我们真的需要在腹腔镜结直肠手术中完全遵守 ERAS 协议吗？一项前瞻性队列研究。
Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study.
机构信息
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland.
2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501 Kraków, Poland.
出版信息
Int J Surg. 2016 Dec;36(Pt A):377-382. doi: 10.1016/j.ijsu.2016.11.088. Epub 2016 Nov 19.
BACKGROUND
Although the relation between adherence to the ERAS protocol and clinical outcomes was extensively studied, there is still ongoing discussion on the need and feasibility of full compliance in laparoscopic colorectal surgery. In this study, we aimed to verify whether a strict adherence to the protocol (>90%) leads to further improvement in clinical outcomes compared to high (70-90%) and low (<70%) compliance groups.
MATERIALS AND METHODS
The analysis included consecutive prospectively registered patients operated laparoscopically for colorectal cancer between January 2012 and December 2015. Patients were divided into three groups depending on the compliance with the ERAS protocol: <70% (Group 1), 70-90% (Group 2), >90% (Group 3). The measured outcomes were: complication rate, readmission rate, recovery parameters (tolerance of early oral diet on 1st postoperative day and mobilization of a patient on the day of surgery), length of stay (LOS).
RESULTS
Group 1 consisted of 70, Group 2 of 65 and Group 3 of 116 patients. There were no statistical differences between the groups based on demographic parameters, stage of cancer and operative parameters (operative time, blood loss, conversion rate). The overall compliance with the protocol in the study group was 85.6 ± 11.9%. There was a significant decrease in complication rate with increasing compliance (35.7% vs. 36.4% vs. 16.4%, p = 0.0024) and severity of complications according to the Clavien-Dindo classification (p = 0.0198). Moreover, we observed differences in recovery parameters between the groups: tolerance of oral diet on the 1st postoperative day (52.8% vs. 79.5% vs. 87.9%, p < 0.0001), mobilization of a patient on the day of surgery (68.6% vs. 92.3% vs. 99.1%, p < 0.0001), respectively. We also observed that with compliance increase, the median LOS decreased (6 vs. 4 vs. 3 days, p < 0.0001).
CONCLUSION
Full implementation of the ERAS protocol significantly improves short term outcomes both in comparison to the high- and low-compliant groups.
背景
尽管 ERAS 方案的依从性与临床结局之间的关系已得到广泛研究，但对于腹腔镜结直肠手术中完全依从的必要性和可行性仍存在争议。本研究旨在验证与高（70-90%）和低（<70%）依从组相比，严格遵守方案（>90%）是否会进一步改善临床结局。
材料与方法
分析纳入 2012 年 1 月至 2015 年 12 月间连续前瞻性注册接受腹腔镜结直肠癌手术的患者。根据 ERAS 方案的依从性将患者分为三组：<70%（组 1）、70-90%（组 2）、>90%（组 3）。测量的结果是：并发症发生率、再入院率、恢复参数（术后第 1 天口服饮食耐受和患者手术当天活动能力）、住院时间（LOS）。
结果
组 1 有 70 例，组 2 有 65 例，组 3 有 116 例。三组在人口统计学参数、癌症分期和手术参数（手术时间、出血量、转化率）方面无统计学差异。研究组总体方案依从率为 85.6±11.9%。随着依从性的提高，并发症发生率显著降低（35.7%比 36.4%比 16.4%，p=0.0024），Clavien-Dindo 分类的并发症严重程度也降低（p=0.0198）。此外，我们观察到各组间恢复参数存在差异：术后第 1 天口服饮食耐受（52.8%比 79.5%比 87.9%，p<0.0001），手术当天患者活动能力（68.6%比 92.3%比 99.1%，p<0.0001）。我们还观察到，随着依从性的增加，中位 LOS 降低（6 天比 4 天比 3 天，p<0.0001）。
结论
与高依从组和低依从组相比，完全实施 ERAS 方案可显著改善短期结局。
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