Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia.
Perioperative Services, University of Virginia Health System, Charlottesville, Virginia.
Ann Thorac Surg. 2018 Jun;105(6):1597-1604. doi: 10.1016/j.athoracsur.2018.01.080. Epub 2018 Mar 3.
To minimize the stress of operations, improve the patient experience, reduce variability, and optimize resource utilization, we implemented a thoracic enhanced recovery after surgery (ERAS) protocol and evaluated progress after 1 year.
Two protocols were developed: video-assisted thoracic surgery (ERAS-VATS) and thoracotomy (ERAS-T). Each incorporated preoperative patient education, carbohydrate loading, opioid-sparing analgesia, conservative fluid management, and early ambulation. Patient outcomes, length of stay, pain scores, opioid use, fluid administration, and cost for ERAS patients were compared with historic controls from the year before program initiation.
Historic VATS (n = 162) were compared with 81 ERAS-VATS patients. Median postoperative morphine equivalents (86 versus 22 mg, p < 0.0001), total fluid balance (1279 versus 227 mL, p < 0.0001), and mean inflation adjusted hospital costs ($20,169 versus $14,870, p = 0.0003) all decreased significantly. Historic thoracotomy patients (n = 62) were compared with 58 ERAS-T patients. Median postoperative morphine equivalents (130 versus 54 mg, p < 0.0001), total fluid balance (788 versus -489 mL, p = 0.012), length of stay (6.0 versus 4.0 days, p = 0.009), and mean inflation adjusted hospital costs ($41,950 versus $26,089, p < 0.00001) all decreased significantly.
Implementation of thoracic ERAS is a dynamic process with potential to improve outcomes in thoracic surgical procedures. In the first year we shortened length of stay, decreased opioid usage, minimized fluid overload, and decreased hospital costs.
为了减轻手术压力，改善患者体验，减少变异性，优化资源利用，我们实施了一项胸外科加速康复外科（ERAS）方案，并在 1 年后评估进展。
制定了两种方案：电视辅助胸腔镜手术（ERAS-VATS）和开胸手术（ERAS-T）。每个方案都包含术前患者教育、碳水化合物负荷、阿片类药物节约性镇痛、保守液体管理和早期活动。将 ERAS 患者的患者结局、住院时间、疼痛评分、阿片类药物使用、液体管理和成本与方案启动前一年的历史对照进行比较。
将历史 VATS（n=162）与 81 例 ERAS-VATS 患者进行比较。术后吗啡等效物中位数（86 与 22mg，p<0.0001）、总液体平衡中位数（1279 与 227mL，p<0.0001）和调整通胀后平均住院费用中位数（$20169 与 $14870，p=0.0003）均显著降低。历史开胸手术患者（n=62）与 58 例 ERAS-T 患者进行比较。术后吗啡等效物中位数（130 与 54mg，p<0.0001）、总液体平衡中位数（788 与-489mL，p=0.012）、住院时间中位数（6.0 与 4.0 天，p=0.009）和调整通胀后平均住院费用中位数（$41950 与 $26089，p<0.00001）均显著降低。
胸外科加速康复外科的实施是一个动态过程，有可能改善胸外科手术的结果。在第一年，我们缩短了住院时间，减少了阿片类药物的使用，最大限度地减少了液体超负荷，并降低了医院成本。
