Harrison Oliver J, Smart Neil J, White Paul, Brigic Adela, Carlisle Elinor R, Allison Andrew S, Ockrim Jonathan B, Francis Nader K
Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT, UK.
Department of General Surgery, Yeovil District Hospital, Yeovil, Somerset, UK.
JSLS. 2014 Apr-Jun;18(2):265-72. doi: 10.4293/108680813X13753907291918.
Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery.
Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days).
Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] 2.02; 95% confidence interval [CI], 1.05-3.90; P = .027), and blood loss of >500 mL (OR 3.114; 95% CI, 1.501-6.462, P = .002).
Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.
腹腔镜手术与加速康复相结合对结直肠手术后的短期预后有益。培训和技术的进步使外科医生能够处理技术上具有挑战性且手术时间较长的病例。腹腔镜技术可改善结直肠手术后加速康复的效果；然而，对于延长手术时间对预后的影响尚无具体说明。目的是阐明延长手术时间和失血对腹腔镜结直肠手术后加速康复预后的影响。
回顾性分析2002年至2009年在约维尔区医院接受择期结直肠切除术并采用术后加速康复方案的400例患者。延迟出院定义为住院时间延长超过本系列的平均值（≥8天）。
纳入385例患者。中位手术时间为180分钟，中位失血量为100毫升。中转手术与住院时间延长无关。手术时间和失血量与住院时间呈逐步相关。手术时间有两个分界点，分别为160分钟和300分钟（5小时），此时延长住院时间的风险显著增加（比值比[OR]2.02；95%置信区间[CI]，1.05 - 3.90；P = 0.027），失血量>500毫升时（OR 3.114；95% CI，1.501 - 6.462，P = 0.002）。
总手术时间对腹腔镜结直肠切除术后加速康复的预后有负面影响，手术持续约2.5小时和5小时后延迟出院风险增加。
