Gastroenterology Area, Clinical Nutrition and Dietetics Unit, Fondazione Policlinico Universitario "Agostino Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
Abdominal Surgery Area, General Surgery Unit, Fondazione Policlinico Universitario "Agostino Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
Nutrition. 2018 Jun;50:74-81. doi: 10.1016/j.nut.2018.01.013. Epub 2018 Feb 5.
Postoperative complications and length of hospital stay (LOS) are major issues and affect hospital costs. Enhanced Recovery After Surgery (ERAS) protocols are effective in reducing morbidity and LOS after major surgery. We propose a nutritional protocol within ERAS programs in colorectal surgery, starting from preadmission.
We compared the ERAS + NutriCatt approach versus the ERAS standard program adopted in our center in the previous months. Complications, LOS, hospital readmission at 30 days, and late complications (at 90 days) were assessed and compared. A cost-effectiveness analysis was performed.
A total of 114 patients were treated according to the ERAS program between April 2015 and January 2016; 105 were enrolled in the ERAS + NutriCatt protocol from February to September 2016; Patients' characteristics were similar in the two groups, except for American Society of Anesthesiologists score, which was significantly worse in the ERAS + NutriCatt cohort; preoperative diagnoses and surgical approaches were similar in the two periods. LOS was significantly inferior in the ERAS + NutriCatt protocol (4.9 ± 1.7 d; 95% confidence interval [CI] 4.60-5.28) compared with the standard ERAS program (6.1 ± 3.9 d, 95% CI 5.36-6.81) (P = 0.006), as were postoperative complications (36, 34.3% versus 55, 48.2%; P = 0.03). Complications within 90 d were 0 in ERAS + NutriCatt and 4 in the ERAS standard cohort. Cost-effectiveness analyses indicated savings in the ERAS + NutriCatt protocol.
Nutritional care, starting from the preadmission visit, is able to reduce LOS, postoperative and late complications, and costs, in addition to ERAS standard items in colorectal surgery.
术后并发症和住院时间（LOS）是主要问题，会影响医院的成本。强化术后康复（ERAS）方案可有效降低重大手术后的发病率和 LOS。我们提出了一种在结直肠手术中的 ERAS 方案中加入营养方案，该方案从入院前开始实施。
我们比较了 ERAS+NutriCatt 方法与前几个月在我们中心采用的 ERAS 标准方案。评估并比较了并发症、 LOS、30 天内的医院再入院率和 90 天的迟发性并发症。进行了成本效益分析。
共有 114 例患者在 2015 年 4 月至 2016 年 1 月期间按照 ERAS 方案治疗；105 例患者在 2016 年 2 月至 9 月期间按照 ERAS+NutriCatt 方案治疗；两组患者的特征相似，除了美国麻醉师协会评分外，在 ERAS+NutriCatt 组中评分明显更差；两个时期的术前诊断和手术方式相似。与标准 ERAS 方案相比，ERAS+NutriCatt 方案的 LOS 明显更短（4.9±1.7d；95%置信区间 [CI] 4.60-5.28）（P=0.006），术后并发症也更少（36 例，34.3%比 55 例，48.2%；P=0.03）。在 ERAS+NutriCatt 组中，90 天内无并发症，而在 ERAS 标准组中有 4 例。成本效益分析表明，ERAS+NutriCatt 方案具有节省成本的效果。
在结直肠手术的 ERAS 标准项目之外，从入院前开始进行营养护理能够降低 LOS、术后和迟发性并发症以及成本。
