Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, E19-125, Montreal, QC, H3G 1A4, Canada.
Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
Surg Endosc. 2019 Nov;33(11):3806-3815. doi: 10.1007/s00464-019-06684-3. Epub 2019 Jan 30.
Patient-reported outcome measures (PROMs) are pivotal to promote patient-centered perioperative care. Adherence to enhanced recovery programs (ERPs) is associated with improved clinical outcomes (i.e., morbidity, length of stay), but the impact of adherence on PROMs is uncertain. The objective of this study was to evaluate the extent to which adherence to an ERP for colorectal surgery is associated with postoperative recovery as assessed using PROMs.
100 patients were included [median age 63 (IQR 50-71) years, 81 laparoscopic, 37 rectal surgery]. Overall adherence to the ERP and adherence to specific ERP elements were analyzed. Adjusted linear regression was used to evaluate the association of adherence with PROMs assessing early recovery [Abdominal surgery impact scale (ASIS) and Multidimensional fatigue inventory (MFI) on POD2] and late recovery (Duke Activity Status Index, RAND-36 Physical and Mental Summary Scores, Life-Space Mobility Assessment at 4 weeks after surgery). Missing data were addressed using multiple imputations.
Median adherence to the ERP was 80% (16/20 elements, IQR 70-90%). Overall adherence was associated with ASIS scores on POD2 (4% increase per additional element, 95% CI 1-8%; p = 0.018). When specific ERP elements were analyzed, ASIS scores were associated with adherence to PONV prophylaxis (34% increase, 95% CI 5-63%; p = 0.023) and early solid food diet (20% increase, 95% CI 5-35%; p = 0.009). MFI General fatigue and MFI Mental fatigue scores on POD2 were associated with adherence to PONV prophylaxis (36% decrease, 95% CI - 64 to - 8%, p = 0.014 and 22% decrease, 95% CI - 44 to - 8%, p = 0.042). Overall adherence and adherence to specific elements were not associated with PROMs at 4 weeks after surgery.
Our findings suggest that, from the perspective of patients, adherence to an ERP for colorectal surgery impacts early, but not late postoperative recovery. This result may reflect the lack of PROMs able to validly measure postoperative recovery beyond hospital discharge.
患者报告的结局测量（PROMs）对于促进以患者为中心的围手术期护理至关重要。遵守强化恢复方案（ERPs）与改善临床结局（即发病率、住院时间）相关，但遵守情况对 PROMs 的影响尚不确定。本研究的目的是评估结直肠手术 ERP 依从性与使用 PROMs 评估的术后恢复之间的关联程度。
纳入 100 例患者[中位年龄 63（IQR 50-71）岁，81 例腹腔镜，37 例直肠手术]。分析了总体 ERP 依从性和特定 ERP 元素的依从性。使用调整后的线性回归评估了依从性与评估早期恢复的 PROMs[术后第 2 天的腹部手术影响量表（ASIS）和多维疲劳量表（MFI）]和晚期恢复（杜克活动状态指数、RAND-36 身体和精神总分、术后 4 周的生活空间移动性评估）之间的关联。使用多重插补处理缺失数据。
ERP 的中位依从率为 80%（20 个元素中的 16 个，IQR 70-90%）。总体依从性与术后第 2 天的 ASIS 评分相关（每增加一个额外元素增加 4%，95%CI 1-8%；p=0.018）。当分析特定的 ERP 元素时，ASIS 评分与 PONV 预防（增加 34%，95%CI 5-63%；p=0.023）和早期固体饮食（增加 20%，95%CI 5-35%；p=0.009）相关。术后第 2 天的 MFI 一般疲劳和 MFI 精神疲劳评分与 PONV 预防的依从性相关（-64%至-8%，p=0.014和-22%至-8%，p=0.042）。总体依从性和特定元素的依从性与术后 4 周的 PROMs 无关。
我们的研究结果表明，从患者的角度来看，结直肠手术 ERP 的依从性会影响早期，但不会影响晚期术后恢复。这一结果可能反映了缺乏能够有效测量出院后术后恢复的 PROMs。
