Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Surgical Science, Vanderbilt University Medical Center, Nashville, Tennessee.
Surg Obes Relat Dis. 2018 Jun;14(6):849-856. doi: 10.1016/j.soard.2018.02.010. Epub 2018 Feb 13.
Patients frequently remain in the hospital after bariatric surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced recovery after surgery (ERAS) concepts address these perioperative complications and therefore improve length of stay for bariatric surgery patients.
To determine if ERAS concepts increase the proportion of patients discharged on postoperative day 1. Secondary objectives included mean length of stay, perioperative opioid use, emergency department visits, and readmissions.
A large metropolitan university tertiary hospital.
A quantitative before and after study was conducted for patients undergoing bariatric surgical patients. Data were collected surrounding length of stay, perioperative opioid consumption, antiemetic therapy requirements postoperatively, multimodal analgesia compliance, emergency department visits, and hospital readmission rates. Wilcoxon rank-sum and χ test were used to compare continuous and categorical variables, respectively. A secondary analysis was performed using Aligned Rank Transformation and Cochran-Mantel-Haenszel χ tests to account for an increase in sleeve gastrectomies in the intervention group.
The 2 groups had clinically similar baseline characteristics. Comparison group (N = 366) and ERAS group (N = 715) patients underwent a primary bariatric surgery procedure. There was an increase in the number of patients undergoing a laparoscopic sleeve gastrectomy in the intervention group. After accounting for this increase, the percentage of patients discharged on postoperative day 1 was unchanged (79.8% non-ERAS versus 83.1% ERAS, P = .52). ERAS length of stay was statistically significantly lower for gastric bypass (P<.001) and robotic gastric bypass (P = .01). Perioperative opioid consumption was reduced (41.0 versus 16.2 morphine equivalents, P<0.001), and fewer ERAS patients required postoperative antiemetics (68.8% versus 46.2%, P<.001). Emergency department visits at 7 days were reduced (6.0% versus 3.2%, P = .04), but hospital readmission rates were unchanged.
Implementing ERAS did not reduce the percentage of patients discharged on postoperative day 1 in a bariatric surgery program with historically low length of stay, but it led to significant reductions in perioperative opioid use, decreases in postoperative nausea, and early emergency room visits.
患者在接受减重手术后常因疼痛、恶心和无法耐受口服摄入而留在医院。术后恢复加速（ERAS）理念解决了这些围手术期并发症，从而缩短了减重手术患者的住院时间。
确定 ERAS 理念是否会增加术后第 1 天出院的患者比例。次要目标包括平均住院时间、围手术期阿片类药物使用、急诊就诊和再入院率。
一家大型都市大学三级医院。
对接受减重手术的患者进行了一项定量的前后研究。收集的数据围绕住院时间、围手术期阿片类药物使用、术后止吐治疗需求、多模式镇痛依从性、急诊就诊和住院再入院率展开。Wilcoxon 秩和检验和卡方检验分别用于比较连续变量和分类变量。采用等级相关转换和 Cochran-Mantel-Haenszel 卡方检验进行二次分析，以考虑干预组中胃袖状切除术数量的增加。
两组患者的基线特征具有临床可比性。对照组（N=366）和 ERAS 组（N=715）患者接受了主要减重手术。干预组中腹腔镜胃袖状切除术患者数量增加。在考虑到这一增加后，第 1 天出院的患者比例没有变化（非 ERAS 组为 79.8%，ERAS 组为 83.1%，P=0.52）。胃旁路术（P<0.001）和机器人胃旁路术（P=0.01）的 ERAS 住院时间明显更短。围手术期阿片类药物使用减少（41.0 吗啡当量与 16.2 吗啡当量，P<0.001），更少的 ERAS 患者需要术后止吐治疗（68.8%与 46.2%，P<0.001）。术后第 7 天急诊就诊率降低（6.0%与 3.2%，P=0.04），但住院再入院率不变。
在一个住院时间历来较短的减重手术项目中实施 ERAS 并没有降低第 1 天出院的患者比例，但它显著减少了围手术期阿片类药物的使用、降低了术后恶心的发生率，并减少了早期急诊就诊。
Zotero 插件