Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Colorectal Dis. 2012 Aug;14(8):1001-8. doi: 10.1111/j.1463-1318.2011.02854.x.
It is questioned whether all separate fast track elements are essential for enhanced postoperative recovery. We aimed to determine which baseline characteristics and which fast track elements are independent predictors of faster postoperative recovery in patients undergoing resection for colon cancer.
Data from the LAFA trial database were used. In this trial, fast track care was compared with standard perioperative care in 400 patients undergoing laparoscopic or open surgery for colonic cancer. During admission 19 fast track elements per patient were prospectively evaluated and scored whether or not they were successfully applied. To identify predictive factors six baseline characteristics and those fast track items that were successfully achieved were entered in a univariate and multivariate linear regression analysis with total postoperative hospital stay (THS) as the primary outcome.
In 400 patients, two baseline characteristics and two fast track elements were found to be significant independent predictors of THS: female sex [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], laparoscopic resection [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], 'normal diet at postoperative days 1, 2 and 3' [B = 0.70; 95% CI 0.61-0.81; reduction of 30% (CI 19-39%) in THS] and 'enforced mobilization at postoperative days 1, 2 and 3' [B = 0.68; 95% CI 0.59-0.80; reduction of 32% (CI 20-41%) in THS].
Evaluating only those fast track elements that were successfully achieved, enforced advancement of oral intake, early mobilization, laparoscopic surgery and female sex were independent determinants of early recovery.
目前仍存在争议，即加速康复外科的各个环节是否都对术后恢复有益。本研究旨在明确结直肠癌患者术后快速康复的独立预测因素，以及这些因素与基线特征的关系。
本研究使用 LAFA 临床试验数据库的数据。该试验共纳入 400 例行腹腔镜或开腹结直肠癌切除术的患者，比较了快速康复外科组与传统围手术期护理组之间的差异。在住院期间，对每位患者的 19 个快速康复外科环节进行前瞻性评估和评分，以判断这些环节是否得到了有效实施。为了确定预测因素，将 6 项基线特征和成功实施的快速康复外科环节纳入单因素和多因素线性回归分析，以总术后住院时间（total postoperative hospital stay，THS）为主要结局。
在 400 例患者中，有 2 项基线特征和 2 项快速康复外科环节被确定为 THS 的独立预测因素：女性（B = 0.85；95%CI 0.75-0.96；THS 减少 15%[95%CI 14-25%]）和腹腔镜手术（B = 0.85；95%CI 0.75-0.96；THS 减少 15%[95%CI 14-25%]），术后第 1、2、3 天给予“正常饮食”（B = 0.70；95%CI 0.61-0.81；THS 减少 30%[95%CI 19-39%]）和“术后第 1、2、3 天强制执行早期活动”（B = 0.68；95%CI 0.59-0.80；THS 减少 32%[95%CI 20-41%]）。
仅评估成功实施的快速康复外科环节，积极推进口服饮食、早期活动、腹腔镜手术和女性患者的性别，是快速康复的独立决定因素。
