98 - Freie Mitteilung
17. Mai 2019, 14:15 - 15:45, Kursaal Arena, 5. OG
Is there a relation between adequate nurse staff and the incidence of infectious complications in patients undergoing colorectal surgery within an ERAS program?
S. Kasmi1, M. Schäfer1, M. Hübner1, N. Demartines1, D. Hahnloser1, M.-O. Sauvain2, 1, Presenter: S. Kasmi1 (1Lausanne, 2Neuchâtel)
Colorectal surgery is still associated with an increased postoperative complication rate. The role of an adequate nurse staffing to provide an optimal patient care has not been yet assessed. This retrospective study aimed to analyze the relationship between the estimated nurse workload and the occurrence of postoperative complications of patients undergoing colorectal surgery within an ERAS program.
Retrospective analyzis of all patients undergoing elective and emergency colorectal surgery from 01/2014 to 12/2016 within our ERAS program. Patient’s characteristics, and complication rates were assessed. Nurse workload for individual patients was calculated by using the Projet de Recherche en Nursing program (PRN). It assigns points to each patient according to the type of care needed. The sum of all PRN on a ward provides an estimation of the number of nurses or equivalent full-time job required to deliver this amount of care. During the period studied, the mean real/required PRN rate was calculated (81.04%). Based on this mean PRN, patients were dichotomized. Overall, infectious, wound and urinary tract infections were assessed as endpoints. Standard statistical testing was used, a p value <0.05 was considered statistically significant.
There were 895 patients (m/f 492/403) with a mean age of 63 years included. There were 276 (31%) open surgeries, 579 (65%) laparoscopic operations, and 40 conversions (4.4%). The overall complication rate was 50.5%, while infectious complications, wound infections, urinary tract infections and surgical complications occurred in 20.5%, 8.6%, 5.1%, and 25.3%, respectively. By comparing the two overall groups (PRN >81.04 vs. PRN <81.04), there were no statistically significant differences regarding all types of assessed complications. The subgroup of patients with open surgeries revealed a statistically significant higher rate of overall (p=0.0002) and infectious (p=0.0260) complications if the PRN was <81.04. Only the overall complication rate after laparoscopic surgery was significantly increased (p=0.0150) in case of understaffing.
Understaffing the nurses was associated with increased overall and infectious complication rates in patients undergoing open colorectal surgery. The PRN system can be used to reliably predict the correct workload for such patients.