Background Patient-reported outcome measures (PROMs) are key elements of assessing the efficacy of perioperative pain management. Here, we aimed to capture the association of 10 individually reported aspects of patient's specific impression of change since surgery (PSIC) related to four outcome domains of a previously defined core outcome set, relative to the patient's global impression of change (PGIC). We further evaluated the influence of type of surgery, sex, preoperative baseline characteristics, and satisfaction with pain management on PGIC. Methods This exploratory analysis used the PROMPT NIT-1 study data (2661 patients, 18 sites, four surgery types: total knee arthroplasty, sternotomy, breast cancer surgery, or endometriosis surgery). Male and female adults were included. All PROMs were assessed on postoperative day 3. We used ordinal regression models with PGIC as a dependent variable and PSICs as independent variables. Results The overall model achieved a pseudo-R2 of 0.55 (relative domain contributions: pain intensity 55%, self-efficacy 19%, adverse events 15%, and pain-related interference of physical functioning 10%). Pain-related worrying and depression had no association with the PGIC, whereas anxiety, preoperative pain, opioid intake, low satisfaction with and wish for more treatment, low treatment agency, and overall dissatisfaction were associated with less improvement after surgery. Receiving information about treatment was associated with greater improvement on the PGIC. Conclusions Although all four domains contributed to PGIC after surgery, pain intensity was the most important. These findings highlight the importance of both managing postoperative pain and optimising patient experience by addressing self-efficacy, adverse events, and pain-related interference of physical functioning. Clinical trial registration NCT 03834922

BACKGROUND:Patient-reported outcome measures (PROMs) are essential instruments for assessing postsurgical pain-related outcomes from the patient's perspective. The concept of minimal clinically important difference (MCID) aims to identify the smallest change in PROMs that is meaningful to patients. In this multicenter study, data were used to calculate MCIDs for several PROMs assessing pain intensity and physical function after surgery and to perform a sensitivity analysis. METHODS:Data from 2,661 patients undergoing sternotomy, total knee arthroplasty, breast surgery, or surgery related to endometriosis, recruited from 18 centers in 10 European countries, were included in the analysis. Eight PROMs were collected on days 1 and 3 after surgery, assessing pain intensity (at rest, average, worst, during movement, during physiotherapy) and physical function (in bed, during movement, during physiotherapy). MCIDs were calculated using a combination of distribution-based (30% of SD, standard error of the measurement) and anchor-based (calculating the absolute change between day 1 and day 3 for patients reporting "minimal improvement" or "minimal worsening" on 7-point global and specific impression of change scales) methods. RESULTS:The MCID estimates for pain intensity ranged from 1.2 (at rest) to 1.6 (during activity), while physical function was consistent between 1.5 (in bed) and 1.6 (during physiotherapy) on an 11-point scale. Sensitivity analyses revealed no significant difference in MCID estimates between symptom improvement and worsening for all PROMs. However, baseline pain influenced MCID estimates, with higher baseline pain leading to patients reporting higher changes as meaningful ( e.g. , for pain at rest, MCID mild pain 1.0, MCID severe pain 2.1). CONCLUSIONS:The authors found differences between MCID estimates for eight PROMs related to pain intensity and physical function. Baseline values appear to have a significant impact on what patients consider to be a minimal relevant change, which should be addressed in future studies.

Objective > Every year, many serious adverse events occur in the care field. Limiting the consequences of medical errors requires attention to the mechanisms of these errors. An anonymous evaluation to list all the errors identified during a working day in the operating room was conducted in 2023. Methods > A prospective survey of anaesthesia professionals in the form of an online questionnaire was performed. For each error identified, it was sought: the type of error, the circumstances of occurrence, the time of occurrence, the possible consequence for the patient, if the error could have been corrected before the action of care and in this case, by what mechanism. A detailed presentation of life-threatening cases was made. Results > The final analysis included 166 participants, of which 53 reported a total of 63 errors. The latter concerned the circuit of the drug (choice of the drug and its concentration mainly), the realization of the checklist, and the ventilator. These errors occurred mainly during routine activity, during induction of anaesthesia. The 4 cases where the vital prognosis was engaged, all involved a catecholamine. Conclusion > This study highlights the difficulty for anaesthesia professionals to identify their own mistakes. Offering solutions based on organizational and human factors is an area of improvement in favour of patient safety and the quality of life and working conditions of professionals.

