Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark.
Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark.
Br J Surg. 2017 Mar;104(4):463-471. doi: 10.1002/bjs.10427. Epub 2017 Jan 23.
Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery.
The AHA study was a prospective single-centre controlled study in consecutive patients undergoing AHA surgery, defined as major abdominal pathology requiring emergency laparotomy or laparoscopy including reoperations after elective gastrointestinal surgery. Consecutive patients were included after initiation of the AHA protocol as standard care. The intervention cohort was compared with a predefined, consecutive historical cohort of patients from the same department. The protocol involved continuous staff education, consultant-led attention and care, early resuscitation and high-dose antibiotics, surgery within 6 h, perioperative stroke volume-guided haemodynamic optimization, intermediate level of care for the first 24 h after surgery, standardized analgesic treatment, early postoperative ambulation and early enteral nutrition. The primary outcome was 30-day mortality.
Six hundred patients were included in the study and compared with 600 historical controls. The unadjusted 30-day mortality rate was 21·8 per cent in the control cohort compared with 15·5 per cent in the intervention cohort (P = 0·005). The 180-day mortality rates were 29·5 and 22·2 per cent respectively (P = 0·004).
The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov).
急性高危腹部（AHA）手术具有很高的发病率和死亡率，是医疗保健的巨大负担。本研究旨在评估对接受 AHA 手术的患者实施标准化多学科围手术期方案的效果。
AHA 研究是一项前瞻性单中心对照研究，连续纳入接受 AHA 手术的患者，定义为需要紧急剖腹手术或腹腔镜检查的主要腹部病变，包括胃肠手术的再次手术。在启动 AHA 方案作为标准护理后，连续纳入患者。干预组与来自同一科室的预先确定的连续历史队列的患者进行比较。该方案涉及持续的员工教育、顾问主导的关注和护理、早期复苏和大剂量抗生素、6 小时内手术、围手术期以每搏量为导向的血流动力学优化、手术后前 24 小时的中级护理、标准化镇痛治疗、早期术后活动和早期肠内营养。主要结局是 30 天死亡率。
该研究纳入了 600 例患者，并与 600 例历史对照进行了比较。对照组的 30 天未调整死亡率为 21.8%，而干预组为 15.5%（P=0.005）。180 天死亡率分别为 29.5%和 22.2%（P=0.004）。
在接受 AHA 手术的患者中，引入多学科围手术期方案与术后死亡率的显著降低相关。NCT01899885（http://www.clinicaltrials.gov）。
