Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann Thorac Surg. 2018 Jul;106(1):272-279. doi: 10.1016/j.athoracsur.2018.01.088. Epub 2018 Mar 9.
Enhanced recovery after surgery (ERAS) pathways aim to improve postoperative recovery through evidence-based practices, including early ambulation, multimodal opioid-sparing analgesia, and reduction of surgical stress. This study evaluated outcomes after implementation of ERAS in patients undergoing resection for pulmonary malignancy.
A retrospective review compared outcomes for patients undergoing pulmonary resection for primary lung cancer. Analysis was performed between three periods: pre-ERAS (January 1, 2006, to December 31, 2011), transitional period with elements of ERAS (January 1, 2012, to August 31, 2015), and full implementation of ERAS (September 1, 2015, to December 31, 2016).
We analyzed 2,886 lung resections (pre-ERAS, n = 1615; transitional, n = 929; ERAS, n = 342). For all patients, length of stay decreased in the ERAS and transitional periods compared with pre-ERAS (4 [3] versus 4 [3] versus 5 [3] days, p < 0.001). Pulmonary complications were decreased with ERAS compared with transitional and pre-ERAS (19.9% versus 28.2% versus 28.7%, p = 0.004). Cardiac complications decreased with ERAS (12.3% versus 13.1% versus 18.1%, p = 0.001). There was less thoracic epidural use (2.9% versus 44.5% versus 75.5%, p < 0.001). There were no differences in hospital readmission (p = 0.772) or mortality rates (p = 0.417). After thoracotomy, ERAS was associated with decreased length of stay, fewer intensive care unit readmissions, and decreased frequency of pneumonia, atrial arrhythmias, and need for home oxygen (all p < 0.05). ERAS was independently associated with decreased pulmonary (p = 0.046) and cardiac (p = 0.001) complications on logistic regression after thoracotomy but not minimally invasive operations.
ERAS was associated with improved postoperative outcomes, including decreased length of stay and pulmonary and cardiac morbidity after thoracotomy, but not after minimally invasive operations. ERAS safety was demonstrated by low rates of adverse events without effect on hospital readmission or perioperative deaths.
加速康复外科（ERAS）路径旨在通过循证实践改善术后恢复，包括早期活动、多模式阿片类药物节约性镇痛和减少手术应激。本研究评估了在接受肺部恶性肿瘤切除术的患者中实施 ERAS 的结果。
回顾性分析比较了原发性肺癌患者行肺切除术的结果。分析在三个时期进行：ERAS 前（2006 年 1 月 1 日至 2011 年 12 月 31 日）、具有 ERAS 要素的过渡期（2012 年 1 月 1 日至 2015 年 8 月 31 日）和 ERAS 全面实施（2015 年 9 月 1 日至 2016 年 12 月 31 日）。
我们分析了 2886 例肺切除术（ERAS 前组 n=1615 例，过渡期组 n=929 例，ERAS 组 n=342 例）。对于所有患者，ERAS 和过渡期的住院时间均短于 ERAS 前（4[3]天 vs 4[3]天 vs 5[3]天，p<0.001）。与过渡期和 ERAS 前相比，ERAS 后肺部并发症减少（19.9% vs 28.2% vs 28.7%，p=0.004）。与过渡期和 ERAS 前相比，ERAS 后心脏并发症减少（12.3% vs 13.1% vs 18.1%，p=0.001）。胸段硬膜外使用减少（2.9% vs 44.5% vs 75.5%，p<0.001）。住院再入院率无差异（p=0.772）或死亡率（p=0.417）。开胸手术后，ERAS 与住院时间缩短、重症监护病房再入院减少以及肺炎、房性心律失常和家庭吸氧需求减少相关（均 p<0.05）。开胸手术后，ERAS 与肺部（p=0.046）和心脏（p=0.001）并发症减少独立相关，但与微创手术无关。
ERAS 与术后结局改善相关，包括开胸手术后住院时间缩短以及肺部和心脏发病率降低，但微创手术后无改善。ERAS 的安全性通过不良事件发生率低而得到证明，并未对住院再入院或围手术期死亡产生影响。
