Aguilar-Nascimento José Eduardo de, Salomão Alberto Bicudo, Caporossi Cervantes, Diniz Breno Nadaf
Department of Surgery, Universidade Federal de Mato Grosso (UFMT), Cuiabá, MT, Brazil.
Arq Gastroenterol. 2010 Apr-Jun;47(2):178-83. doi: 10.1590/s0004-28032010000200012.
Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery.
To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients.
Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity.
The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01).
The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.
围手术期护理的多模式方案可能会促进术后恢复。基于证据，这些围手术期护理的新常规改变了手术中的传统处方。
评估多模式方案（ACERTO方案）在老年患者中的效果。
在一家三级大学医院的外科病房进行了非随机历史队列研究。117名60岁及以上的患者接受了择期腹部手术，其中42名采用传统方式（传统组，2004年1月至2005年6月），75名采用名为ACERTO的快速围手术期方案（ACERTO组，2005年7月至2007年12月）。主要终点指标为术前禁食时间、术后重新进食天数、静脉输液量、住院时间和发病率。
实施ACERTO方案后，术前禁食时间缩短（15[8 - 20]小时对4[2 - 20]小时，P<0.001），术后重新进食天数提前（术后第1天[第1 - 10天]对术后第0天[第0 - 5天]；P<0.01），静脉输液量减少（10.7[2.5 - 57.5]升对2.5[0.5 - 82]升，P<0.001）。方案的改变使平均住院时间缩短了4天（6[1 - 43]天对2[1 - 97]天；P = 0.002），手术部位感染率降低了85.7%（19%；8/42对2.7%；2/75，P<0.001；相对风险 = 1.20；95%置信区间 = 1.03 - 1.39）。按方案分析显示，仅在完成方案的患者中，大手术的住院时间有所减少（P<0.01）。
ACERTO方案多学科常规的实施减少了接受腹部手术的老年患者的住院时间和手术部位感染。
