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Invited Critique |

Surgical Care Is a Team Sport  Comment on “Association Between Implementation of a Medical Team Training Program and Surgical Morbidity”

Gerald M. Fried, MD
Arch Surg. 2011;146(12):1374. doi:10.1001/archsurg.2011.961.
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Quality improvement is the Holy Grail for those administering surgical programs. It benefits patients by reducing complications and enhancing recovery and saves resources for the health care system. Holte and Kehlet1 have used the term fast track surgery to describe an approach whereby clinical pathways are defined for specific surgical procedures by creating high-level evidence to support each step in the process of surgical care. In this concept, surgeons work collaboratively with anesthesiologists, nurses, nutritionists, and physical therapists to develop and manage the perioperative care. Each step in the care map is based on evidence and evaluated prospectively. As a result, surgical dogma is being replaced by evidence-based surgical practice. This has led to more effective, more efficient, and less morbid surgical care. A recent meta-analysis2 reviewed the evidence in support of such a plan for colorectal operations. The investigators evaluated measures such as early ambulation, early feeding, use of regional anesthesia, avoiding hypothermia, and avoiding overhydration to identify the impact of each of these maneuvers on surgical morbidity and recovery. The ERAS (Enhanced Recovery After Surgery) collaboration has documented a similar benefit after colorectal surgery.3 They have confirmed improvement in recovery, morbidity, and postoperative symptoms in large prospective trials when clinical pathways are developed on the basis of high-level evidence and applied to specific surgical procedures. Other publications47 have shown similar benefits for a variety of surgical procedures.

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