Department of Surgery, Rivierenland Hospital Tiel, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands.
Surg Endosc. 2012 Feb;26(2):361-7. doi: 10.1007/s00464-011-1877-9. Epub 2011 Oct 13.
The Enhanced Recovery After Surgery (ERAS) protocol, which is developed to enhance postoperative recovery of patients treated with open colorectal surgery, has been widely adopted. The ERAS protocol has also been introduced in patients treated with laparoscopic colectomy, without data to support its additional value. We investigated whether laparoscopic colectomy in combination with the use of the ERAS protocol leads to a reduction of postoperative length of stay compared to laparoscopic colectomy with conventional care.
We performed a comprehensive medical record review. Inclusion criteria were patients who had undergone a laparoscopic colectomy at a single center between April 2004 and September 2009 (n = 186). The ERAS protocol had been introduced at the end of 2006. We divided the patients in a pre-ERAS group (n = 77), and an ERAS group (n = 109). We compared the baseline characteristics of both groups. The primary outcome was postoperative length of stay.
We did not find significant differences in gender, age, body mass index (BMI), diabetes mellitus (DM), American Society of Anesthesiologists (ASA) classification, and diagnosis and type of surgery between the two groups. Median postoperative length of stay was 6 days (range = 2-28) in the pre-ERAS group and 4 days (range = 2-55) in the ERAS group (P = 0.007). Median return of bowel function was 3 days (range = 1-6) in the pre-ERAS group and 2 days (range = 1-5) in the ERAS group (P < 0.001). We did not find significant differences in postoperative procedure-related complications (wound infection, anastomotic leakage, abscesses), postoperative morbidity, 30-day readmission, 30-day reoperation, and 30-day mortality.
The postoperative length of stay was significantly reduced in the ERAS group without differences in patient outcome. It is suggested that these results are the effect of a combination of the ERAS protocol with laparoscopic colectomy.
加速康复外科（ERAS）方案旨在促进接受开腹结直肠手术的患者术后康复，目前已广泛应用。该方案也已引入腹腔镜结直肠切除术患者中，但缺乏其额外价值的数据支持。我们调查了腹腔镜结直肠切除术联合 ERAS 方案是否比常规护理下的腹腔镜结直肠切除术能减少术后住院时间。
我们进行了全面的病历回顾。纳入标准为 2004 年 4 月至 2009 年 9 月期间在单中心接受腹腔镜结直肠切除术的患者（n=186）。ERAS 方案于 2006 年底推出。我们将患者分为 ERAS 前组（n=77）和 ERAS 组（n=109）。我们比较了两组的基线特征。主要结局是术后住院时间。
两组在性别、年龄、体重指数（BMI）、糖尿病（DM）、美国麻醉医师协会（ASA）分级以及诊断和手术类型方面无显著差异。ERAS 前组的中位术后住院时间为 6 天（范围=2-28），ERAS 组为 4 天（范围=2-55）（P=0.007）。ERAS 前组的中位肠道功能恢复时间为 3 天（范围=1-6），ERAS 组为 2 天（范围=1-5）（P<0.001）。两组术后与手术相关的并发症（伤口感染、吻合口漏、脓肿）、术后发病率、30 天再入院、30 天再次手术和 30 天死亡率无显著差异。
ERAS 组的术后住院时间显著缩短，而患者结局无差异。提示这些结果是 ERAS 方案联合腹腔镜结直肠切除术的效果。
