Implementation of the multimodal protocol ACERTO (Acceleration of Total Postoperative Recovery) in the urology specialty of an oncological hospital.

Abstract

Context: The ACERTO (Acceleration of Total Postoperative Recovery) is a care strategy which aims to reduce the surgical stress, maintain the physiological function in the postoperative period, with potential result in lower morbidity rates, faster recovery and shorter hospital stay.
Objective: To evaluate the implementation of ACERTO in patients undergoing urological surgeries, in an oncology hospital, clinical results, postoperative symptoms and complications and length stay.
Methods: There was prior training on the job for the nursing staff and medical doctors to guarantee adherence to the ACERTO. The patients included underwent nutritional care, shortened preoperative fasting, early postoperative refeeding and other elements of the protocol. All relevant data were collected prospectively in the studied group and retrospectively in the control group after inclusion of patients in the study.
Results: Most patients had no symptoms on the first postoperative day and no complications in the 30-day postoperative period in both groups, with statistically a significant difference for the vomiting symptom (p<0.05), being more frequent among the pre-ACERTO group. Among the other variables,
there was no statistically significant difference. Regarding the length of hospital of hospital stay, a statistically significant difference (p<0.05) is noted between the two groups analyzed, with the post-ACERTO group being less hospitalized.
Conclusion: The implementation of ACERTO is safe, feasible and is associated with better results. However, given the difficulties encountered, there is still resistance in changing surgical dogmas. Therefore, further studies are needed with the intention of suggesting other strategies for its implementation, in order to increase the use of this approach.