Martinez, Valeria; Lehman, Thomas; Zahn, Esther M. Pogatzki; Komann, Marcus; Meissner, Winfried; Fletcher, Dominique Author Information

Objectifs Chaque année, de nombreux évènements indésirables graves surviennent dans le domaine du soin. Limiter les conséquences des erreurs médicales impose de s’intéresser aux mécanismes de ces erreurs. Une évaluation anonyme visant à lister l’ensemble des erreurs identifiées au cours d’une journée de travail au bloc opératoire a été menée en 2023. Méthodes Il s’agissait d’une enquête prospective réalisée auprès de professionnels de l’anesthésie sous forme d’un questionnaire en ligne. Pour chaque erreur identifiée, il était recherché : le type d’erreur, les circonstances de survenue, le moment de survenue, la conséquence éventuelle pour le patient, le cas échéant si l’erreur avait pu être corrigée avant l’action de soin et dans ce cas, par quel mécanisme. Une présentation détaillée des cas ayant mis en jeu le pronostic vital était réalisée. Résultats L’analyse finale a porté sur 166 participants, parmi lesquels 53 déclaraient un total de 63 erreurs. Ces dernières concernaient le circuit du médicament (choix du médicament et de sa concentration principalement), la réalisation de la check-list, et le ventilateur. Ces erreurs sont survenues principalement lors d’une activité de routine, pendant l’induction d’anesthésie. Les 4 cas où le pronostic vital était engagé, impliquaient tous une catécholamine. Conclusion Cette étude met en exergue la difficulté pour les professionnels de l’anesthésie d’identifier leurs propres erreurs. Proposer des solutions basées sur les facteurs organisationnels et humains constitue un axe d’amélioration en faveur de la sécurité des patients et de la qualité de vie et des conditions de travail des professionnels.

BACKGROUND:Chronic postsurgical pain (CPSP) is a clinical problem, and large prospective studies are needed to determine its incidence, characteristics, and risk factors. OBJECTIVE:To find predictive factors for CPSP in an international survey. DESIGN:Observational study. SETTING:Multicentre European prospective observational trial. PATIENTS:Patients undergoing breast cancer surgery, sternotomy, endometriosis surgery, or total knee arthroplasty (TKA). METHOD:Standardised questionnaires were completed by the patients at 1, 3, and 7 days, and at 1, 3, and 6 months after surgery, with follow-up via E-mail, telephone, or interview. MAIN OUTCOME MEASURE:The primary goal of NIT-1 was to propose a scoring system to predict those patient likely to have CPSP at 6 months after surgery. RESULTS:A total of 3297 patients were included from 18 hospitals across Europe and 2494 patients were followed-up for 6 months. The mean incidence of CPSP at 6 months was 10.5%, with variations depending on the type of surgery: sternotomy 6.9%, breast surgery 7.4%, TKA 12.9%, endometriosis 16.2%. At 6 months, neuropathic characteristics were frequent for all types of surgery: sternotomy 33.3%, breast surgery 67.6%, TKA 42.4%, endometriosis 41.4%. One-third of patients experienced CPSP at both 3 and 6 months. Pre-operative pain was frequent for TKA (leg pain) and endometriosis (abdomen) and its frequency and intensity were reduced after surgery. Severe CPSP and a neuropathic pain component decreased psychological and functional wellbeing as well as quality of life. No overarching CPSP risk factors were identified. CONCLUSION:Unfortunately, our findings do not offer a new CPSP predictive score. However, we present reliable new data on the incidence, characteristics, and consequences of CPSP from a large European survey. Interesting new data on the time course of CPSP, its neuropathic pain component, and CPSP after endometriosis surgery generate new hypotheses but need to be confirmed by further research. TRIAL REGISTRATION:clinicaltrials.gov ID: NCT03834922.

