Grant Michael C, Yang Dongjie, Wu Christopher L, Makary Martin A, Wick Elizabeth C
*Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Institutions, Baltimore, MD †Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China ‡Department of Surgery, The Johns Hopkins Institutions, Baltimore, MD.
Ann Surg. 2017 Jan;265(1):68-79. doi: 10.1097/SLA.0000000000001703.
The aim of this study was to establish if enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols are associated with reduction in healthcare-associated infection (HAIs).
Evidence suggests that prevention strategies for HAIs should be multifaceted and transdisciplinary. ERAS and FTS protocols are collaborative approaches to perioperative care which reduce length of stay but may also be an effective strategy for reducing HAIs.
We performed a meta-analysis of randomized trials involving either ERAS or FTS for abdominal or pelvic surgery. Primary outcome included postoperative incidence of 3 major HAIs: lung infection (LI), urinary tract infection (UTI), and surgical site infection (SSI).
Among all included trials, ERAS/FTS was associated with a significant reduction in postoperative LI [risk ratio (RR) = 0.38; 95% confidence interval (CI) = 0.23-0.61; P < 0.0001; I = 0%], UTI (RR = 0.42; 95% CI = 0.23-0.76; P = 0.004; I = 0%), and SSI (RR = 0.75; 95% CI = 0.58-0.98; P = 0.04; I = 0%) compared with conventional controls. Sensitivity analysis performed following the exclusion of high risk of bias publications did not appreciably affect these results. ERAS/FTS was also associated with a significant decrease in hospital length of stay (standard mean difference = -0.83; 95% CI = -0.92 to -0.75; P < 0.0001; P for heterogeneity <0.0001, I = 93%). Subgroup analysis of trials involving colorectal surgery and open incision also resulted in significant reduction in all 3 HAIs among ERAS/FTS compared with conventional counterparts.
Our results suggest ERAS/FTS protocols are powerful tools to prevent HAIs. Further study is needed to establish the mechanism. Providers should consider adoption of similar transdisciplinary programs to reduce perioperative HAIs and at the same time improve the value of surgical care.
本研究旨在确定术后加速康复（ERAS）和快速康复外科（FTS）方案是否与减少医疗相关感染（HAIs）有关。
有证据表明，HAIs的预防策略应是多方面的和跨学科的。ERAS和FTS方案是围手术期护理的协作方法，可缩短住院时间，但也可能是减少HAIs的有效策略。
我们对涉及腹部或盆腔手术的ERAS或FTS的随机试验进行了荟萃分析。主要结局包括3种主要HAIs的术后发生率：肺部感染（LI）、尿路感染（UTI）和手术部位感染（SSI）。
在所有纳入的试验中，与传统对照组相比，ERAS/FTS与术后LI（风险比[RR]=0.38；95%置信区间[CI]=0.23-0.61；P<0.0001；I=0%）、UTI（RR=0.42；95%CI=0.23-0.76；P=0.004；I=0%）和SSI（RR=0.75；95%CI=0.58-0.98；P=0.04；I=0%）的显著降低相关。排除高偏倚风险出版物后进行的敏感性分析并未明显影响这些结果。ERAS/FTS还与住院时间的显著缩短相关（标准平均差=-0.83；95%CI=-0.92至-0.75；P<0.0001；异质性P<0.0001，I=93%）。涉及结直肠手术和开放切口的试验的亚组分析也显示，与传统对照组相比，ERAS/FTS组的所有3种HAIs均显著降低。
我们的结果表明，ERAS/FTS方案是预防HAIs的有力工具。需要进一步研究以确定其机制。医疗服务提供者应考虑采用类似的跨学科方案，以减少围手术期HAIs，同时提高手术护理的价值。
