Venkata Hari K, van Dellen James R
Department of Anesthetics, Queen Elizabeth Hospital, Birmingham, UK.
Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK -
J Neurosurg Sci. 2018 Jun;62(3):245-254. doi: 10.23736/S0390-5616.16.03695-X. Epub 2016 Apr 14.
A means of significantly shortening patients' length of hospital stay, improving their outcome and thereby also reducing costs is to use an enhanced recovery program (ERP) which is increasingly being used in a number of surgical sub-specialties. This paper provides a perspective on its prospective use in a wide-ranging, unselected cohort of patients undergoing open spinal surgery for degenerative lumbar and cervical spinal conditions. Selected spinal cases undergoing day surgery have been increasingly reported.
A prospective, unselected, consecutive cohort of 246 cases, over an 18-month period, undergoing open, non-instrumented decompression spinal surgery and using ERP (and the concept of "bundles of care") was analyzed.
Nine cases could not be included as they did not fully meet the entry criteria. No routine follow-up was arranged for the study group. The ages ranged widely, from 23-90 years (mean 57). In 187 the surgery for degenerative conditions was lumbar and in 50 cervical. The ASA (American Association of Anesthesiologists) ratings were 108=1; 107=2 and 22=3. Using the United Kingdom (UK) National Health Service (NHS) definitions of length of stay 225 (95%) could be finally classified as "ambulatory" and 12 (5%) were "short stay". A sub-cohort of 126 (53.2%) were "day cases". The follow-up was >1 year for all. There were no wound infections reported; 5 postdischarge cases (2.1%) needed to be seen in the Accident and Emergency (A&E) Department (less than 4 days postsurgery), but none needed re-admission; and there were 7 re-admissions (2.5%), between 4 and 30 days, and of these 6 required a further surgical procedure. There were no long-term instability complications reported in this cohort.
ERP can be used for spinal surgery. There were identifiable and correctable medical and social factors found on analysis which could significantly increase the "day cases" number to over 90%.
显著缩短患者住院时间、改善其治疗效果并从而降低成本的一种方法是采用强化康复计划（ERP），该计划在多个外科亚专业中越来越多地被使用。本文提供了关于其在接受开放性脊柱手术治疗退行性腰椎和颈椎疾病的广泛、未选择的患者队列中的前瞻性应用的观点。越来越多的报道称有脊柱病例接受日间手术。
分析了一个前瞻性、未选择的连续队列，共246例患者，在18个月期间接受开放性、非器械减压脊柱手术并采用ERP（以及“护理束”概念）。
9例患者因未完全符合纳入标准而未被纳入。未为研究组安排常规随访。年龄范围广泛，从23岁至90岁（平均57岁）。187例退行性疾病手术为腰椎手术，50例为颈椎手术。美国麻醉医师协会（ASA）分级为108例=1级；107例=2级和22例=3级。根据英国国家医疗服务体系（NHS）的住院时间定义，最终225例（95%）可归类为“门诊患者”，12例（5%）为“短期住院患者”。一个126例（53.2%）的亚队列是“日间手术病例”。所有患者的随访时间均超过1年。未报告伤口感染；5例出院后患者（2.1%）需要到急诊部就诊（术后不到4天），但无人需要再次入院；有7例再次入院（2.5%），在术后4至30天之间，其中6例需要进一步手术。该队列中未报告长期不稳定并发症。
ERP可用于脊柱手术。分析发现了可识别和可纠正的医学和社会因素，这些因素可将“日间手术病例”数量显著增加至90%以上。