BACKGROUND Chronic postsurgical pain (CPSP) is a clinical problem, and large prospective studies are needed to determine its incidence, characteristics, and risk factors. OBJECTIVE To find predictive factors for CPSP in an international survey DESIGN Observational study SETTING Multicentre European prospective observational trial PATIENTS Patients undergoing breast cancer surgery, sternotomy, endometriosis surgery, or total knee arthroplasty (TKA). METHOD Standardised questionnaires were completed by the patients at 1, 3, and 7 days, and at 1, 3, and 6 months after surgery, with follow-up via E-mail, telephone, or interview. MAIN OUTCOME MEASURE The primary goal of NIT-1 was to propose a scoring system to predict those patient likely to have CPSP at 6 months after surgery. RESULTS A total of 3297 patients were included from 18 hospitals across Europe and 2494 patients were followed-up for 6 months. The mean incidence of CPSP at 6 months was 10.5%, with variations depending on the type of surgery: sternotomy 6.9%, breast surgery 7.4%, TKA 12.9%, endometriosis 16.2%. At 6 months, neuropathic characteristics were frequent for all types of surgery: sternotomy 33.3%, breast surgery 67.6%, TKA 42.4%, endometriosis 41.4%. One-third of patients experienced CPSP at both 3 and 6 months. Pre-operative pain was frequent for TKA (leg pain) and endometriosis (abdomen) and its frequency and intensity were reduced after surgery. Severe CPSP and a neuropathic pain component decreased psychological and functional wellbeing as well as quality of life. No overarching CPSP risk factors were identified. CONCLUSION Unfortunately, our findings do not offer a new CPSP predictive score. However, we present reliable new data on the incidence, characteristics, and consequences of CPSP from a large European survey. Interesting new data on the time course of CPSP, its neuropathic pain component, and CPSP after endometriosis surgery generate new hypotheses but need to be confirmed by further research. TRIAL REGISTRATION clinicaltrials.gov ID: NCT03834922

BACKGROUND For setting up and implementing an international follow-up survey study in different countries, many prerequisites are necessary: obtaining permission or licenses to use the tools/questionnaires selected, translating the questionnaires according to a standardised translation process, implementing the survey technically, recruiting, training and monitoring the data collecting study sites, obtaining ethics approvals and data protection clearance, developing the study and training materials, and registering the study. OBJECTIVE Within the IMI-PainCare project (Improving the care of patients suffering from acute or chronic pain), we needed to conduct a large noninterventional patient survey – PROMPT NIT-1 – aiming to find out which PROMs (patient-reported outcome measures) work best for postoperative pain assessment. Planning and implementing this international multicentre, multilanguage, follow-up study was complex and time consuming. Consequently, experiences from its successful implementation may help future study coordinators. DESIGN The NIT-1 surveys consisted of several established tools. We planned to include 4000 patients, and to collect data at seven time points: baseline, postoperative days (POD) 1, 3 and 7 and follow-up on postoperative months (POM) 1, 3 and 6. SETTING Eighteen hospitals, mostly primary care, across Europe collected data for our study. First patient in was in August 2019, last patient out in June 2022. PATIENTS Adult patients of both sexes who had undergone one of four defined surgical procedures answered our surveys; total knee arthroplasty (TKA), breast surgery, endometriosis surgery and sternotomy. MAIN OUTCOMES Results from the study related to the primary and secondary outcomes are not part of this publication and will be presented separately. This publication describes only the technical, administrative and coordinating implementation. RESULTS Although the COVID-19 pandemic affected patient inclusion, and some preparations took longer than foreseen, 18 hospitals across Europe included 3303 patients. We were able to attain sufficient case numbers, and follow-up rates were very good. CONCLUSION The setting up and implementation of a large, international, multilanguage data collection is challenging and ambitious but feasible if it is well planned, if sufficient resources (project management and technical/IT expertise, qualified staff, funding, commitment) are available and if the timeframe for preparing the study is generously calculated. TRIAL REGISTRATION clinicaltrials.gov (ID NCT03834922).

Background: Postsurgical outcome measures are crucial to define the efficacy of perioperative pain management; however, it is unclear which are most appropriate. We conducted a prospective study aiming to assess sensitivity-to-change of patient-reported outcome measures assessing the core outcome set of domains pain intensity (at rest/during activity), physical function, adverse events, and self-efficacy. Methods: Patient-reported outcome measures were assessed preoperatively, on day 1 (d1), d3, and d7 after four surgical procedures (total knee replacement, breast surgery, endometriosis-related surgery, and sternotomy). Primary outcomes were sensitivity-to-change of patient-reported outcome measures analysed by correlating their changes (d1 -d3) with patients' global impression of change and patients' specific impression of change items as anchor criteria. Secondary outcomes included identification of baseline and patient characteristic variables explaining variance in change for each of the scales and descriptive analysis of various patient-reported outcome measures from different domains and after different surgeries. Results: Of 3322 patients included (18 hospitals, 10 countries), data from 2661 patients were analysed. All patient-re-ported outcome measures improved on average over time; the median calculated sensitivity-to-change for all patient-reported outcome measures (overall surgeries) was 0.22 (range: 0.07-0.31, scale: 0-10); all changes were independent of baseline data or patient characteristics and similar between different procedures. Conclusions: Pain-related patient-reported outcome measures have low to moderate sensitivity-to-change; those showing higher sensitivity-to-change from the same domain should be considered for inclusion in a core outcome set of patient-reported outcome measures to assess the effectiveness and efficacy of perioperative pain management.

