Debarros Mia, Steele Scott R
Department of Surgery, Madigan Healthcare System, Tacoma, Washington.
Clin Colon Rectal Surg. 2013 Sep;26(3):139-45. doi: 10.1055/s-0033-1351128.
The reduction in health-care expenditures and more efficient use of medical resources are now overriding health policy priorities with the two-pronged goal of improving patient outcomes while decreasing overall cost. Current reports show colorectal surgery accounting for 25% of all operative complications and an average length of stay of 8 to 12 days for a standard elective colon resection. To combat this, Kehlet and colleagues introduced a concept of enhanced recovery after surgery (ERAS) or fast-track pathways, with the goal of using current evidence and multimodal therapies to decrease surgical stress, enhance postoperative recovery, and reduce length of stay. The benefits, safety, and cost-effectiveness of fast-track protocols are validated in multiple randomized controlled trials. In this review, the authors focus on the evidence regarding fast-track pathways, use of minimally invasive surgery and its role in fast-track pathways, newer perioperative interventions, and future directions.
降低医疗保健支出以及更高效地利用医疗资源，如今已成为首要的卫生政策重点，其目标是双管齐下，在降低总体成本的同时改善患者治疗效果。当前报告显示，结直肠手术占所有手术并发症的25%，标准择期结肠切除术的平均住院时间为8至12天。为应对这一情况，克勒特及其同事引入了术后加速康复（ERAS）或快速康复路径的概念，目标是利用现有证据和多模式疗法来减轻手术应激、促进术后康复并缩短住院时间。快速康复方案的益处、安全性和成本效益已在多项随机对照试验中得到验证。在本综述中，作者重点关注关于快速康复路径的证据、微创手术的应用及其在快速康复路径中的作用、新的围手术期干预措施以及未来方向。
