Bakker Nathalie, Cakir Hamit, Doodeman H J, Houdijk A P J
Medical Center Alkmaar, Alkmaar, The Netherlands; Trial Center Holland Health, Alkmaar, The Netherlands; VU Medical Center, Amsterdam, The Netherlands.
Medical Center Alkmaar, Alkmaar, The Netherlands.
Surgery. 2015 Jun;157(6):1130-6. doi: 10.1016/j.surg.2015.01.016. Epub 2015 Mar 16.
Perioperative treatment of patients with colorectal cancer according to the Enhanced Recovery After Surgery (ERAS) protocol has proven to reduce complications and duration of stay. However, strict adherence remains a challenge and the benefits may decrease with lower adherence. In this study, we report on 8 years of adherence to the ERAS protocol and its effect on postoperative outcome in patients with colon cancer.
In 2006, the ERAS protocol was introduced for treatment of colon cancer patients in the Medical Center Alkmaar, a large teaching hospital. Patients scheduled for elective colon cancer resection were included in this study. Adherence to ERAS items was monitored and along with clinical data prospectively gathered in a database. In 2011, several measures to improve adherence were implemented.
In total, 816 patients were included. Mean adherence rate was 73% in 2006 and 2007, 66% in 2008 and 2009, 63% in 2010 and 2011, and 82% in 2012 and 2013. There was a shorter duration of stay in the years with high adherence (5.7 days) compared with the years with low adherence (7.3 days; P < .001). The ERAS items that were the strongest predictors for a shorter duration of stay were no nasogastric tube, early mobilization, early oral nutrition, early removal of epidural, early removal of catheter, and nonopioid oral analgesia.
It is possible to improve adherence to the ERAS protocol and related outcomes with specific measures. Adherence to the ERAS protocol was related inversely to duration of stay. Only postoperative items of the ERAS protocol were predictive for a shorter duration of stay. Keeping adherence optimal remains an ongoing challenge that requires repeated training and dedicated personnel.
根据术后加速康复（ERAS）方案对结直肠癌患者进行围手术期治疗已被证明可减少并发症和缩短住院时间。然而，严格遵守该方案仍然是一项挑战，且随着依从性降低，其益处可能会减少。在本研究中，我们报告了8年来对ERAS方案的依从情况及其对结肠癌患者术后结局的影响。
2006年，大型教学医院阿尔克马尔医疗中心引入ERAS方案用于治疗结肠癌患者。本研究纳入计划接受择期结肠癌切除术的患者。监测对ERAS项目的依从性，并将临床数据前瞻性地收集到一个数据库中。2011年实施了多项提高依从性的措施。
总共纳入816例患者。2006年和2007年的平均依从率为73%，2008年和2009年为66%，2010年和2011年为63%，2012年和2013年为82%。与依从性低的年份（7.3天）相比，依从性高的年份住院时间更短（5.7天；P <.001）。对住院时间缩短预测最强的ERAS项目是不使用鼻胃管、早期活动、早期口服营养、早期拔除硬膜外导管、早期拔除导尿管和非阿片类口服镇痛。
通过特定措施有可能提高对ERAS方案的依从性及相关结局。对ERAS方案的依从性与住院时间呈负相关。只有ERAS方案的术后项目可预测住院时间缩短。保持最佳依从性仍然是一项持续的挑战，需要反复培训和专业人员。