Objective: The French Society of Anesthesiology and Intensive Care Medicine [SocieteFranc,aise d'Anesthesie et de Reanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. Design: A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. Methods: Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE & REG; methodology. The recommendations were formulated according to the GRADE & REG; methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE & REG; methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. Results: The experts' work on synthesis and application of the GRADE & REG; method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1 & PLUSMN;) and ten a low level of evidence (GRADE 2 & PLUSMN;). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. Conclusions: Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields. ⠂C 2023 Societefranc,aise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Chronic post-surgical pain predictive scores exist, but none has yet demonstrated an impact on patient care. Van Driel and colleagues offer an additional perspective on early postoperative detection of patient at risk of chronic post-surgical pain to enable early interventions in prevention and treatment. The authors derived and validated a model based on four easily obtainable predictors that could help clinicians assess and treat patients at risk. Additional work is needed to prove reliability and clinical benefit of chronic post-surgical pain prediction and intervention.

BACKGROUND:The COVID-19 pandemic has required urgent organisational and managerial adaptation, with hospital medical and administrative leaders under considerable pressure.METHODS:At a single French university hospital, we performed a sociological analysis of management adaptation by medical and administrative leaders during the first wave of the COVID-19 crisis. Two sociologists performed interviews with representative members of staff from all the structures involved in managing the crisis to analyse adaptation and the solutions found during this period.RESULTS:The answers collected during interviews were classified into three main topics describing the organisational adaptations of the hospital staff during the COVID-19 crisis: (1) exceptional mobilisation and collaboration; (2) crisis management based primarily on the principle of subsidiarity; and (3) survival of the administrative structure with interventions to support caregivers.CONCLUSION:This study, focusing on a single hospital, identified a number of factors associated with successful mobilisation in the very specific conditions of this viral pandemic.

La crise sanitaire engendrée par la COVID-19 a eu un impact majeur sur le système de soin et les soignants. L’attention à porter aux professionnels du soin est indispensable, et passe par l’identification des facteurs de risques pour leur santé psychique. Dans les unités de soins intensifs (USI) la crise sanitaire a induit un stress professionnel important du fait de l’afflux de patients, de l’exposition au virus et du manque de connaissance de ce virus. L’étude présentée a pour objectif d’évaluer et comparer l’impact psychosocial de la crise COVID-19 sur les soignants exerçant dans une USI standard versus une USI ad hoc gérée par les anesthésistes en salle de réveil ou salle d’opération, dans le même hôpital universitaire. L’étude est une enquête transversale composée de questionnaires validés (HADS, Brief COPE, CBI et PCLS), de question sociodémographiques et d’un questionnaire ad hoc sur les caractéristiques professionnelles, soumis ç l’ensemble des professionnels travaillant dans les deux USI d’un hôpital Universitaire Français, d’avril à mai 2020. Une régression logistique a été réalisée pour identifier les facteurs de risques indépendants de l’anxiété, la dépression, le burnout et l’état de stress post traumatique (ESPT) ; avec une valeur significative pour un p < 0,05. Le taux de réponse était de 76 % (66/84) et 84 % (142/168), respectivement dans les USI ad hoc et standard. L’anxiété est statistiquement plus fréquente dans l’unité ad hoc que la standard 3,01 IC 95 % [1,24 ; 7,29] p 0,014). Il n’y a pas de différence significative entre les ICU concernant les incidences de la dépression, le burnout et l’ESPT. L’analyse multivariée révèle que le genre féminin et le travail en USI ad hoc était des facteurs de risque d’anxiété. Le genre féminin et l’usage de psychotrope étaient liée à la dépression. Le burnout était lié au sentiment de protection et à l’usage de psychotrope. Aucun facteur de risque significatif n’a été identifié pour l’ESPT. L’évaluation de l’impact psychosocial sur les professionnels travaillant en USI classique ou ad hoc dans le même hôpital révèle des facteurs de risque spécifiques pour l’anxiété, le burnout et la dépression. Ces informations doivent être prise en compte dans l’adaptation des structures de soin pour de futures organisations de crise.

BACKGROUND:Multimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery.METHODS:We performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions.RESULTS:From November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p =  0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p =  0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis.CONCLUSION:Skin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters.

Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.

Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia (OBA) in five international databases. The co-primary outcomes were postoperative acute pain and morphine consumption at 2, 24, and 48 h. The secondary outcomes were the incidence of postoperative chronic pain, hemodynamic tolerance, severe adverse effects, opioid-related adverse effects, and specific adverse effects related to substitution drugs. Overall, 33 RCTs including 2209 participants were assessed. At 2 h, the OFA groups had lower pain scores at rest MD (0.75 (−1.18; −0.32)), which did not definitively reach MCID. Less morphine was required in the OFA groups at 2 and 24 h, but with very small reductions: 1.61 mg (−2.69; −0.53) and −1.73 mg (p < 0.05), respectively, both not reaching MCID. The reduction in PONV in the OFA group in the PACU presented an RR of 0.46 (0.38, 0.56) and an RR of 0.34 (0.21; 0.56), respectively. Less sedation and shivering were observed in the OFA groups with an SMD of −0.81 (−1.05; −0.58) and an RR of 0.48 (0.33; 0.70), respectively. Quantitative analysis did not reveal differences between the hemodynamic outcomes, although severe side effects have been identified in the literature. No clinically significant benefits were observed with OFA in terms of pain and opioid use after surgery. A clear benefit of OFA use was observed with respect to a reduction in PONV. However, more data on the safe use of OFAs should be collected and caution should be taken in the development of OFA.

BACKGROUND:Mental health and well-being is a significant problem for medical students in training. In this study, we aim to estimate the prevalence of anxiety and depressive symptoms, burnout and psychosocial distress in French anaesthesia and intensive care residents.METHODS:A national online observational study used validated questionnaires (Hospital Anxiety and Depression Scale (HADS), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS) and work-related questions (work-hours per week, night shift per month, safety rest after night shift, average time to start and end work, break time and time for lunch) to assess mental health and well-being of French residents in anaesthesia and intensive care.RESULTS:We obtained 519 answers (22.5% of 2302 students), 55% of respondents working in anaesthesia, 41% in intensive care at the time of study. Residents describe certain symptomatology in anxiety (19.8%) and depressive symptoms (7.8%). PSS identifies a perceived high stress (score > 27) for 55.7% of the subjects. The CBI questionnaire identifies 205 (38.9%) residents undergoing burnout, 80.7% working more than 48 h per week and 39.1% more than 60 h. The duration of work per week (> 50 h), gender (female) and on-going training in intensive care are independent risk factors of psychological suffering. Lifestyle and level of training are not statistically identified risk factors.CONCLUSION:This first online survey of French anaesthesia and intensive care residents reveals a significant frequency of anxiety and depressive symptoms, burnout and a link to potential targets of improvement in work conditions mainly related to the number of work hours per week.

La récupération accélérée après chirurgie (RAAC) a pour objectif de réduire la durée d’hospitalisation tout en garantissant la qualité des soins. Cette étude a évalué l’implantation et le déploiement de ce dispositif organisationnel à travers deux dimensions : 1-la description des modalités de déploiement ; 2-l’identification de facteurs structurants. Nous avons procédé par étude de cas auprès de 4 établissements et avons eu recours à une méthodologie qualitative (entretiens, observations, analyse documentaire). L’ensemble des données collectées a été analysé par analyse de contenu. L’implantation de la RAAC dépend du contexte et a des modalités de déploiement (institutionnelles, organisationnelles et professionnelles) variables d’un établissement à un autre. Pour autant, des facteurs structurants conditionnent la réussite de l’implantation de ces programmes. L’implantation de la RAAC repose sur plusieurs dimensions structurantes, qui ne peuvent être standardisées et qu’il importe d’activer de manière concomitante. Enhanced recovery after surgery (ERAS) aims to reduce the duration of hospital stay while improving the quality of care. We have evaluated the setting and development of an ERAS programme through the description of the details of implentation and the identification of structural factors. The study was conducted in four institutions. We use a qualitative methodology (interviews, observations, analysis of documents). We have performed a content analysis of all the data collected. The conclusions of this analysis was that implementation of ERAS programme varies according the institution. However structural factors determine the success of the procedure. There is a need to identify such factors in a given institution to facilitate the setting of ERAS programme.

Le terme de Burn out date de 1974. Il concerne des personnes très investies dans leur travail, souvent dans des activités à connotation sociale. Les internes en médecine sont donc particulièrement exposés. Une enquête déclarative récente réalisée aux États Unis par questionnaires envoyés par mail auprès d’internes en chirurgie a retrouvé une incidence de 75 % burn out, 39 % de dépression et 12 % d’idées suicidaires (Williford 2018).