Cabellos Olivares Mercedes, Labalde Martínez María, Torralba Miguel, Rodríguez Fraile José R, Atance Martínez Juan C
Department of Anesthesia, Hospital Universitario de Guadalajara, Guadalajara, Spain.
Department of Surgery, Hospital 12 de Octubre, Madrid, Spain.
J Surg Oncol. 2018 Mar;117(4):717-724. doi: 10.1002/jso.24909. Epub 2018 Jan 22.
The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day.
We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications.
The presence of complications was independently associated with an increase in CRP values in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values.
The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.
本研究旨在评估术后加速康复方案(ERAS)在降低手术引起的全身炎症反应(SIR)方面的有效性,通过检测术后第1天(POD1)、第2天(POD2)和第3天(POD3)的C反应蛋白(CRP)来评估。
我们纳入了121例行择期结直肠手术并采用ERAS的患者(ERAS组),并将其与135例在该方案实施前接受手术的患者(preERAS组)进行比较。我们进行单因素分析,以比较preERAS/ERAS组之间、腹腔镜/开放手术以及是否存在Clavien Dindo并发症情况下POD1、POD2和POD3时的CRP值。采用多变量线性回归来评估ERAS在POD1、POD2和POD3时对CRP是否有降低作用,并根据年龄、性别、腹腔镜使用情况和并发症进行调整。
并发症的存在与POD1、POD2和POD3时CRP值的升高独立相关。POD1和POD2时的腹腔镜手术以及POD2时的ERAS与CRP值的降低独立相关。
分析表明,有并发症的患者中,以CRP值衡量的SIR升高。POD1和POD2时腹腔镜手术以及POD2时ERAS可使SIR降低。