Lee Grace C, Hodin Richard A
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Clin Colon Rectal Surg. 2019 Mar;32(2):134-137. doi: 10.1055/s-0038-1676479. Epub 2019 Feb 28.
Enhanced Recovery after Surgery (ERAS) pathways have become popular in colorectal surgery due to their associated decrease in length of stay (LOS), complications, and readmission rate. However, it is unclear if these pathways are safe, feasible, or effective in unique patient populations such as elderly patients, urgent/emergent surgeries, patients with specific comorbidities, inflammatory bowel disease, or pediatric patients. Enhanced recovery pathways appear safe in elderly patients, associated with decreased complications, though with slightly lower rates of adherence and increased LOS and readmission rates. Modified ERAS pathways have been applied to urgent and emergent surgeries, resulting in decreased morbidity and LOS. There have been no studies that performed subgroup analyses of ERAS pathways in patients with specific comorbidities. Studies investigating patients with inflammatory bowel disease on enhanced recovery pathways are extremely limited, but suggest that they are safe and feasible. Data on ERAS pathways in pediatric patients are still emerging. Therefore, though data are sparse, enhanced recovery pathways appear to be safe in unique patient populations, with similar efficacy in decreasing LOS and complications. There is an urgent need for more studies investigating these specific patient groups to aid perioperative decision making by colorectal surgeons.
术后加速康复（ERAS）路径在结直肠手术中已变得流行，因为其可使住院时间（LOS）、并发症及再入院率降低。然而，对于这些路径在老年患者、急诊/紧急手术患者、患有特定合并症的患者、炎症性肠病患者或儿科患者等特殊患者群体中是否安全、可行或有效尚不清楚。加速康复路径在老年患者中似乎是安全的，并发症减少，尽管依从率略低，住院时间和再入院率有所增加。改良的ERAS路径已应用于急诊和紧急手术，从而降低了发病率和住院时间。目前尚无对患有特定合并症的患者进行ERAS路径亚组分析的研究。关于炎症性肠病患者采用加速康复路径的研究极为有限，但表明这些路径是安全可行的。儿科患者的ERAS路径数据仍在不断涌现。因此，尽管数据稀少，但加速康复路径在特殊患者群体中似乎是安全的，在降低住院时间和并发症方面具有相似的疗效。迫切需要更多研究来调查这些特定患者群体，以帮助结直肠外科医生进行围手术期决策。
