Hughes Michael J, McNally Stephen, Wigmore Stephen J
Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
HPB (Oxford). 2014 Aug;16(8):699-706. doi: 10.1111/hpb.12245. Epub 2014 Mar 24.
Enhanced recovery after surgery (ERAS) programmes aim to improve postoperative outcomes. They are being utilized increasingly in hepatic surgery. This review aims to evaluate the impact of ERAS programmes on outcomes following liver surgery.
EMBASE, MEDLINE, PubMed and the Cochrane Database were searched for trials comparing outcomes in patients undergoing liver surgery utilizing ERAS principles with those in patients receiving conventional care. The primary outcome was occurrence of postoperative complications within 30 days. Secondary outcomes included length of stay (LoS), functional recovery and adherence to ERAS protocols.
Nine articles were included in the review, of which two were randomized controlled trials (RCTs). Overall complication rates were 25.0% (range: 11.5-46.4%) in ERAS patients, and 31.0% (range: 11.8-46.2%) in conventional care patients. Significantly reduced overall complication rates following ERAS care were demonstrated by a meta-analysis of the data reported in the two RCTs (odds ratio: 0.49, 95% confidence interval 0.28-0.84; P = 0.01) The median LoS reported by the studies was 5.0 days (range: 2.5-7.0 days) in ERAS patients, and 7.5 days (range: 3.0-11.0 days) in non-ERAS patients. Recovery milestones, when reported, were improved following ERAS care.
The adoption of ERAS protocols improves morbidity and LoS following liver surgery. Future ERAS programmes should accommodate the unique requirements of liver surgery in order to optimize postoperative outcomes.
术后加速康复（ERAS）方案旨在改善术后结局。它们在肝脏手术中的应用越来越广泛。本综述旨在评估ERAS方案对肝脏手术后结局的影响。
检索EMBASE、MEDLINE、PubMed和Cochrane数据库，以寻找比较采用ERAS原则进行肝脏手术的患者与接受传统护理的患者结局的试验。主要结局是30天内术后并发症的发生情况。次要结局包括住院时间（LoS）、功能恢复和对ERAS方案的依从性。
该综述纳入了9篇文章，其中2篇为随机对照试验（RCT）。ERAS组患者的总体并发症发生率为25.0%（范围：11.5 - 46.4%），传统护理组患者为31.0%（范围：11.8 - 46.2%）。对两项RCT报告的数据进行荟萃分析表明，ERAS护理后总体并发症发生率显著降低（优势比：0.49，95%置信区间0.28 - 0.84；P = 0.01）。研究报告的ERAS组患者中位住院时间为5.0天（范围：2.5 - 7.0天），非ERAS组患者为7.5天（范围：3.0 - 11.0天）。报告的恢复里程碑在ERAS护理后有所改善。
采用ERAS方案可改善肝脏手术后的发病率和住院时间。未来的ERAS方案应适应肝脏手术的独特要求，以优化术后结局。
