Department of Anesthesia and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada.
Department of Anesthesia and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada.
J Clin Anesth. 2019 Aug;55:7-12. doi: 10.1016/j.jclinane.2018.12.034. Epub 2018 Dec 21.
There is growing evidence internationally to support Enhanced Recovery After Surgery (ERAS) pathways. The impact of pathway compliance and the relative importance of individual components, however, remains less clear. Our institution implemented a multimodal ERAS protocol for elective colorectal surgery in November 2013. The objectives of this study were to investigate the impact of the introduction of the pathway, the relationship between pathway adherence and patient outcomes, and the relative importance of individual components.
This was a single-center, observational cohort study of elective colorectal surgical patients.
A tertiary care and academic teaching hospital in Canada.
Prospective data was collected from 495 consecutive major colorectal surgical patients following the ERAS launch. Retrospective data was also collected from a pre-ERAS cohort of 99.
Adherence to 12 ERAS components were measured, along with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) defined patient complications and hospital length of stay (LOS). Post-ERAS patients were divided in to two groups: high compliance (≥75% process adherence) and low compliance (<75% adherence). Outcomes were compared between groups.
There was a significant reduction in both complication rate (31.5% vs 14.6%; p ≤0.05) and hospital mean LOS (10.1 vs 6.9 days; p ≤0.05) following introduction of the ERAS pathway. The high adherence group had a shorter mean LOS (5.7 vs 8.6 days; p ≤0.01) and lower rate of complications (11.2% vs 19.6%; p = 0.02) compared with the low compliance group.
Higher adherence to the standardized ERAS protocol was associated with improved patient outcomes, including reduced pulmonary complications. The cause-effect relationship is complex and likely influenced by confounding factors. Our data provides feedback to aid ongoing innovation of our pathway locally and adds to the growing body of evidence supporting the value of ERAS in general.
国际上有越来越多的证据支持术后快速康复（ERAS）途径。然而，途径的依从性及其各个组成部分的相对重要性仍不太清楚。我们机构于 2013 年 11 月为择期结直肠手术实施了多模式 ERAS 方案。本研究的目的是调查该途径的引入所产生的影响、途径依从性与患者结局之间的关系以及各个组成部分的相对重要性。
这是一项针对择期结直肠手术患者的单中心观察性队列研究。
加拿大的一家三级护理和学术教学医院。
在 ERAS 启动后，从 495 例连续的主要结直肠手术患者中收集了前瞻性数据。还从 ERAS 前队列中收集了 99 例患者的回顾性数据。
测量了 12 个 ERAS 组成部分的依从性，以及美国外科医师学会国家外科质量改进计划（ACS NSQIP®）定义的患者并发症和住院时间（LOS）。将 ERAS 后患者分为两组：高依从性（≥75%的过程依从性）和低依从性（<75%的依从性）。对两组间的结果进行了比较。
在引入 ERAS 途径后，并发症发生率（31.5%比 14.6%；p ≤0.05）和医院平均 LOS（10.1 比 6.9 天；p ≤0.05）均显著降低。高依从性组的平均 LOS（5.7 比 8.6 天；p ≤0.01）和并发症发生率（11.2%比 19.6%；p = 0.02）均低于低依从性组。
更高程度地遵循标准化的 ERAS 方案与改善患者结局相关，包括降低肺部并发症发生率。因果关系很复杂，可能受到混杂因素的影响。我们的数据为我们的本地途径提供了反馈，以帮助其持续创新，并为支持 ERAS 总体价值的不断增长的证据添砖加瓦。
