Departments of Gynecologic Oncology and Reproductive Medicine, Anesthesiology and Perioperative Medicine, Biostatistics, and Symptom Research, and the Division of Pharmacy, the University of Texas MD Anderson Cancer Center, Houston, Texas; Tennessee Oncology, Nashville, Tennessee; and the University of Tennessee Health Sciences Center, Memphis, Tennessee.
Obstet Gynecol. 2018 Aug;132(2):281-290. doi: 10.1097/AOG.0000000000002735.
To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods.
We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS. For 293 patients, patient-reported outcomes were compared using the MD Anderson Symptom Inventory-Ovarian Cancer.
Median age was 58 years (range 18-85 years). Median length of stay decreased by 25% for patients in the ERAS pathway (P<.001). Overall, patients in the ERAS group had a 72% reduction in median opioid consumption and 16% were opioid-free during admission up to postoperative day 3 (P<.001). There was no difference in pain scores (P=.80). Patients on ERAS reported less fatigue (P=.01), interference with walking (P=.003), and total interference (composite score of physical and affective measures) during hospitalization (P=.008). After discharge, those on the ERAS pathway demonstrated a significantly shorter median time to return to no or mild fatigue (10 vs 30 days, P=.03), mild or no interference with walking (5 vs 13 days, P=.003), and mild to no total interference (3 vs 13 days, P=.02). There were no significant differences in complications, rates of readmission, or reoperation between the pre- and post-ERAS groups.
Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.
探讨加速康复外科（ERAS）方案对围手术期结局的影响，重点关注术后即刻和延长期间阿片类药物的使用和患者报告的结果。
我们于 2014 年 11 月作为一项质量改进计划的一部分启动了 ERAS 方案。我们比较了在实施 ERAS 前后接受开腹妇科手术的 607 名女性患者的临床结局。对于 293 名患者，使用 MD 安德森症状量表-卵巢癌比较了患者报告的结果。
中位年龄为 58 岁（范围 18-85 岁）。ERAS 组患者的中位住院时间缩短了 25%（P<.001）。总体而言，ERAS 组患者的中位阿片类药物使用量减少了 72%，并且在术后第 3 天之前有 16%的患者无需使用阿片类药物（P<.001）。疼痛评分无差异（P=.80）。ERAS 组患者报告在住院期间疲劳感（P=.01）、行走干扰（P=.003）和总干扰（身体和情感指标的综合评分）（P=.008）较少。出院后，ERAS 组患者在返回无或轻度疲劳的中位时间明显更短（10 天 vs 30 天，P=.03）、轻度或无行走干扰（5 天 vs 13 天，P=.003）和轻度至无总干扰（3 天 vs 13 天，P=.02）。在预 ERAS 和后 ERAS 组之间，并发症、再入院率或再次手术率没有显著差异。
实施 ERAS 方案与手术后阿片类药物使用量显著减少相关，并改善了与手术后功能恢复相关的关键患者报告结果，而不会影响疼痛评分。
