de Aguilar-Nascimento José Eduardo, Bicudo-Salomão Alberto, Caporossi Cervantes, Silva Raquel de Melo, Cardoso Eduardo Antonio, Santos Tiago Pádua, Diniz Breno Nadaf, Hartmann Arthur André
Department of Surgery of Faculdade de Ciências Médicas da Universidade Federal do Mato Grosso, MT, Brazil.
Rev Col Bras Cir. 2009 Jul;36(3):204-9.
To evaluate the outcomes after the implementation of a multimodal protocol (ACERTO protocol) with patients undergoing colorectal operations.
Fifty-three patients (37 M and 16 F; 57 [18-82] years old) submitted to various colorectal operations were prospectively studied in two different periods of time: from January 2004 through July 2005 (n=25, conventional group) and from August 2005 through June 2008 (n=28; ACERTO group). The patients received either the traditional perioperative management (including mechanical bowel cleansing) or a multidisciplinary protocol of perioperative care (without mechanical bowel cleansing) established by the ACERTO protocol. We looked at morbidity and mortality rates and length of hospital stay for comparisons between the groups.
Mortality was 3.8% (2 patients) without difference between groups. Preoperative fasting and postoperative feeding were shortened and intravenous fluids were diminished in patients operated under the ACERTO protocol (p<0.05). Postoperative morbidity (36% vs. 28.6%; p=0.56) and the incidence of anastomotic leak (12 vs. 10.7%; p=1.00) were similar. The number of complications per patient with any complication was lower in the ACERTO group (p=0.01). Changing protocols reduced the length of hospital stay by 4.5 days (12 [4-43] vs. 7.5 [3-47] days, p= 0.04).
The multidisciplinary routines of the ACERTO protocol are safe and enhanced recovery in colorectal surgery by reducing both hospitalization and the severity of postoperative morbidity.
评估对接受结直肠手术的患者实施多模式方案（ACERTO方案）后的效果。
前瞻性研究了53例接受各种结直肠手术的患者（37例男性和16例女性；年龄57[18 - 82]岁），分两个不同时间段：2004年1月至2005年7月（n = 25，传统组）和2005年8月至2008年6月（n = 28；ACERTO组）。患者接受传统围手术期管理（包括机械性肠道准备）或ACERTO方案制定的多学科围手术期护理方案（无机械性肠道准备）。我们观察了两组之间的发病率、死亡率和住院时间以进行比较。
死亡率为3.8%（2例患者），两组间无差异。接受ACERTO方案手术的患者术前禁食和术后进食时间缩短，静脉输液量减少（p < 0.05）。术后发病率（36%对28.6%；p = 0.56）和吻合口漏发生率（12对10.7%；p = 1.00）相似。ACERTO组中发生任何并发症的患者的并发症数量较少（p = 0.01）。方案改变使住院时间缩短了4.5天（12[4 - 43]天对7.5[3 - 47]天，p = 0.04）。
ACERTO方案的多学科常规方法是安全的，通过减少住院时间和术后发病的严重程度，促进了结直肠手术的恢复。
