Patel Sephalie Y, Garcia Getting Rosemarie E, Alford Brandon, Hussein Karim, Schaible Braydon J, Boulware David, Lee Jae K, Gilbert Scott M, Powsang Julio M, Sexton Wade J, Spiess Philippe E, Poch Michael A
Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
World J Surg. 2018 Sep;42(9):2701-2707. doi: 10.1007/s00268-018-4665-z.
Although enhanced recovery after surgery (ERAS) components include both anesthesia and surgical care processes, it is unclear whether a multidisciplinary approach to implementing ERAS care processes improves clinical outcomes. The addition of multidisciplinary care with anesthesiology-related components to an existing ERAS protocol for radical cystectomy at a US comprehensive cancer center provided an opportunity to compare short- and long-term outcomes.
We retrospectively compared the outcomes of 116 consecutive patients who underwent cystectomy after implementation of a multidisciplinary ERAS protocol with those of a historical control group of 143 consecutive patients who had been treated with a surgical ERAS protocol. Length of stay, return of bowel function, rate of blood transfusion, nausea, pain, and readmission rates were examined.
Implementation of a multidisciplinary ERAS protocol was associated with better postsurgical symptom control, as indicated by lower rates of patient-reported nausea (P < .05). Multivariate Poisson regression analysis showed a decrease in estimated intraoperative transfusions (P ≤ .001) after adjusting for the effects of potential confounding variables. There were no statistically significant differences noted in length of stay, return of bowel function, 30- and 90-day complications, or readmissions.
This is the first study to investigate the effects of adding anesthesia ERAS components to an existing surgical ERAS protocol for radical cystectomy. We found that with the addition of anesthesia-related interventions, there was a decrease in transfusions and nausea.
尽管手术后加速康复（ERAS）的组成部分包括麻醉和手术护理流程，但尚不清楚采用多学科方法实施ERAS护理流程是否能改善临床结局。在美国一家综合癌症中心，将与麻醉相关的多学科护理纳入现有的根治性膀胱切除术ERAS方案，为比较短期和长期结局提供了契机。
我们回顾性比较了116例在实施多学科ERAS方案后接受膀胱切除术的连续患者与143例接受手术ERAS方案治疗的连续患者的历史对照组的结局。检查了住院时间、肠功能恢复情况、输血率、恶心、疼痛和再入院率。
多学科ERAS方案的实施与更好的术后症状控制相关，患者报告的恶心发生率较低表明了这一点（P < 0.05）。多变量泊松回归分析显示，在调整潜在混杂变量的影响后，估计术中输血量减少（P ≤ 0.001）。在住院时间、肠功能恢复、30天和90天并发症或再入院方面，未观察到统计学上的显著差异。
这是第一项研究将麻醉ERAS组成部分添加到现有的根治性膀胱切除术手术ERAS方案中的效果的研究。我们发现，增加与麻醉相关的干预措施后，输血和恶心情况有所减少。
