Wrench I J, Allison A, Galimberti A, Radley S, Wilson M J
Department of Anaesthetics, Royal Hallamshire Hospital, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Int J Obstet Anesth. 2015 May;24(2):124-30. doi: 10.1016/j.ijoa.2015.01.003. Epub 2015 Jan 14.
The widespread adoption of enhanced recovery programmes in various surgical specialties has resulted in patient benefits including reduced morbidity, reduced length of stay and an earlier return to normal activities. This evidence, along with the increased financial pressures in the UK National Health Service, has led many units to consider introducing such a programme for obstetric surgery. We report our experience in setting up an enhanced recovery programme for women undergoing elective caesarean section and a prospective analysis of factors that influence length of stay.
An enhanced recovery pathway was designed by a multidisciplinary team and introduced in March 2012. Factors influencing length of stay were determined using a log normal model.
The proportion of women discharged on Day 1 increased from 1.6% in the first quarter of 2012 to 25.2% in the first quarter of 2014. The 30-day readmission rate was 4.4% for those discharged on Day 1 and 5.6% for Day 2. Earlier gestation, multiple birth, intention to breast feed, longer surgery and more time in the post-anaesthesia recovery unit were all independently associated with a longer postoperative stay. Women presenting for obstetric surgery with the indication "one previous caesarean section" were more likely to leave hospital earlier compared to most other indications.
An enhanced recovery programme was successfully introduced into our unit. Many of the interventions were straightforward and could be adopted easily elsewhere.
强化康复计划在各个外科专科的广泛应用已给患者带来诸多益处，包括发病率降低、住院时间缩短以及更早恢复正常活动。这些证据，再加上英国国民医疗服务体系日益增加的财政压力，促使许多科室考虑为产科手术引入这样一个计划。我们报告了我们为接受择期剖宫产的女性建立强化康复计划的经验，以及对影响住院时间的因素进行的前瞻性分析。
一个多学科团队设计了一条强化康复路径，并于2012年3月引入。使用对数正态模型确定影响住院时间的因素。
术后第1天出院的女性比例从2012年第一季度的1.6%增至2014年第一季度的25.2%。术后第1天出院者的30天再入院率为4.4%，第2天出院者为5.6%。孕周较早、多胎妊娠、打算母乳喂养、手术时间较长以及在麻醉后恢复室停留时间较长均与术后住院时间较长独立相关。与大多数其他指征相比，因“曾行一次剖宫产”这一指征接受产科手术的女性更有可能较早出院。
我们科室成功引入了强化康复计划。许多干预措施简单直接，可在其他地方轻松采用。
