Grant: Project Grant

Surgery is essential for the health and quality of life of over 1.5M Canadians a year, but it can burden patients and the healthcare system-complications are common and costly to patients and healthcare systems. Taken together, optimizing surgical care is critical. Our large systematic review confirmed that Enhanced Recovery After Surgery (ERAS) guidelines greatly reduce complications, length of hospital stay and costs. We also found that when surgical care is more congruent with ERAS guidelines outcomes are better. But, we found that ERAS guidelines are not always followed. Improving adoption of ERAS is a priority locally and for the international ERAS Society. Our objective is to improve the uptake of ERAS guidelines to improve surgical outcomes. Using evidence from our previous CIHR studies, we will design an implementation strategy and conduct a hybrid type III implementation-effectiveness study with outcomes informed by the RE-AIM framework. We will use existing clinical and administrative data to monitor adoption of ERAS guidelines and measure effectiveness of the implementation strategy (primary) and guidelines (secondary), including a value-for-money analysis, using a cluster randomized step-wedge study. We have used these methods in our previous CIHR-funded study. All adult patients undergoing ERAS-guided surgeries from 2025-2028 will be included and identified using our local ERAS audit system which captures key compliance metrics and our outcomes and has been validated by our team. By improving compliance with ERAS guidelines, more surgical patients will benefit from the evidence-based approach to improving outcomes. Our team of experts includes surgeons, implementation scientists, patients, and decision makers who are end-users of the guidelines, which makes us well-positioned to increase the impact of the findings.