接受开放性肝切除术患者强化康复路径的安全性
Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection.
作者信息
Clark Clancy J, Ali Shahzad M, Zaydfudim Victor, Jacob Adam K, Nagorney David M
机构信息
Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, United States of America.
Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, Minnesota, United States of America.
出版信息
PLoS One. 2016 Mar 7;11(3):e0150782. doi: 10.1371/journal.pone.0150782. eCollection 2016.
BACKGROUND
Enhanced recovery pathways (ERP) have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection.
METHODS
A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS) were compared between pre-ERP and ERP groups.
RESULTS
126 patients (pre-ERP n = 73, ERP n = 53) were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343). Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7) vs. 5 (IQR 4-6) days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.02, p = 0.055) or LOS greater than 5 days (OR 1.21, 95% CI 0.56-2.62, p = 0.627).
CONCLUSIONS
Routine use of a multimodal ERP is safe and is not associated with increased postoperative morbidity after open hepatic resection.
背景
强化康复路径（ERP）在肝脏手术中尚未得到广泛应用。本研究的目的是评估ERP在接受开放性肝切除术患者中的安全性。
方法
进行了一项单术者回顾性观察队列研究，比较了实施ERP前后接受开放性肝切除术患者的临床结局。比较了ERP前组和ERP组之间的发病率、死亡率和住院时间（LOS）。
结果
126例患者（ERP前组n = 73，ERP组n = 53）被纳入研究。两组患者的特征和手术细节相似。ERP前组和ERP组的总体并发症发生率相似（37%对28%，p = 0.343）。在路径实施前后，中位住院时间相似，分别为5天（四分位间距4 - 7天）和5天（四分位间距4 - 6天），p = 0.708。在调整年龄、肝切除类型和美国麻醉医师协会（ASA）分级后，ERP组发生重大并发症的风险没有增加（比值比0.38，95%置信区间0.14 - 1.02，p = 0.055），住院时间超过5天的风险也没有增加（比值比1.21，95%置信区间0.56 - 2.62，p = 0.627）。
结论
常规使用多模式ERP是安全的，且与开放性肝切除术后发病率增加无关。
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