增强恢复方案依从性对择期结直肠癌切除术的影响：来自国际注册处的结果。

The Impact of Enhanced Recovery Protocol Compliance on Elective Colorectal Cancer Resection: Results From an International Registry.

出版信息

Ann Surg. 2015 Jun;261(6):1153-9. doi: 10.1097/SLA.0000000000001029.

Abstract

BACKGROUND

The ERAS (enhanced recovery after surgery) care has been shown in randomized clinical trials to improve outcome after colorectal surgery compared to traditional care. The impact of different levels of compliance and specific elements, particularly out with a trial setting, is poorly understood.

OBJECTIVE

This study evaluated the individual impact of specific patient factors and perioperative enhanced recovery protocol compliance on postoperative outcome after elective primary colorectal cancer resection.

METHODS

The international, multicenter ERAS registry data, collected between November 2008 and March 2013, was reviewed. Patient demographics, disease characteristics, and perioperative ERAS protocol compliance were assessed. Linear regression was undertaken for primary admission duration and logistic regression for the development of any postoperative complication.

FINDINGS

A total of 1509 colonic and 843 rectal resections were undertaken in 13 centers from 6 countries. Median length of stay for colorectal resections was 6 days, with readmissions in 216 (9.2%), complications in 948 (40%), and reoperation in 167 (7.1%) of 2352 patients. Laparoscopic surgery was associated with reduced complications [odds ratio (OR) = 0.68; P < 0.001] and length of stay (OR = 0.83, P < 0.001). Increasing ERAS compliance was correlated with fewer complications (OR = 0.69, P < 0.001) and shorter primary hospital admission (OR = 0.88, P < 0.001). Shorter hospital stay was associated with preoperative carbohydrate and fluid loading (OR = 0.89, P = 0.001), and totally intravenous anesthesia (OR = 0.86, P < 0.001); longer stay was associated with intraoperative epidural analgesia (OR = 1.07, P = 0.019). Reduced postoperative complications were associated with restrictive perioperative intravenous fluids (OR = 0.35, P < 0.001).

CONCLUSIONS

This analysis has demonstrated that in a large, international cohort of patients, increasing compliance with an ERAS program and the use of laparoscopic surgery independently improve outcome.

摘要

背景

随机临床试验表明，与传统护理相比，ERAS（手术后强化康复）护理可改善结直肠手术后的结果。但对于不同水平的依从性和特定因素的影响，特别是在试验环境之外，人们知之甚少。

目的

本研究评估了特定患者因素和围手术期增强恢复方案依从性对择期原发性结直肠癌切除术后术后结果的个体影响。

方法

回顾了 2008 年 11 月至 2013 年 3 月期间收集的国际多中心 ERAS 注册数据。评估了患者人口统计学、疾病特征和围手术期 ERAS 方案依从性。对主要住院时间进行线性回归，对任何术后并发症的发生进行逻辑回归。

结果

在 6 个国家的 13 个中心共进行了 1509 例结肠和 843 例直肠切除术。结直肠切除术的中位住院时间为 6 天，2352 例患者中有 216 例（9.2%）再入院，948 例（40%）发生并发症，167 例（7.1%）再次手术。腹腔镜手术与减少并发症相关[比值比（OR）=0.68；P<0.001]和缩短住院时间（OR=0.83，P<0.001）。ERAS 依从性的增加与并发症减少（OR=0.69，P<0.001）和主要住院时间缩短（OR=0.88，P<0.001）相关。较短的住院时间与术前碳水化合物和液体负荷（OR=0.89，P=0.001）和全静脉麻醉（OR=0.86，P<0.001）相关；较长的住院时间与术中硬膜外镇痛（OR=1.07，P=0.019）相关。术后并发症减少与限制围手术期静脉补液（OR=0.35，P<0.001）相关。