous colorectal subgroup and assessed generalisability in multispecialty patients. Finally, LOS and complications were compared across hospitals,
stratified by DrEaMing compliance.
Results: The exploratory cohort comprised 22 218 records, the colorectal subgroup 7230, and the multispecialty subgroup
5713. DrEaMing compliance was 59% (13 112 patients), 60% (4341 patients), and 60% (3421), respectively, but varied
substantially between hospitals. Delivery of DrEaMing predicted reduced odds of prolonged LOS in colorectal (odds ratio
0.51 [0.43e0.59], P<0.001) and multispecialty cohorts (odds ratio 0.47 [0.41e0.53], P<0.001). At the hospital level, compli-
cations were not the primary determinant of LOS after colorectal surgery, but consistent delivery of DrEaMing was
associated with significantly shorter LOS.
Conclusions: Delivery of bundled and unbundled DrEaMing was associated with substantial reductions in postoperative
LOS, independent of the effects of confounder variables. Consistency of process delivery, and not complications, pre-
dicted shorter hospital-level length of stay. DrEaMing may be adopted by perioperative health systems as a quality metric
to support improved patient outcomes and reduced hospital length of stay.
recovery pathways have become more complex and varied, compliance has reduced. The ‘DrEaMing’ bundle re-
prioritises early postoperative delivery of drinking, eating, and mobilising. We investigated relationships between
DrEaMing compliance, postoperative hospital length of stay (LOS), and complications in a prospective multicentre major
surgical cohort.
Methods: We interrogated the UK Perioperative Quality Improvement Programme dataset. Analyses were conducted in
four stages. In an exploratory cohort, we identified independent predictors of DrEaMing. We quantified the association
between delivery of DrEaMing (and its component variables) and prolonged LOS in a homogenous colorectal subgroup and assessed generalisability in multispecialty patients. Finally, LOS and complications were compared across hospitals,
stratified by DrEaMing compliance.
Results: The exploratory cohort comprised 22 218 records, the colorectal subgroup 7230, and the multispecialty subgroup
5713. DrEaMing compliance was 59% (13 112 patients), 60% (4341 patients), and 60% (3421), respectively, but varied
substantially between hospitals. Delivery of DrEaMing predicted reduced odds of prolonged LOS in colorectal (odds ratio
0.51 [0.43e0.59], P<0.001) and multispecialty cohorts (odds ratio 0.47 [0.41e0.53], P<0.001). At the hospital level, compli-
cations were not the primary determinant of LOS after colorectal surgery, but consistent delivery of DrEaMing was
associated with significantly shorter LOS.
Conclusions: Delivery of bundled and unbundled DrEaMing was associated with substantial reductions in postoperative
LOS, independent of the effects of confounder variables. Consistency of process delivery, and not complications, pre-
dicted shorter hospital-level length of stay. DrEaMing may be adopted by perioperative health systems as a quality metric
to support improved patient outcomes and reduced hospital length of stay.
| Original language | English |
|---|---|
| Pages (from-to) | 114-126 |
| Number of pages | 13 |
| Journal | British Journal of Anaesthesia |
| Volume | 129 |
| Issue number | 1 |
| Early online date | 11 May 2022 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |
Bibliographical note
Funding Information:The Perioperative Quality Improvement Programme (PQIP) is funded by the Royal College of Anaesthetists, UK; the University College London/University College London Hospitals Surgical Outcomes Research Centre, UK; and by the Health Foundation, UK. NIAA RCoA/BJA project grant to DMG. University College London/University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre to SRM and MGM. All views expressed here are those of the authors and not of the NIHR or Department of Health and Social Care.
Funding Information:
The Perioperative Quality Improvement Programme (PQIP) is funded by the Royal College of Anaesthetists , UK; the University College London /University College London Hospitals Surgical Outcomes Research Centre, UK; and by the Health Foundation , UK. NIAA RCoA/BJA project grant to DMG. University College London/University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre to SRM and MGM. All views expressed here are those of the authors and not of the NIHR or Department of Health and Social Care.
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© 2022 The Authors