Berberat P O, Ingold H, Gulbinas A, Kleeff J, Müller M W, Gutt C, Weigand M, Friess H, Büchler M W
Department of General Surgery and Department of Anesthesia, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
J Gastrointest Surg. 2007 Jul;11(7):880-7. doi: 10.1007/s11605-007-0167-2.
Concepts in "fast-track" surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools, normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients' age, operation time, and early extubation proved to be independent factors of early discharge, shown through multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe and promotes earlier discharge without compromising patient outcomes.
“快速康复”手术的理念可提供最佳围手术期护理，已被证明能显著降低并发症发生率并缩短住院时间。本研究探讨快速康复理念是否也能安全应用于大型胰腺切除术并改善其手术效果。对一家大型医疗中心连续255例行快速康复手术胰腺切除术患者的围手术期数据进行单因素和多因素分析。255例患者中，180例行胰头切除术，51例行胰体尾切除术，15例行全胰切除术，9例行节段性胰腺切除术。患者中位出院时间为术后第10天，30天再入院率为3.5%。住院死亡率为2%，内科和外科并发症发生率分别为17%和25%。首次排便、正常饮食、完全活动及返回普通病房等快速康复指标与早期出院显著相关（p<0.05）。多因素分析显示，患者年龄、手术时间及早期拔管是早期出院的独立因素（比值比分别为4.0、2.0和2.8；p<0.05）。低再入院率、死亡率和并发症发生率表明，快速康复手术实际上是可行且安全的，能促进患者更早出院且不影响手术效果。
