Colorectal Surgery and Enhanced Recovery: Impact of a Simulation-Based Care Pathway Training Curriculum

Laura Beyer-Berjot, MD1, Philip Pucher, MRCS2, Daniel A Hashimoto, MD, MS3, Paul Ziprin, MD, FRCS2, Stephane V Berdah, MD, PhD1, Ara Darzi, KBE, MD, FACS, FRCS, HonFREng, FMedSci2, Rajesh Aggarwal, MD, PhD, MA, FRCS4. 1Centre for Surgical Teaching and Research (CERC), Aix-Marseille Universite, Marseille, France., 2Department of Surgery and Cancer, St. Mary’s Campus, Imperial College, London, UK., 3Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., 4Arnold & Blema Steinberg Medical Simulation Centre, McGill University, Montreal, Canada.

Introduction: The aim was to determine whether a surgical simulation pathway curriculum could improve compliance for enhanced recovery programs (ERP), and residents’ participation in laparoscopic colorectal procedures (LCP). Indeed, junior surgeons have limited access to LCP as primary operator, and ERP have improved patients’ outcomes in colorectal surgery (CS).

Methods and Procedures: All residents of our department of CS were trained in a simulation-based pathway care approach: pre- and postoperative training consisted in virtual patients built in accordance with guidelines in both ERP and colorectal surgery, whilst intraoperative training involved a virtual reality simulator curriculum. Twenty patients undergoing CS were prospectively included before (n = 10) and after (n = 10) the training. All demographic and perioperative data were prospectively collected from their medical records, including compliance for ERP. Residents’ participation in LCP was measured as the percentage of time during which they were primary operator.

Results: Five residents were enrolled ranging from PGY 4 to 7. All had performed over 50 laparoscopic procedures, but none had performed LCP as primary operator. Overall satisfaction and usefulness were both rated 4.5/5, usefulness of preoperative, postoperative and intraoperative training was rated 5/5, 4.5/5 and 4/5, respectively. Residents’ participation in LCP significantly improved after the training (0% (0-100) vs. 82.5% (10-100); P = 0.006). Pre- and intraoperative data were comparable between pre-training and post-training patients. Postoperative morbidity was also comparable, with a trend toward less major morbidity (P = 0.07). Compliance for ERP improved at day 2 in post-training patients (3 (30%) vs. 8 (80%); P = 0.035). Length of stay was not modified (9,5 days (4-26) vs. 6,5 (5-30); P = 0.74).

Conclusion: A surgical simulation pathway curriculum for training in CS improved compliance for ERP and residents’ participation as primary operator without adversely altering patients’ outcomes.

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