Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, Michael Garron Hospital, Toronto, Ontario, Canada.
J Gastrointest Surg. 2018 Feb;22(2):259-266. doi: 10.1007/s11605-017-3555-2. Epub 2017 Sep 15.
Enhanced Recovery After Surgery (ERAS) guidelines have been widely promoted and supported largely due to several studies showing decreased post-operative complications and length of stay. The objective of this study was to review the emergency room (ER) visits and readmission rates and reasons for both in patients who were part of the Implementation of an Enhanced Recovery After Surgery (iERAS) program for colorectal surgery.
All patients having elective colorectal surgery at 15 academic hospitals were enrolled in the iERAS program. All patients were prospectively followed until 30 days post-discharge. Data were analyzed using descriptive statistics and multivariable analysis.
A total of 2876 patients (48% female; mean 60 years old) were enrolled. Cancer was the most frequent indication (68.2%) for surgery. Overall, the median length of stay (LOS) was 5 days. Post-discharge, 359 (11.6%) of patients had a visit to the ER not requiring admission. The most common reasons for visiting the ER were surgical site infections (SSI) (34.5%), other wound complications (10.0%), and urinary tract infections (UTI) (8.6%). In addition, a smaller proportion of patients, 260 (8.2%) required readmission. The most common reasons for readmission were ileus and nausea/vomiting (26.1%), intra-abdominal abscess (23.9%), and SSI (11.5%). Patient and disease factors associated with ER visits, on multivariable analysis, included extremes of BMI (RR 1.02, 95%CI 1.01-1.04, p = 0.002), rectal surgery versus colon surgery (RR 1.34, 95%CI 1.14-1.58, p < 0.001), and open operative approach (RR 1.63, 95%CI 1.28-2.09, p < 0.001). Independent factors associated with hospital readmissions included rectal surgery (RR 1.89, 95%CI 1.34-2.77, p < 0.001), formation of a stoma (RR 1.34, 95%CI 1.04-1.74, p = 0.026), and reoperation during first admission (RR 4.60, 95%CI 3.50-6.05, p < 0.001). Length of stay of 5 days or less was not associated with ER visits or readmission (RR 0.99, 95%CI 0.72-1.35 and RR 0.91, 95%CI 0.71-1.18, respectively).
Following colorectal surgery using an ERAS pathway, shortened length of stay is not associated with an increased return to the ER or hospital readmission. The majority of return visits to the hospital are ER visits not requiring readmission and the predominant reason for return are surgical site infections and wound complications.
加速康复外科（ERAS）指南得到了广泛的推广和支持，这主要是因为多项研究表明其可以降低术后并发症和住院时间。本研究的目的是回顾接受结直肠手术的患者中，实施增强型加速康复外科（iERAS）计划后的急诊（ER）就诊率和再入院率及其原因。
在 15 家学术医院接受择期结直肠手术的所有患者均被纳入 iERAS 计划。所有患者均前瞻性随访至出院后 30 天。使用描述性统计和多变量分析对数据进行分析。
共纳入 2876 例患者（48%为女性；平均 60 岁）。手术最常见的指征是癌症（68.2%）。总体而言，中位住院时间（LOS）为 5 天。出院后，359 例（11.6%）患者因非住院需要去急诊。去急诊的最常见原因是手术部位感染（SSI）（34.5%）、其他伤口并发症（10.0%）和尿路感染（UTI）（8.6%）。此外，较小比例的患者（8.2%）需要再次入院。再次入院的最常见原因是肠梗阻和恶心/呕吐（26.1%）、腹腔脓肿（23.9%）和 SSI（11.5%）。多变量分析显示，与 ER 就诊相关的患者和疾病因素包括 BMI 极端值（RR 1.02，95%CI 1.01-1.04，p=0.002）、直肠手术与结肠手术（RR 1.34，95%CI 1.14-1.58，p<0.001）和开放手术方法（RR 1.63，95%CI 1.28-2.09，p<0.001）。与医院再入院相关的独立因素包括直肠手术（RR 1.89，95%CI 1.34-2.77，p<0.001）、造口形成（RR 1.34，95%CI 1.04-1.74，p=0.026）和首次住院期间再次手术（RR 4.60，95%CI 3.50-6.05，p<0.001）。5 天或更短的住院时间与 ER 就诊或再入院无关（RR 0.99，95%CI 0.72-1.35 和 RR 0.91，95%CI 0.71-1.18）。
在使用 ERAS 途径进行结直肠手术后，缩短住院时间与增加返回急诊或医院再入院无关。大多数返回医院的就诊是不需要再入院的急诊就诊，返回的主要原因是手术部位感染和伤口并发症。
